Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

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I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : October | Volume : 3 | Issue : 5 | Page : 1719 - 1725

The Role Of Fine Needle Aspiration Cytology In Palpable Head And Neck Masses.

FERNANDES H *, D’SOUZA C R S**, THEJASWINI B N ***

*,**Fr Muller Medical College,Mangalore,(India)***Anand Diagnostic Laboratory,Bangalore,(India)

Correspondence Address :
Dr Hilda Fernandes Professor,Dept of
pathology Fr Muller Medical college
Kankanady-575002
Mangalore,(INDIA)E.mail:
hilda67@rediffmail.com

Abstract

Background And Objective: This study is done to evaluate the role of FNAC in palpable head and neck masses and also to study their distribution. A correlation was done between cytology and histopathology whenever surgical specimens were available and to assess the accuracy, sensitivity, specificity, positive predictive value and negative predictive value in various head and neck lesions.
Materials And Methods: From 620 cases, FNA smears were taken and stained with PAP, MGG and special stains whenever required. FNA results were interpreted and analysed according to the anatomical sites and the lesions were categorized into inflammatory and neoplastic conditions. The cytological findings were compared with those of histopathology wherever available. With the help of K value, the agreement between the methods was de-termined.
Results: Among 620 cases, histopathological correlations were available only in 129 cases. The sensitivity, specificity, predictive value of the positive test, predictive value of the negative test and false negatives of the thyroid lesions which were being detected were 83.33%, 100%, 100%, 97% and 16.66%, respectively. There were no false positives. The diag-nostic accuracy of the salivary gland, lymph node and soft tissue lesions were 100%.
Interpretation And Conclusion: There was perfect agreement in a majority of the lesions. The technique is simple, safe, convenient and an accurate method for tissue di-agnosis. Hence, FNAC is an effective diagnostic tool in the diagnosis of head and neck masses.

Keywords

FNAC, histopathology, thyroid, lymph nodes, salivary glands, soft tissue.

Introduction
Fine needle aspiration cytology (FNAC) is one of the most valuable tests available in the initial assessment of the patient who presents with a mass in the head and neck region or where a re-currence is suspected after previous treatment1. It is accurate, inexpensive and quick. The tissues which are most frequently sampled are lymph nodes, thyroid and major salivary glands. The present study was done to evaluate the role of FNAC in palpable head and neck masses.

Material and Methods

FNAC was done on 624 patients who presented with palpable head and neck masses in a tertiary hospital for a period of 2 years from March 2005 to March 2007. Prior to FNAC, the patients were examined in detail, which included the recording of their pertinent clinical history and significant clinical findings. Relevant investigations were carried out as per requirements. After a brief explanation of the technique, an informed con-sent of the patient was obtained.

FNA was done using a 23 gauge needle fitted to a 10ml disposable syringe. An average of 2 passes was performed and some slides were air dried and stained by the May-Grunwald Giemsa stain. The rest of the slides were fixed in metha-nol and stained by the Papanicolaou stain. The Zeihl-Neelsen’s stain for AFB was done in those cases with lymph node swelling, where the clinical suspicion or diagnosis was tuberculosis and /or in those cases where purulent or cheesy material was aspirated. Surgically excised specimens were available in 129 cases, which were routinely processed and stained with Haematoxylin and Eosin stains.

Observations
Among the 624 patients, 4 were excluded from the study as the smears were unsatisfactory. The distribution of the 620 cases are given in [Ta-ble/Fig 1].The accuracy of FNAC was verified by histological examination in the 129 patients. Among the 129 patients, 24 were males and 105 were females (M:F ratio =1:4.41). Thyroid gland (71.31%) was the commonest site aspirated, fol-lowed by lymph node (22.48%), salivary gland (3.87%) and soft tissue lesions (2.32%).

Patients with a thyroid swelling comprised of 13 males and 79 females and their ages ranged from 18- 73 years. The commonest lesion encountered in the thyroid gland was Nodular goitre, fol-lowed by Hashimoto’s thyroiditis. Among the malignant neoplasms, Papillary carcinoma was the most common lesion noted. Fifty two cases of histologically proven nodular goitres were correctly diagnosed by the FNA cytology. Out of the fifty two cases, smears from fifty cases were moderately cellular and two were hypocel-lular. The smears showed follicular cells in clus-ters which were scattered singly. Forty eight cases had a few cyst macrophages and thick col-loid in the background. Four cases showed nu-merous cyst macrophages in a background of thick and thin colloid.

