Diagnosing Squamous Lesions of Head and Neck: Categorization, Risk of Malignancy, and Follow-Up: An Institutional Experience.

Introduction: Fine-needle aspiration (FNA) is essential for evaluating the wide range of squamous lesions that present in the head and neck. In this retrospective study, we reviewed cytology cases from our institution involving squamous lesions of the head and neck region to characterize their diagnostic categorization and evaluate concordance between cytological assessments and corresponding surgical pathology diagnoses.

Methods: All in-house and consult head and neck FNA cases containing the term "squamous" from September 2021 to September 2024 were reviewed. Electronic medical records were reviewed to extract patient demographics and lesion characteristics, including anatomic site, size, and solid versus cystic composition. Radiological findings and follow-up surgical pathology were also obtained when available.

Results: In this study, cytology demonstrated a sensitivity of 99.3%, specificity of 81.8%, positive predictive value of 97.4%, and negative predictive value of 94.7% yielding an overall accuracy of 97.1%. The risk of malignancy (ROM) by cytological category was 66.7% for nondiagnostic/scant, 5.3% for benign, 76.4% for atypical, 100% for suspicious for malignancy, and 96.9% for malignant. Both benign and malignant entities were diagnosed across all anatomic sites and lesion size categories.

Conclusion: FNA is a highly effective and reliable method for evaluating squamous lesions of the head and neck with high sensitivity and accuracy. The progressive increase in ROM across diagnostic categories supports the utility of a stratified diagnostic system. Radiological-pathological concordance highlights the strength of a multidisciplinary diagnostic approach, though discrepancies show the limitations of relying on imaging or clinical features alone.