FNAC is first line investigation in approach towards diagnosis of lesions of head and neck region. It has contributed a great deal to transform cytology from a primarily screening tool to powerful diagnostic technique. FNAC is applicable to easily palpable lesions of thyroid, salivary glands, superficial lymph nodes, superficial growth of skin & soft tissue. With the help of newer radiological techniques FNAC of deeper structures is easily possible. Palpable head and neck lesion varies from benign to malignant in nature. A wide age group is involved from 1 to 95 years of age. It is also a common site for metastatic deposit. In that situation especially when financial resources are limited, early detection with reliable diagnostic technique is needed. Fine needle aspiration cytology (FNAC) is an effective diagnostic tool in the diagnosis of head and neck masses. It is a safe, inexpensive, well tolerated and rapid procedure that categorizes the lesions. It is eminently suitable as the first line investigation for almost all superficial palpable swellings as well as many deep seated lesions. Follow up of cancer patient can easily be done by FNAC. FNAC is the only procedure for those patient that cannot with stand for small open biopsy. It is a time tested simple office procedure having a high degree of diagnostic accuracy & precision. The specificity & sensitivity of diagnostic precision lie in range of 60% & 80% respectively. AIMS AND OBJECTIVES: To study the role of FNAC in the diagnosis of clinically suspected Head and Neck pathology. To evaluate lesions based on cytopathological diagnosis into common age group, sex wise distribution and as per laboratory diagnosis into neoplastic and non neoplastic pathology.

The current study was done in Cytopathology laboratory in Department of Pathology, P.D.U. Medical College and Hospital, Rajkot. This was a retrospective observational study. Patient data were retrieved and studied in Department of Pathology and results were tabulated and analyzed . Clinical and radiological details were obtained from patients files. Inclusion criteria-All the cases of head and neck cases were segregated from other lesions which were aspirated over a period of one year (July 2024 to July 2025). Both air dried and alcohol fixed smears stained with May Grund wald Giemsa (MGG) and also stained with H &E stain, were studied. Results were also correlated with special stains like Ziehl Nelson (ZN) stain wherever applicable. The sites of FNAC were classified as lymph nodes, thyroid, skin, soft tissue, salivary gland. Statistical methods-Data was tabulated, slides were reviewed wherever necessary and the percentages were calculated for estimating frequency of various pathological conditions. The cytological diagnosis were evaluated.

Over a period of one year total 416 cases with clinically palpable head and neck masses underwent FNAC procedure. Age groups ranged from 0-80 years. The cases were grouped as per age (Fig 1) and the maximum number of cases were seen in the age group 41-60 years 183 cases (44%) followed by 21-40 years 162 cases (38.95%0, 0-20 years 46 cases (11.05%) and 61-80 years 25 (6%) respectively. In our study, out of 416 cases; 228 (54.8%) cases were males and 188 (45.2 %) camses were females. The male to female ratio was 1.2:1 (Table: 1) Table 1: Gender wise distribution of head and neck lesions Gender No. of cases Percentage (%) Male 228 54.8% Female 188 45.2% Total 416 100% In present study, the maximum number of pateints presented with Lymphadenopathy (58.89%) followed by thyroid gland (25.23%), Salivary gland (11.05%), Soft tissue and miscellaneous lesion (4.83%) respectively. (Table2). Table 2: Distribution of Head & Neck Lesions according to site [Cases=416] Site No. of cases Percentage (%) Lymph Node 245 58.89% Thyroid gland 105 25.23% Salivary gland 46 11.05% Soft tissue and miscellaneous 20 4.83% Total 416 100% The lesions from different sites were then majorly divided into Non neoplastic and Neoplastic lesions according to cytopathological diagnosis. Non neoplastic lesions constituted 79.58% (331 cases) of all cases whereas Neoplastic lesions constituted 18.02% (75 cases) and 2.40% (10 cases) were inconclusive. Neoplastic lesions were further classified as benign and malignant where benign lesions included 47 cases (62.67%) whereas malignant lesions included 28 cases (37.33%). Benign lesions included thyroid gland neoplasms like suspicious for follicular neoplasm (10.67%) and follicular neoplasm (20%), and salivary gland neoplasms like pleomorphic adenoma (24%) and warthin’s tumor (8%). Malignant neoplasms majorly constituted metastatic carcinoma (32%) followed by papillary carcinoma thyroid (2.67%) and lymphoma (2.67%). Table 3: Distribution of various Neoplastic lesions [N=75] Nature of neoplasm Lesion No. of cases Percentage (%) Benign Thyroid gland Suspicious of Follicular neoplasm 8 10.67% Follicular neoplasm 15 20% Salivary gland Pleomorphic adenoma 18 24% Warthin’s tumor 6 8% Malignant Lymph node Metastatic carcinoma 24 32% Lymphoma 2 2.67% Thyroid gland Papillary thyroid carcinoma 2 2.67% Total 75 100% Non neoplastic lesions included Inflammatory 159 (48.03%) and Non inflammatory lesions 172 (51.97%). (Table 4). Table 4: Distribution of various Non neoplastic lesions [N=331] Nature of lesions Lesion No. of cases Percentage (%) Inflammatory Lymph node Tuberculous lymphadenitis 139 42% Reactive lymphadenitis 49 14.80% Non specific lymphadenitis 31 9.36% Thyroid gland Hashimoto’s thyroiditis 3 0.91% Salivary gland Acute on chronic sialadenitis 9 2.71% Chronic sialadenitis 8 2.41% Non inflammatory Thyroid gland Colloid goitre 72 21.75% Soft tissue Keratinous cyst 17 5.15% Lipoma 3 0.91% Total 331 100% Out of all Non neoplastic, the maximum cases were of tuberculous lymphadenitis (139 cases). Out of 139 cases of tuberculous lymphadenitis, 14 (10.2%) cases showed epitheloid granuloma without necrosis, 100 (72%) cases showed epitheloid granuloma with necrosis and (17.80%) cases showed only necrosis without epitheloid granuloma.

