Diagnostic Yield of Ultrasound-Guided FNAC versus Open Excisional Biopsy in Persistent Cervical Lymphadenopathy

Abstract

A common issue in head and neck practice is persistent cervical lymphadenopathy, and it is often difficult to address when we have limited results from imaging and clinical evaluations. Although ultrasound-guided fine-needle aspiration cytology (USG-FNAC) is a popular minimally invasive diagnostic option, open excisional biopsy is still the gold standard among patients where USG-FNAC is performed. Existing literature has also failed to assess the direct comparison of diagnostic yields of USG-FNAC and excisional biopsy, along with the procedural and patient outcomes. The purpose of this study is to investigate the difference in diagnostic yields of USG-FNAC and excisional biopsy for patients with persistent cervical lymphadenopathy. This was a prospective comparative study conducted at Swat Medial College Teaching Hospital Saidu Sharif Swat, where a total of 120 patients with persistent cervical lymphadenopathy were included. USG-FNAC was performed for patients in Group A (n=60), while open excisional biopsy was performed for patients in Group B (n=60). Information was collected on definitive diagnosis, diagnostic adequacy, time taken to complete the procedure, complications, post-procedure pain (measured by the Visual Analog Scale), time to histopathology, and the need to repeat the diagnostic procedure. Statistical analyses were performed utilizing SPSS version 26.0. A p-value of <0.05 was considered significant. For ultrasound-guided FNAC, the overall diagnostic yield was 88.3%, and for open excisional biopsy, 98.3%. Open excisional biopsy had significantly greater diagnostic yield with lower repeat procedure rates (p < 0.05). However, ultrasound-guided FNAC had less procedure time, lower post-procedural pain scores, and was associated with fewer minor complications and quicker recovery (p < 0.05). Time for the initial diagnostic was also shorter in the FNAC group, allowing for earlier clinical interventions. Due to its rapid diagnostic capability, advantages to the patient, and being less invasive, ultrasound-guided FNAC is a timely and effective first-line diagnostic test for cases of persistent cervical lymphadenopathy. Open excisional biopsy is still warranted for persistent cases of cervical lymphadenopathy, and FNAC is still warranted for cases of cervical lymphadenopathy with an uncertain diagnosis and when definitive assessment of cytopathology is warranted. A stepwise diagnostic test process that begins with ultrasound-guided FNAC and is followed by a selective excisional biopsy may help in diagnostic precision with a lower rate of surgical intervention.