Fine‐needle aspiration in pediatric patients 12 years of age and younger

Abstract

Fine-needle aspiration (FNA) is a well-established diagnostic tool in adult patients, and while in recent years it has gained popularity in the pediatric population, it is still far less universally accepted in children than in adults. A computerized search of our tertiary medical center's laboratory information system was performed for the 20-year period from 1992 to 2012. All FNAs in children 12 years of age and younger and all related surgical pathology reports were identified. Cytologic and histologic diagnoses were stratified into six diagnostic categories--benign, atypical, suspicious, malignant, cyst contents, and nondiagnostic--and then compared to determine the utility of FNA in this patient population. Four hundred and three FNAs in 389 patients were included in this study, of which there were 288 benign (71.5%), 8 atypical (2.0%), 10 suspicious (2.5%), 42 malignant (10.4%), 12 cyst contents (3.0%), and 43 nondiagnostic (10.6%) cases. The most common benign diagnoses were reactive lymph node and inflammatory infiltrate/abscess, while the most common malignant diagnoses were leukemia/lymphoma, rhabdomyosarcoma, and neuroblastoma. Of the 127 FNAs (31.5%) with histologic follow-up, we identified just one false positive and one false negative case. Like FNA in adults, this study shows that the technique is both sensitive (97.2%) and specific (98.5%), and has high positive predictive (97.2%) and negative predictive (98.5%) values for diagnosing malignancy in childhood. As FNA is a simpler, less invasive, and more cost-effective procedure when compared with surgical biopsy, it represents a valuable diagnostic tool in the pediatric population.