Ten cases of adenomatous hyperplasia were con-firmed by histological diagnosis. The smears were moderately cellular and showed follicular cells in clusters and tissue fragments in nine cases. Fire flares were seen in seven cases. Papillaroid fragments were seen in three cases. The colloid was either scanty or absent in all these cases.

Hashimoto’s thyroiditis was detected by the FNA cytology in eleven out of twelve cases. The smears showed large clusters of Hurthle cells and lymphocytes in nine cases. Multi-nucleate giant cells and epitheloid histio-cytes were seen in three cases. Cyst macro-phages were seen in one case. The colloid was scant to absent in ten cases. One case showed the presence of thick colloid. Three cases showed fire flares.

Thyroglossal cysts yielded a clear yellow col-oured fluid. The smears were hypocellular and showed follicular cells, lymphocytes and cyst macrophages.

Papillary carcinoma of the thyroid was detected by the FNA cytology in nine out of eleven cases. The smears were hypercellular and showed pap-illary tissue fragments (Table/Fig 2) and syncytial aggregates in six cases. Nuclear grooves were seen in seven cases and intranu-clear cytoplasmic inclusions were seen in three cases. Cyst macrophages were seen in three cases. Psammoma bodies were seen in one case. Thick colloid was seen in five cases.

One case, which was suspected for malignancy, showed moderately cellular smears comprising of small papillaroid fragments and numerous cyst macrophages. Few cells with dense cyto-plasm and nuclear grooves were seen. The histopathological diagnosis made, was that of papillary carcinoma.

Four follicular adenomas in the series were des-ignated as follicular neoplasms in cytology. Three were moderately cellular and one was hy-pocellular. The smears showed follicular cells in a repetitive manner and scant colloid in a haem-orrhagic background. One case showed syncytial aggregates and microfollicles.

One case of Hurthle cell neoplasm showed hy-percellular smears (Table/Fig 3) with predomi-nant Hurthle cells in sheets and clusters and a few follicular cells. Cyst macrophages and col-loid were also seen in the background.

One case of medullary carcinoma was correctly diagnosed by cytology. The smears were hyper-cellular and showed tumour cells dispersed sin-gly and in sheets. The tumour cells exhibited fine granular nuclear chromatin and moderate amounts of granular cytoplasm. A few of them had a plasmacytoid appearance. Fragments of hyaline material, lymphocytes, cyst macro-phages, focal calcification and scant colloid were seen in the background. The overall accu-racy rate for the thyroid series was 96.3%.

Patients with lymph node swelling com-prised of 8 males and 21 females and their ages ranged from 2-76 years. Reactive lym-phadenopathy was the commonest cause of lymphadenopathy, followed by tuberculous and granulomatous, metastatic lymphade-nopathy. The present study did not make any attempt to categorize the type of Reactive lymphadenopathy. All ten cases of tubercu-lous lymphadenopathy showed moderately cellular smears. There were epithelioid granulomas (Table/Fig 4) in seven cases and caseation necrosis in three cases. The special stain for acid fast bacilli was positive in four cases.

One case of suppurative lymphadenitis showed neutrophils in a necrotic back-ground. No granulomas/giant cells were seen. The special stain for AFB showed negative re-sults. This case was confirmed by histological diagnosis.

Four cases of granulomatous lymphadenitis were correctly diagnosed by cytology. The smears showed focal collections of epithelioid cells in association with reactive lymphoid cells. The special stain for AFB showed negative results.

One case of metastatic carcinoma showed tu-mour cells in sheets and they were dispersed singly. These cells exhibited pleomorphism and had hyperchromatic nuclei with dense cytoplasm in a necrotic background. This was subsequently confirmed by histopathology.

Smears from Langerhans cell histiocytosis re-vealed histiocytic cells in clusters and they were dispersed singly. Binucleate and multinucleate forms were of cells were seen along with eosi-nophils in the background. A subsequent biopsy confirmed the cytological diagnosis.Patients with salivary gland lesions comprised of 3 males and 2 females and their ages ranged from 20-49 years. The commonest benign and malignant tumours reported were Pleomorphic adenoma and Mucoepidermoid carcinoma, respectively. One case of benign cystic lesion of the salivary gland showed cyst macrophages, lymphocytes and stromal fragments in a proteinaceous back-ground. Three cases of pleomorphic adenoma showed moderately cellular smears. Epithelial cells in clusters and sheets were seen in two cases. Fibrillary chondromyxoid ground sub-stances were seen in all the three cases. One case showed plasmacytoid cells with well defined cell borders. Cyst macrophages were seen in one case. One case of mucoepidermoid carcinoma was confirmed by histological diagnosis. The smears were hypercellular and showed cohesive clusters and sheets of tumour cells. Some of the cells had cytoplasmic vacuolization. The back-ground was dirty, with mucus and necrotic de-bris. The diagnostic accuracy for salivary gland lesions was 100%.

