Role of Fine Needle Aspiration Cytology (FNAC) in the Differential Diagnosis of Neck Swelling: A Hospital Based Study

Background:
Both neck swellings are usually due to lymph nodes, thyroid,
paralymphatic, or soft tissue swellings that can vary from inflammatory
to malignancies, which are manifestations of head and neck
malignancies in adults. FNAC, USG-guided FNAC, and ultrasonography
are the major diagnostic modalities in hematologic swellings of lymph
nodes that are accurate to the extent of 82–96% sensitivity and in
nonthyroid swellings of the neck that are accurate for their sensitivity of
93% and specificity of 72%. This study aims to investigate the
cytological distribution of FNAC in 61 cases.
Objective:
To assess the diagnostic efficacy, accuracy, and cytological findings of
Fine Needle Aspiration Cytology (FNAC) in case of neck swellings and
correlation of cytological results with demographic details and site-wise
distribution for appropriate patient care.
Methods:
This retrospective study included 61 patients with head and neck
swellings from the Department of ENT, Ad-Din Sakina Hospital,
between December 2024 and March 2025; FNAC was performed in all
cases under strict aseptic conditions using a 23-gauge needle and 10-ml
syringe, with aspirated material stained by MGG, H&E, and
Papanicolaou methods, Z-N staining applied for suspected tuberculous
or purulent cases, and repeat FNAC conducted when initial samples
were inadequate.
Results:
Among 61 FNAC-evaluated neck swellings, thyroid lesions were most
common (42.6%), followed by neck and parotid swellings (13.1%
each), with female predominance (~66%) and peak incidence in middle
age (45–59 years; 26.2%); cytology showed mainly benign and
inflammatory lesions predominantly nodular goiter and lymphadenitis
(14.8% each) with fewer malignant cases, highlighting FNAC’s
effectiveness in characterizing the anatomical and cytological spectrum.
Conclusion:
Neck swellings predominantly involve the thyroid gland with female
and mid-life predominance, are largely benign with inflammatory and
benign neoplastic lesions forming the majority despite a notable
malignant proportion, and FNAC proves to be a precise, minimally
invasive, and indispensable primary diagnostic tool enabling reliable
benign–malignant differentiation and optimal clinical management.