Fine needle aspiration cytology of head and neck diseases: advantages and limitations

Fine needle aspiration cytology is a valuable technique in the diagnostic assessment and management of patients with head and neck lesions. Combining the technique with ultrasound examination allows both the clinical assessment and confidence in appropriate cytological sampling to be enhanced. Inadequate sample rates may be reduced to about 5% or less. The multidisciplinary team approach optimizes the use of available information, and lack of correlation between clinical, imaging and cytological findings may be reviewed critically before treatment of the patient. Concordant findings may guide appropriate management and avoid unnecessary tests. The cytological diagnosis of many head and neck lesions may be made with a high degree of accuracy, but awareness of the diagnostic pitfalls is essential for safe practice. These include cystic lesions, and the differential diagnosis of well differentiated, especially keratinized, squamous cells. Most salivary gland tumours are accurately classified cytologically, but a group remains in which a differential diagnosis must be given.