Abstract / Summary
Background: Neck masses pose a broad diagnostic challenge in otolaryngology, encompassing congenital, inflammatory, and neoplastic etiologies. Fine-needle aspiration cytology (FNAC) is widely adopted as a first-line investigation, yet its performance across diverse etiological categories requires systematic validation, particularly in tuberculosis (TB)-endemic regions. Aims and Objective: This study aimed to evaluate the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC relative to histopathological examination (HPE) across five categories of neck masses. Materials and Methods: A prospective, observational study was conducted in the Department of ENT, Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India, over 18 months (December 2015–July 2017). One hundred consecutive patients undergoing both FNAC and surgical biopsy were enrolled. FNAC diagnoses were compared with HPE using the Galen and Gambino method. Results: The cohort included 100 patients (63 females, 37 males; mean age 34.18±14.88 years). Lymph node masses predominated (43%), followed by thyroid (28%), other masses (11%), congenital (9%), and salivary gland (9%). Benign lesions comprised 76%. Overall, FNAC-HPE concordance was 87%. Specificity was 100% across all categories; PPV was 100% in malignant cases (lymph node, thyroid, and salivary gland); NPV was 93.8%. Accuracy ranged from 83.7% (lymph node) to 90.9% (other masses). Discordances chiefly involved non-Hodgkin lymphoma and follicular carcinoma. Conclusions: FNAC demonstrates high accuracy and perfect specificity for neck masses, reinforcing its role as a first-line tool. Limitations in lymphoma subtyping and follicular carcinoma necessitate excision biopsy. A stepwise diagnostic algorithm is proposed for resource-limited, TB-endemic settings.