FLEX February 2024

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R. Locke et al. / International Journal of Pediatric Otorhinolaryngology 78 (2014) 393–401

Perhaps the most important variable in paediatric FNAC is the skill and experience of the cytopathologist. Studies report high sensitivity and specificity using experienced cytopathologists [55,56,59]. Anne et al. performed the majority of FNA biopsy under general anaesthetic and there was still the need for excisional biopsy in certain cases. Annam et al. suggest comparable sensitivity and specificity to lymph node biopsy however they also report a 57% exclusion rate due to inadequate aspiration [57].

3.8. Multi-factorial predictive models

Slap et al. have published a multi-factorial model to identify children and young adults for excision biopsy [58]. Their original report was of 123 patients who had undergone excision biopsy of lymph nodes from various sites (not just head and neck). Multivariate analysis identified three factors that could be used to produce a predictive model with 95% accuracy: lymph node size,

Yes

Small , fl uct uatin g si ze

No

>2cm measured w ith calliper s

Yes

Supraclavicular nodes

No

Looks abn ormal

CXR

Discuss with radio logi st

Loo ks norma l

Take blood for FB C

and serology fo r CMV, to xoplasma , bartone lla, EBV.

Review 4 week s with re sult s

including fo rmal CXR report

Nodes smal ler

Nodes bigger/unc hanged

And te sts a ll normal

or FBC abnorma l

or CXR report ed abno rmal

suspicious result or ultrasound

FNA*/EXC ISE

DISCHARGE

Fig. 1. *If FNA has a role, then it would be at this point, and only if it could be done without the need for general anaesthetic. An FNA result positive for serious pathology can be used to help direct further investigation, but a negative FNA result cannot be relied upon to exclude serious pathology.