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%. |
