Fine needie aspiration biopsy: a safe and accurate diagnostic modality for intraoral and oropharyngeal lesions
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This study was designed to determine the accuracy of diagnosis of intraoral and oropharyngeal lesions depending on findings obtained by fine needle aspiration, biopsy (FNAB) compared versus the standard histopathological examination of excised specimens. The study comprised 37patients (24 men and 13 women) assigned to undergo surgical resection of intraoral or oropharyngeal lesions. FNAB was performed under local spray or infiltration anesthesia, and patients were observed for 24-hrs after biopsy for the occurrence of bleeding, respiratory difficulty and fever and were surveyed for the degree of satisfaction during the procedure and the occurrence of pain either during or after the procedure using four-points verbal analogue scale (VrAS). All patients underwent surgical procedure assigned, 24 hours after biopsy taking, and excisional biopsy was obtained for histopathological examination. Results of both cytology and histopathology were compared to evaluate the sensitivity, specificity, accuracy and predictive values of FNAB for diagnosis. Occurrence of complications during the 24-hr follow-up period after obtaining biopsy was minimal apart from a case of bleeding from the pretonsillar area that required emergency operative interference for control of bleeding and excision of the swelling. There was a significant increase in the number of patients satisfied during the FNAB procedure and considered it not tiring, this was assured by the minimal requirement of postprocedure analgesia and the significantly longer duration that lapsed before requesting rescue analgesia. FNAB gave no result in only one patient with a failure •"- rate of 2.86%, however no false positive result was reported and FNAB could detect all cases proved by histopathology to be malignant with a specificity and positive predictive value for malignancy of 100% and an accuracy rate of 88.6%. However, FNAB gave 4 false negative results with sensitivity of 83.3% and a negative predictive . value of 73.3% for malignancy. It can be concluded that information provided by preoperative fine needle aspiration cytology is always to be considered as complementary to that offered by clinical evaluation so as to aid the surgeon to achieve the most accurate diagnosis of cases of indooral and oropharyngeal lesions and to avoid open biopsy with specificity and positive predictive value for malignancy of 100%.