Patients with soft tissue lesions comprised of 3 females and their ages ranged from 13-60 years. One case each of Lipoma, Hamartoma and Spindle cell tumour were cytologically diag-nosed and confirmed by histopathology.

The correlation between cytological diagnosis and subsequent histological studies in all the 129 cases is shown in (Table/Fig 5). In the 129 cases, the sensitivity was 87.5%, the specificity was 100%, the positive predictive value was 100%, the negative predictive value was 98.26% and false negatives were 12.5%.

Discussion

Head and neck masses often pose a challenging diagnostic problem to the clinician. Malignancy remains an important differential diagnosis and neck mass is often the first or the only symptom of this disease. Although surgical biopsy is the commonest method of tissue diagnosis, FNAC is in practice since the 1930s.This method has be-come popular as a diagnostic step in the evalua-tion of a head and neck mass (2).

The results of 620 aspirates from head and neck masses have been categorized into inflamma-tory, benign and malignant lesions. Four aspi-rates (0.64%) were excluded, as they were in-adequate. The incidence of inadequate or unsat-isfactory samples in various studies has ranged from 0-25% (3). Unsatisfactory aspirates were the result of poor handling of the aspirated mate-rial and the lack of trained cytopathologists. In-adequacy was also attributable to the small size of the lesions (4).

Two cytologically diagnosed nodular goitres turned out to be papillary carcinoma after they were studied histopathologically. The slides on review revealed follicular cells in clusters and singles in a background of thick colloid. How-ever, no papillary fragments/ nuclear grooves/ intranuclear cytoplasmic inclusions were seen. The causes of false negative results were the poorly cellular sample in a large cystic papillary carcinoma and the thick fibrous capsule. Gag-neten stressed the importance of doing multiple aspirations in a thyroid swelling in order to ob-tain representative samples (1).

One case of thyroglossal cyst was correctly di-agnosed and the accuracy was similar to that in the study done by Hsu and Boey (5). In our study, the patient was 40 years old. It is well known that thyroglossal cyst presents clinically in children, but lesions can also be seen in adults even late in life (4).

The diagnostic errors were most commonly due to inadequate specimens and cystic lesions. One must be careful in committing a false negative diagnostic error in cystic lesions that contain macrophages and scanty material, since these features do not exclude malignancy. Repeat FNAC or thyroidectomy is advised for persistent nodules (5),(6). Cystic thyroid lesions pose di-agnostic difficulties. Cystic change and/or haemorrhage in neoplasms is seen in upto 25% of primary Papillary carcinomas, in 20% of Fol-licular neoplasms and in 26% of Follicular car-cinomas (1). Recurrent cysts, incompletely de-compressed lesions, lesions greater than 3-4 cm in diameter in which aspiration of several areas does not give good evidence of the colloid nod-ule and lesions in young males, have all been recommended as indications for surgical exci-sion.Intranuclear cytoplasmic inclusions and psammoma bodies detected in up to 83% and 24% of cases of Papillary thyroid carcinoma,(7) were seen in only three cases (33.3%) and one case (11.1%) respectively, in the present study.

One case of Nodular goitre turned out to be Hashimoto’s thyroiditis after studying it histopa-thologically. The slides on review revealed hy-pocellular smears comprising of few follicular cells and scanty thick colloid. No Hurthle cells/lymphocytes were seen. Jayaram (7), in her study, misdiagnosed two cases as colloid goiters. Hurthle cells and lymphocytes were not be pre-sent in the smears, which probably are examples of non representative sampling. Hashimoto’s thyroiditis was sometimes a problem, since aspi-rates of that lesion, not uncommonly show a marked proliferation of Hurthle cells or follicu-lar cells in nodular masses. A needle sampling of such an area would yield a cytological picture similar to that of Follicular or Hurthle cell tu-mour (7).

Follicular and Hurthle cell neoplasms posed no diagnostic problems. Aspirates from hyperplas-tic areas of some goitres presented a picture similar to that of Follicular neoplasms. This po-tential cause of misdiagnosis was counteracted in most cases by the sampling of two to three different areas of the thyroid nodule (7).The ma-jor limitation of FNAC in cases of tumour of the thyroid, is in the evaluation of the nature of the neoplasm, which is done by histopathology.

