Stellenwert der Feinnadelaspirationszytologie und Stanzbiopsie im Kopf-Hals-Bereich

Zusammenfassung

Hintergrund: Mit der Feinnadelaspirationszytologie (FNAC) und der Stanzbiopsie (auch: Grobnadelpunktion, GNP) existieren 2 wenig invasive Methoden zur Dignitätsklärung von klinisch oder bildgebungstechnisch auffälligen Veränderungen im Kopf-Hals-Bereich. Zum Vergleich beider Techniken liegen bisher wenige Daten vor. Das Ziel dieser retrospektiven Studie ist es, den diagnostischen Stellenwert sowie die Sensitivität und Spezifität der FNAC und der Stanzbiopsie zu vergleichen.

Material und Methoden: Im definierten Zeitraum wurde bei 86 Patienten eine Stanzbiopsie und bei 408 Patienten eine FNAC durchgeführt. Aufgrund der Ergebnisse aus FNAC oder Stanz­biopsie wurden 52 Patienten der Stanzbiopsie-Gruppe und 224 Patienten der FNAC-Gruppe anschließend operiert, sodass die Ergebnisse mit der endgültigen Histopathologie verglichen werden konnten.

Ergebnisse: Die Sensitivität der FNAC lag mit 85% höher als die der Stanzbiopsie (80%), die Spezifität (87 vs. 94%) und der positiv prädiktive Wert (64 vs. 97%) waren geringer. Überlegen war die FNAC beim negativ prädiktiven (92 vs. 71%) und dem falsch-negativen Wert (5 vs. 13%). Bei der Berechnung des falsch-positiven Wertes schnitt die Stanzbiopsie besser ab (2 vs. 15%).

Schlussfolgerungen: Beide Methoden sind gut geeignet, die Dignität von Raumforderungen im Kopf-Hals-Bereich zu klären. Die FNAC eignet sich besonders zur Diagnostik von hämatologischen Erkrankungen und zum Ausschluss von Malignomen bei suspekten Lymphknoten. Die Stanzbiopsie hat sich als besonders valide bei der Erkennung von Rezidiven in bereits bestrahltem oder operiertem Gewebe erwiesen. Zudem hat sie den Vorteil einer Histologiegewinnung zur definitiven Therapieplanung.

Abstract

Background: Fine-needle aspiration cytology (FNAC) and core-needle biopsy (CNB) represent 2 minimal invasive methods for further assessment of suspect lesions of the head and neck area. However, only limited data on the direct comparison of both methods has been published. The aim of this retrospective study was to evaluate the diagnostic value of FNAC and CNB and to compare their sensitivity and specificity.

Material and methods: Between 2005 and 2012, CNB was performed in 86 patients and FNAC in 408 patients. 52 of 86 CNB-patients and 224 of 408 FNAC-patients underwent surgery afterwards and were included into the study (n=276). In order to compare the results of both methods the corresponding final histopathological finding from surgery was considered.

Results: The sensitivity of the FNAC-group was higher (85%) compared to the CNB-group (80%), the specificity (87 vs. 94%) as well as the positive predictive value (64 vs. 97%) was lower. The negative predictive value (92 vs. 71%) and also the false negative value of the FNAC (5 vs. 13%) were superior to the results of the CNB-group. Concerning the false positive value the CNB-group showed better results (2 vs. 15%).

Conclusion: Both methods are well suited to clarify the dignity of lesions in the head and neck region. In the current case series, FNAC seemed particularly suitable for diagnosis of hematologic diseases and the exclusion of malignancy in suspicious lymph nodes. The GNP has proven to be valid in the detection of tumor recurrences in irradiated or previously operated tissue, furthermore the definitive oncological treatment can be planed, based on the histopathological results obtained by GNP.

Schlüsselwörter

Feinnadelaspirations­zytologie - Grobnadelpunktion - Kopf-Hals-Karzinome - FNAC - GNP - Stanzbiopsie

Key words

core needle biopsy - fine needle aspiration ­cytology - head and neck cancer - FNAC - CNB

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