In 1930, Martin and Ellis described and first introduced the technique of FNAC for diagnosis of organ lesions. The two fundamental requirements on which success of FNAC depends are representative sample and high quality of preparation .These two prerequisites will always remain a sine qua non, no matter how sophisticated are the supplementary techniques. Head and neck neoplasms constitute a major form of cancer in India accounting for 23% of all cancers in males and 6% in females and approximately 5% all childhood neoplasms. Increased prevalence of malignancies may be due to use of various forms tobacco in our country. Palpable lesions of head and neck include variety of developmental, inflammatory and neoplastic lesions. The present study was carried out over a period of 1 year to find out the frequency of a variety of pathological conditions and to find out the accuracy of FNAC as a rapid diagnostic tool in outdoor patients. The present study also compares its findings with various national and international studies published in the literature. The study included patients from all age groups. In this study, majority of patients were males with male to female ratio of 1.2:1. Similar male preponderance was reported by Rathod G (2012). Table 6: Comparision of results of various national and international studies Variables Our Study, Rajkot (2025) Kishor H. et al., Dhule (2015) Muddagowda et al., Wayanad & Salem (2014) Bhagat VM et al., Surat (2013) Mohmed MH, Malaysia (2013) Rathod G., India (2012) Duration of study 1 year 3 years 8 months 8 months 1 year 1 year 5 months 1 year 4 motnhs No. of Patients 416 280 100 100 701 37 200 M:F ratio 1.2:1 0.71:1 0.29:1 0.53:1 0.25:1 0.3:1 1.43:1 Predominant site of FNAC was lymph nodal lesions (58.89%) followed by thyroid gland (24%). Similar results were reported by various studies. [Table-6] .In lymph nodal lesions tuberculous lymphadenitis was the most common pathological findings followed by reactive lymphadenitis which is in concordance with Bhagat VM et al. and Rathod G. FNAC of thyroid lesions was the next common site in our study. Nodular goiter (72%) was the predominant finding in benign lesion followed by inflammatory lesions consisting of Hashimoto’s thyroiditis. Muddegowda et al and Rathod G. found thyroid lesions as the predominant site of FNAC in their study with colloid goiter as the predominant finding. In salivary gland lesions pleomorphic adenoma comprised 43.9% followed by acute on chronic sialdenitis in 21.95% cases. In soft tissue lesions benign lesions were the commonest finding including 17 cases (85%) of epidermal cyst and 3 (15%) cases of lipoma. Bhagat et al reported neoplastic lesions in 63% cases with lipoma as the predominant benign tumor. Table 7: Comparision of results of various national and international studies Pathological condition Our Study, Rajkot (2025) Kishor H. et al., Dhule (2015) Muddagowda et al., Wayanad & Salem (2014) Bhagat VM et al., Surat (2013) Mohmed MH, Malaysia (2013) Rathod G., India (2012) Predominant site Lymph node Lymph node Thyroid Thyroid Lymph node Lymph node Thyroid Reactive LN (%) 20 18.75 17 13 11.98 8 9.5 TB LN (%) 57 18.75 4 12 35.66 4 12 Maliganat neoplasm (%) 11 4.16 7 16 20.68 5 15 Goitre (%) 72 20.83 60 46 -- 9 35 Benign neoplasm (%) 23 12.84 8 9 6.56 6 12.5 Inconclusive (%) 2 3.12 2 3 10 3.2 4.5 To avoid or minimize false positive results various factors including regenerative changes, metaplasia and others should be taken into consideration while reporting. False negative results may be due to cystic change, necrotic and haemorrhagic areas revealing no diagnostic cellular yield. Repeat FNAC of solid areas or adjacent area may minimize false negative results in such cases. In this study we observed that FNAC is a rapid, cost effective, highly accurate and feasible first line diagnostic tool in swellings. Though FNAC has certain limitations and pitfalls diagnostic accuracy rate in various studies including our study was over 90%.

