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Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 154(5):928-935.

Original Research—Pediatric Otolaryngology

Otolaryngology– Head and Neck Surgery 2016, Vol. 154(5) 928–935 American Academy of Otolaryngology—Head and Neck

Utility of Fine-Needle Aspiration Biopsy in the Evaluation of Pediatric Head and Neck Masses

Surgery Foundation 2016 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599816631728 http://otojournal.org

Phillip Huyett, MD 1 , Sara E. Monaco, MD 2 , Sukgi S. Choi, MD 3 , and Jeffrey P. Simons, MD 3

Received October 29, 2015; revised January 14, 2016; accepted January 20, 2016. F ine-needle aspiration biopsy (FNAB) dates back as far as 1857 and has been established in the diagnosis of head and neck masses (HNMs) since the late 1920s. 1 In the adult population, FNAB is widely used and accurate for diagnosis of both benign and malignant lesions throughout the head and neck region. 2,3 For example, FNAB has been used with great success as the primary screening test for thyroid nodules in adults, 4 but such a structured approach has lagged in the evaluation of pediatric thyroid nodules. 5,6 This diagnostic modality has gradually become more accepted in the pediatric population but remains underused. The first studies examining pediatric FNAB were published in the 1980s, 7-9 and the first report dedicated to pediatric HNM FNAB was published in 1991 by Mobley et al. 10 Since that time, several publications have related the safety, accuracy, and feasibility of FNAB in pediatric HNM 11-16 but have been limited by case numbers or restricted ana- tomic subsites. The potential avoidance of surgery with associated scar- ring, complications, general anesthetic risk, recovery time, and expense have all been heralded as benefits of FNAB, especially given the high prevalence of nonneoplastic pediatric HNM. The objectives of this study were to assess the diagnos- tic accuracy and safety profile of FNAB in a large number of thyroid and nonthyroid pediatric HNMs. In addition, we exam- ined the clinical application of FNAB, including the use of 1 Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 2 Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 3 Department of Otolaryngology, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Sponsorships or competing interests that may be relevant to content are dis- closed at the end of this article.

Abstract Objectives . Fine-needle aspiration biopsy (FNAB) has a well- established role in the evaluation of an adult head and neck mass (HNM) but remains underused in children. The objec- tives of this study were to assess the diagnostic accuracy, safety profile, use of anesthesia, and influence on surgical deci- sion making of FNAB of HNM in the pediatric population.

Study Design . Case series with chart review.

Setting . Tertiary care children’s hospital.

Subjects and Methods . In total, 257 consecutive patients with HNM who underwent 338 FNABs from July 2007 to July 2014 were reviewed. Patients ranged in age from 0 to 21 years (mean, 9.3 years); lesions ranged in size from 0.3 to 12.5 cm (mean, 2.4cm). Fine-needle aspiration biopsies were performed in the interventional radiology suite, operating room, clinic, or ward. Results . The most common patient final diagnoses included reactive lymphadenopathy (n = 99, 38.5%), benign thyroid colloid nodule (n = 31, 12.1%), malignancies (n = 21, 8.2%), and atypical mycobacterial infection (n = 15, 5.8%). On sur- gical histopathologic and clinical follow-up, overall sensitivity of FNAB was 94.6% and specificity was 97.7%. The compli- cation rate was 2.1%, and general anesthesia or sedation was used for 73% of FNAB. Surgery occurred only 9 times following the 191 patients with negative FNAB results, indi- cating that 95.3% of unnecessary surgeries were avoided with the assistance of the FNAB result. Conclusions . Fine-needle aspiration biopsy is an accurate and safe diagnostic tool for guiding management of persistent lymphadenopathy, thyroid nodules, and other HNM in pedia- tric patients. Negative FNABs can often obviate the need for surgical intervention.

Corresponding Author: Phillip Huyett, MD, Department of Otolaryngology–Head & Neck Surgery, University of Pittsburgh Medical Center, 203 Lothrop St, Suite 500,

Keywords fine-needle aspiration biopsy, head and neck mass, thyroid nodule, pediatrics, sensitivity and specificity

Pittsburgh, PA 15213, USA. Email: huyettpa@upmc.edu

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