11.1 Discuss the provision of an on-site assessment FNA service to a district general hospital.
Consider the benefits to the service users. Carry out a user survey and find out their needs. How would you staff it? Would you offer an on-site assessment service just for FNAs or extend it to bronchoscopy or EUS samples? What are the financial considerations?
11.2 Carry out an appraisal of fine-needle aspiration biopsy of the thyroid.
Carry out a literature search. Assess the result of FNA thyroid effect on patient management and cost. Consider its accuracy and limitations.
11.3 The National Institute for Health and Care Excellence (NICE) guidance on cancer services produced the document Improving Outcomes in Head and Neck Cancers in 2004. One of the ‘key recommendations’ was the stipulation that ‘diagnostic clinics should be established for patients with neck lumps’. Is this recommendation evidence based?
Carry out a literature search with ‘one-stop clinic’ and ‘neck lump’ as search terms. Look at original articles as well as review articles. Analyse all the facts and determine objective evidence to justify this recommendation.
11.4 Discuss the role of cytology in assessment of salivary glands.
FNA offers valuable information which is not obtained by any other means. Tumours the salivary gland lesions account for 2-6.5% of all the neoplasms of the head and neck. FNA is advantageous for both the patients and the clinicians because of its fast turnaround of results, accuracy, economy, and lack of complications. FNA cytology is an accepted, sensitive and specific technique in the diagnosis of both neoplastic and non-neoplastic lesions. It is a relatively painless and safe procedure for a rapid and current diagnosis. Many clinicians believe that FNA as a reliable and useful technique for the management of their patients. FNA can distinguish inflammatory lesions from neoplastic conditions, lymphomas from epithelial malignancies, and diagnose some of the malignant tumors with accuracy. FNA provides information for planning the operation. It is important to realise that is not always possible to distinguish between benign and malignant salivary gland tumours and these can only be confirmed on excision.
11.5 What are the indications for lymph-node fine needle aspiration?
FNA cytology of the lymph glands offers rapid turnaround time, low-cost, provide cells for immunocytochemistry, molecular testing and it acceptable to the patient. It’s useful for confirming the clinical impression of reactive hyperplasia, diagnose suspected infection and diagnose a suspected malignancy. Some Hodgkin lymphomas, and large cell lymphomas can be recognised by FNA cytology. Cytology may not always be diagnostic in a small cell lymphoma as the cells may resemble reactive hyperplasia.
Cytology offer useful in confirming the metastatic tumour or assessment of a tumour of unknown origin.