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Step Description 1 Review prebiopsy images to determine the approach 2 Obtain informed consent 3 Obtain scout view 4 Obtain limited nonenhanced axial views through the lesion 5 Place skin markers on the line of the image that has best line of sight to the lesion 6 Repeat scanning to determine the puncture site 7 Perform sterile preparation of the puncture site 8 Insert the introducer needle 9 Repeat scan to verify the position of the introducer needle 10 Insert the aspiration needle 11 Verify the position of the needle tips 12 Place the needle to the edge of the mass 13 Call cytology department 14 Perform multiple multidirectional plunges into the mass 15 Withdraw only the aspiration needle 16 Submit specimen for analysis 17 Repeat steps as required on the basis of the cytologic results Diagnosis Parapharyngeal Space Thyroid Parotid Paraspinal Other Total Correct 23 (85) 49 (92) 29 (81) 25 (100) 65 (87) 191 None 3 (11) 4 (8) 6 (17) 0 8 (11) 21 Wrong 1 (4) 0 1 (2) 0 2 (2) 4 Total 27 53 36 25 75 216 Note.—Data in parentheses are percentages.
Cytologic Diagnosis No. of Lesions Malignant neoplasm Squamous cell carcinoma 24 Adenocarcinoma 4 Papillary carcinoma 6 Follicular neoplasm 4 Acinic cell carcinoma 3 Adenoid cystic carcinoma 1 Mucoepidermoid carcinoma* 3 Lymphoma 1 Melanoma 2 Chordoma 2 Metastatic disease† 4 Myeloma 1 Neuroendocrine tumor 1 Spindle cell malignancy 3 Synovial sarcoma 1 Low-grade sarcoma 1 Posttransplant lymphoproliferative disorder 1 Undifferentiated carcinoma 4 Vasoformative neoplasm 1 Benign neoplasm Multinodular goiter 21 Cyst‡ 10 Follicular adenoma 2 Pleomorphic adenoma§ 14 Monomorphic adenoma 1 Warthin tumor 3 Lipoma 2 Hurthle cell tumor 3 Paraganglioma 3 Giant cell tumor 1 Granulation tissue 2 Reactive lymph node 7 No evidence of neoplasm‖ 44 Infection 8 Inflammation 7 Nondiagnostic study 21 * One wrong diagnosis (abscess).
† Renal cell, breast, or prostate carcinoma.
‡ Colloid, hemorrhagic, or branchial cleft cyst.
§ One wrong diagnosis (mucoepidermoid carcinoma).
‖ Radiation change or fibrous, glandular, adipose, or muscular tissue with no tumor cells. Two wrong diagnoses (squamous cell carcinoma, schwannoma).
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