It was concluded from the present study, that tubercular lymphadenitis is the commonest pathology in patients presenting with head and neck swellings in our hospital, most common benign lesion in thyroid gland was colloid goiter and most common malignant lesion was metastatic carcinoma of lymph node. FNAC had got significant diagnostic value in diagnosing secondaries in lymphnode from primary growth. FNAC is a rapid, cost effective, highly accurate and feasible first line diagnostic tool in management of palpable head and neck swellings.

1. Turbat-Herrera EA, Knowles K. Cytology screening or diagnostic tool? Hum Pathol. 1999; 29:1356-1366. 2. Kirk RM, Ribbans WJ. Clinical Surgery in General. 4th edition, Edinburgh: Elsevier, 2004. 3. Orell SR. In: Orell SR, Sterrett GF, Walters MN, Whitakar D, editors. Manual and atlas of fine needle aspiration cytology. New Delhi: Churchill-Livingstone, 2005. 4. Kevin Burnand G, Antony Young E, Jonathan Lucas et al. The New Aird’s companion in surgical studies 3rd ed, Elsevier, Churchill Livingstone, 2005, 179-81. 5. Afridi S, Malik K, Waheed I. Role of fine needle aspiration biopsy and cytology in breast lumps J Coll Physicians Surg. Pak. 1995; 5:75-7. [PubMed). 6. Bagga PK, Mahajan NC. Fine needle aspiration cytology of thyroid swellings: how useful and accurate is it? Indian J Cancer. 2010; 47(4):437-42. doi: 10.4103/0019-509X.73564. [PubMed] 7. Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg. 1930; 92(2):169-81. [PubMed]. 8. Ponder TB, Smith D, Ramzy I. Lymphadenopathy in children and adolescents: role of fine-needle aspiration in management. Cancer Detect Prev. 2000; 24:228-33. 9. Muddegowda PH, Srinivasan S, Lingegowda JB, Ramkumar KR, Murthy KS. Spectrum of Cytology of Neck Lesions: Comparative Study from Two Centers. Journal of Clinical and Diagnostic Research. 2014; 8(3):44-45. 10. Bhagat VM, Tailor HJ, Saini PK, Dudhat RB, Makawana GR, Unjiya RM. Fine Needle Aspiration Cytology In Nonthyroidal Head And Neck Masses-A Descriptive Study In Tertiary Care Hospital. National Journal of Medical Research. 2013; 3(3):273-76. 11. El-Hag IA, Chiedozi LC, al-Reyees FA et al. Fine needle aspiration cytology of head and neck masses. Seven years' experience in a secondary care hospital. Acta Cytol. 2003; 47(3):387-92. 12. Kishor SH, Damle RP, Dravid NV et al. Spectrum of FNAC in palpable head and neck lesions in a tertiary care hospital in India-a 3 years study. Indian J of pathology and oncology. 2015; 2(1):7-13. 13. Rathod GB, Parmar P. Fine needle aspiration cytology of swellings of head and neck region. Indian Journal of Medical Science. 2012; 66(3):49-54. 14. Ahmad T, Naeem M, Ahmad S, Samad A, Nasir A. Fine needle aspiration cytology (FNAC) and neck swellings in the surgical outpatient. JAMC. 2008; 20:30-2. [PubMed] [Google Scholar] 15. Mohamed MH, Hitam S, Brito-Mutunayagam S, Yunus MRM. Role of FNAC in evaluation of neck masses.