Literature survey has shown that the FNAC di-agnostic accuracy rate in tuberculous lymphade-nitis is as high as 90-100%. FNAC coupled with ZN staining for AFB is a very useful diagnostic tool in the diagnosis of tuberculous lymphadeni-tis.There are problems in arriving at a definitive diagnosis in certain cases of Tuberculous lym-phadenitis, when the aspirate shows a polymor-phous picture with occasional epithelioid cells, with an absence of Langhan’s giant cells or cas-eous necrosis, making it necessary to resort to excisional biopsy for a definitive diagnosis. This is particularly true in children, in whom a similar picture may be seen in cases of reactive hyper-plasia due to viral or Toxoplasma infection, since the mere presence of the epithelioid cells is not diagnostic of any specific condition (8).

Two cases of Reactive lymphadenopathy diag-nosed cytologically, proved to be Kikuchi’s lym-phadenitis after histopathological studies. The slides were reviewed to look for the typical cy-tomorphological features. There were no ne-crotic debris or plasmacytoid monocytes. Few clusters of histiocytes were seen. The special stain for AFB showed negative results. Tong et al. (9), in their study, had a similar problem.

Smears from Catscratch disease did not show typical cytological features. Literature survey showed that the cytology in early lesions of Cat scratch disease may be nonspecific, with a mix-ture of lymphocytes, immunoblasts, macro-phages, plasma cells and neutrophils (10).Characteristic granulomas with peripherally palisading epithelioid histiocytes and centrally located neutrophils and an associated polymor-phic cell population, are observed in Cat scratch disease. Cytological appreciation of the suppura-tive granulomas can be expected in FNA of the intermediate and the advanced lesions. The cyto-logical differential diagnosis includes any dis-ease in which epithelioid cells and/or granulo-mas occur. (10).

One case diagnosed by cytology as Reactive lymphadenopathy proved to be Castleman’s disease after histopathological studies. The plasma cell lesion represents an earlier, more active stage and the hyaline vascular type represents a later stage. The cytological characterization of Castleman’s disease may be difficult(11).

Among the salivary gland lesions, the pa-rotid was the most commonly involved gland. Our observation is similar to that of Cristallini et al.(12) and Cajulis et al.,(13). Among benign tumours, pleomorphic ade-noma was the commonest tumour and among the malignant tumours mucoepider-moid carcinoma was the most common one. This finding is similar to that of Fernandes et al.(14). The overall diagnostic accuracy was 100%. Review of literature shows that the accuracy has ranged from 80.4 to 98% (14).
One case of Lipoma was correctly diagnosed by cytology. One case of Hamartoma diag-nosed by cytology proved to be Capillary haemangioma after histological studies. One case of Spindle cell tumour which was sus-pected to be malignant turned out to be ma-lignant peripheral nerve sheath tumour. FNAC usually faces no problem in distin-guishing high grade soft tissue sarcomas from benign lesions. However, borderline and low grade lesions are susceptible to be missed. Accurate typing and grading of the tumour is not possible in many cases by FNAC alone. Almost all studies on soft tis-sue tumours have reported this limitation of FNAC (15).

The present study highlights certain limita-tions of the procedure in the head and neck region, namely:
- Typing the various Reactive lymphade-nopathies (9),(10),(11).
- To categorize the borderline and malig-nant soft tissue tumours (15).
- To differentiate Colloid goiter from the Follicular variant of papillary carcinoma (1).

On comparing the results of the present se-ries with other workers (Table/Fig 6), it can be said that the results of this study are fa-vourable with those published in literature and are fairly accurate.

Conclusion

Fine Needle Aspiration Cytology is a rapid, convenient and accurate method of tissue diag-nosis that can be done on an out patient basis. FNAC offers a simple method of diagnosis of neoplastic and non neoplastic lesions of the head and neck. The procedure is safe and free from complications and is well tolerated by the pa-tients. There is no need of anaesthesia and speedy results are obtained. It serves as a com-plementary diagnostic procedure to histopa-thological examination. There was almost per-fect agreement between the cytological and his-tological findings and there was fairly good ac-curacy. There were only two false negatives and no false positives in our study. Hence, we con-clude that Fine Needle Aspiration Cytology is a highly effective diagnostic procedure in the di-agnosis and management of palpable head and neck masses.

Key Message

FNAC is an effective diagnostic tool in the diagnosis of head and neck masses.

References

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