Fine needle aspiration at a Regional Head and Neck Clinic: A clinically beneficial and cost-effective service

Background:  Fine needle aspiration (FNA) is an important adjuvant to the diagnosis of a palpable lesion which often permits the complete assessment of patients. The main objective of this study was to determine the clinical benefit of a dedicated FNA service at a tertiary referral Head and Neck Clinic and to assess if such a service is cost effective.
Methods:  All patients attending the Head and Neck Clinic during 2004 were prospectively assessed in this study. Patient records were analysed regarding investigative modalities including FNA, the subsequent cytology result and the requirement for further histopathological investigations. A cost analysis for all investigative procedures was performed.
Results:  A total of 135 patients (36 males) had FNAs performed during the study period. The median age was 51.5 years (range 17–92). Patients presented with lesions of lymph nodes ( n  = 46), thyroid ( n  = 41), salivary, parotid or submandibular glands ( n  = 22) and other cutaneous or cystic lesions ( n  = 26). Cytological grading results were; C1 = 26, C2 = 93, C3 = 8, C4 = 2 and C5 = 6. Patients with lesions C3 or above normally proceeded to further investigations. The overall cost of the FNA per episode in the out-patient clinic was £114 per episode compared to day case open biopsy per patient of £333 and an in-patient stay per patient was £2371. FNA provided sufficient pathological diagnosis to avoid day case surgery in 57 patients (42.2%), and inpatient surgery in 65 patients (48.1%) resulting in a total saving of £158 372 in 2004.
Conclusion:  This study demonstrates the clinical benefit and cost-effectiveness of FNA services in a dedicated Head and Neck clinic.