On 2015 Mar 28, Amit Kumar Chowhan commented:

Dear Sir,

We read the article by Srikanth S et al.¹ on ‘A comparative study of fine-needle aspiration cytology (FNAC) and fine-needle non-aspiration cytology (FNNAC) techniques in head and neck swellings’ with interest and appreciate the inclusion of multiple organs i.e. lymph node, thyroid and salivary gland located in head and neck region in the study. Although fine needle aspiration cytology is a well-established tool as a first line diagnostic modality, however, a major criticism pertains to its use in highly vascular organs such as thyroid and liver, or in haemorrhagic lesions where large quantities of blood compromise cytologic interpretation. Hence we agree with the authors when they excluded lesions of vascular origin from their study.

We agree with the authors that FNNAC allows greater ease of sampling with better control of the hand during the procedure and a good perception of the lesion consistency, enabling more precise entry into the mass and thus is more user friendly. Apart from being less traumatic and painful to the patient, as suggested by the authors, we would like to add that with this technique the patient would also be less apprehensive about the procedure, when a large syringe with needle and a syringe holder is not seen, thus making FNNAC more patient friendly. Another advantage of FNNAC is that the syringe is used to expel the material after the procedure is completed, whereas in FNA it is used to create a suction force to aspirate the cells in to the needle. A fresh sterile syringe is therefore not necessary for FNNAC, thus reducing the cost of procedure.

In their study the authors concluded that for thyroid lesions the non-aspiration technique was better than aspiration technique with respect to all the five parameters proposed by Mair et al.² i.e. background blood/clot, amount of cellular material, degree of cellular degeneration & trauma and retention of appropriate cellular architecture. In a similar study conducted by us³ on thyroid lesions, we found that the non-aspiration technique was better in relation to all the parameters except for amount of cellular material, which was better with aspiration technique. In cases of colloid goiter, brownish colloidal fluid drained out immediately on putting needle and drenched the fingers holding the needle. This problem was handled by keeping a syringe ready, which was immediately attached to the needle and the fluid collected in the syringe – to be cyto-centrifuged for better cellularity. Another problem encountered was for calcified nodules, which required vigorous aspiration, as it didn’t yield any material on non-aspiration. We therefore, would recommend first non-aspiration technique to be performed and if the material obtained is insufficient then only to go for another pass with aspiration technique.

References:

1.Srikanth S, Anandam G, Kashif MM. A comparative study of fine-needle aspiration and fine-needle non aspiration techniques in head and neck swellings. Indian J Cancer 2014;51:98-9.

2.Mair S, Dunbar F, Becker PJ, Du Plessis W. Fine needle cytology - is aspiration suction necessary? A study of 100 masses in various sites. Acta Cytol. 1989;33:809-13.

3.Chowhan AK, Babu KV, Sachan A, Rukmangdha N, Patnayak R, Radhika K, Phaneendra BV, Reddy MK. Should we apply suction during fine needle cytology of thyroid lesions? A prospective study of 200 cases. Journal of Clinical and Diagnostic Research 2014;8:19-22.

On 2015 Mar 28, Amit Kumar Chowhan commented:

Dear Sir,

We read the article by Srikanth S et al.¹ on ‘A comparative study of fine-needle aspiration cytology (FNAC) and fine-needle non-aspiration cytology (FNNAC) techniques in head and neck swellings’ with interest and appreciate the inclusion of multiple organs i.e. lymph node, thyroid and salivary gland located in head and neck region in the study. Although fine needle aspiration cytology is a well-established tool as a first line diagnostic modality, however, a major criticism pertains to its use in highly vascular organs such as thyroid and liver, or in haemorrhagic lesions where large quantities of blood compromise cytologic interpretation. Hence we agree with the authors when they excluded lesions of vascular origin from their study.

We agree with the authors that FNNAC allows greater ease of sampling with better control of the hand during the procedure and a good perception of the lesion consistency, enabling more precise entry into the mass and thus is more user friendly. Apart from being less traumatic and painful to the patient, as suggested by the authors, we would like to add that with this technique the patient would also be less apprehensive about the procedure, when a large syringe with needle and a syringe holder is not seen, thus making FNNAC more patient friendly. Another advantage of FNNAC is that the syringe is used to expel the material after the procedure is completed, whereas in FNA it is used to create a suction force to aspirate the cells in to the needle. A fresh sterile syringe is therefore not necessary for FNNAC, thus reducing the cost of procedure.

In their study the authors concluded that for thyroid lesions the non-aspiration technique was better than aspiration technique with respect to all the five parameters proposed by Mair et al.² i.e. background blood/clot, amount of cellular material, degree of cellular degeneration & trauma and retention of appropriate cellular architecture. In a similar study conducted by us³ on thyroid lesions, we found that the non-aspiration technique was better in relation to all the parameters except for amount of cellular material, which was better with aspiration technique. In cases of colloid goiter, brownish colloidal fluid drained out immediately on putting needle and drenched the fingers holding the needle. This problem was handled by keeping a syringe ready, which was immediately attached to the needle and the fluid collected in the syringe – to be cyto-centrifuged for better cellularity. Another problem encountered was for calcified nodules, which required vigorous aspiration, as it didn’t yield any material on non-aspiration. We therefore, would recommend first non-aspiration technique to be performed and if the material obtained is insufficient then only to go for another pass with aspiration technique.

References:

1.Srikanth S, Anandam G, Kashif MM. A comparative study of fine-needle aspiration and fine-needle non aspiration techniques in head and neck swellings. Indian J Cancer 2014;51:98-9.

2.Mair S, Dunbar F, Becker PJ, Du Plessis W. Fine needle cytology - is aspiration suction necessary? A study of 100 masses in various sites. Acta Cytol. 1989;33:809-13.

3.Chowhan AK, Babu KV, Sachan A, Rukmangdha N, Patnayak R, Radhika K, Phaneendra BV, Reddy MK. Should we apply suction during fine needle cytology of thyroid lesions? A prospective study of 200 cases. Journal of Clinical and Diagnostic Research 2014;8:19-22.