Concordance in diagnosis of Neck masses using Clinical Pre-diagnosis and Pathological analysis

Abstract

Background: Neck swelling is one of the commonest presentations in otorhinolaryngological practice. Study aimed to analyze the demographics and symptomatology of cervical masses, the degree of accuracy of clinical examination as well as the correlation between the clinical diagnosis and pathological results in patients presenting with neck masses. Material & Method: The present prospective observational study is conducted among the patients attending the out-patient and in-patients setting of ENT department with complaints of neck mass/ masses either primarily or in conjunction with other complaints, for more than 3 weeks duration. The patients with complaints of neck mass of acute inflammatory origin of less than 3 weeks and patients with inflammatory causes of lymphadenopathy including those secondary to upper aero-digestive tract infection and those of tubercular origin on initial assessment were excluded. Following a thorough clinical examination appropriate radiological investigations were advised, followed by cytological evaluation. FNAC was performed, either guided or unguided as per the discretion of the pathologist. Further Histopathogical evaluation was conducted in tissue specimens, wherever required, after either surgical excision of the entire mass or a biopsy. Histopathology involves the examination of sampled whole tissues under the microscope. Results: Age distribution placed majority of females in the young adult (16-40 yrs) category and males in the late adult (> 40 yrs) group. The majority of neck masses were thyroid swellings (42%) followed by lymph nodal masses (29%) and salivary gland lesions (14%). Of all the neck masses in females 87% were benign whereas amongst males 62% were malignant. The accuracy of clinical pre-diagnosis was seen to be 93.4%. The sensitivity for thyroid lesions for suspicion of malignancy however, was seen to be only 33% as papillary carcinoma thyroid essayed no symptoms or signs of malignancy. FNAC as an investigation for pre-diagnosis, the accuracy on the whole was seen to be 84.7% with a sensitivity of 82.5% which is comparable to other Indian studies. For thyroid lesions however the sensitivity was very low, 33.3%. This may be due to the inconsistent use of guidance systems and inexperience of our junior aspirators which act as confounding factors. Conclusion: Accuracy of FNAC in comparison to the definitive diagnosis was 84.7%. Inconsistent use of guidance systems, inexperience of junior aspirators and aspiration from representative node/ part of the lesion may act as confounding factors resulting in the discordance between clinical pre-diagnosis and FNAC accuracy with respect to the definitive diagnosis

Keywords

• fnac
• accuracy
• thyroid
• histopathology