Diagnostic Accuracy, Sensitivity, Specificity and Positive Predictive Value of Fine Needle Aspiration Cytology (FNAC) in Intra Oral Tumors

  • Gillani, Munazza (Department of Histopathology, Armed Forces Institute of Pathology) ;
  • Akhtar, Farhan (Department of Histopathology, Armed Forces Institute of Pathology) ;
  • Ali, Zafar (Department of Histopathology, Armed Forces Institute of Pathology) ;
  • Naz, Irum (Department of Histopathology, Armed Forces Institute of Pathology) ;
  • Atique, Muhammad (Department of Histopathology, Armed Forces Institute of Pathology) ;
  • Khadim, Muhammad Tahir (Department of Histopathology, Armed Forces Institute of Pathology)
  • Published : 2012.08.31


Objective: The objective of this study was to establish the diagnostic accuracy, specificity and sensitivity of fine needle aspiration cytology(FNAC) for intra-oral tumors, comparing with histopathology as the gold standard. Materials and methods: Forty cases of FNA cytology from intraoral tumors was performed in AFID along with the demographic data and clinical information and then diagnosed at AFIP, Rawalpindi. Then the cytology results obtained per FNAC were compared with the histopathological biopsy results of the same lesions. The following variables were recorded for each patient: Age, gender, site of biopsy, diagnosis. The data were entered and analyzed using Open-epi version 2.0. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Cohen Kappa was further applied to compare the agreement between the biopsy and FNAC diagnoses. A p-value of < 0.05 was considered as statistically significant. Results: Among the total patients included in the study there were 24 males and 16 females, with a ratio of 1.5:1. Age of the patients ranged from 24 to 80 years with a mean of 52 years. A total of six sites were aspirated from the oral cavity with maximum (11) aspirates taken from alveolar ridge. The results of FNAC revealed that there were 32 malignant and 8 benign aspirates. Confirmation through histopathological analysis came for 31/32 malignant cases while one was falsely given positive for malignancy on FNAC. Among a total of 40 cases, 31(77%) cases diagnosed were found to be malignant and remaining 9(23%) were benign. The FNAC results revealed 32 malignant and 8 benign lesions. Histopathology of the subsequent surgically excised specimen showed malignant lesions in 31(77%) and benign in 9(23%) patients. As a whole, it was found that the absolute sensitivity for introral FNAC was 100% and specificity 89% with positive predictive value of 97% and negative predictive value of 100%. Conclusion: Cytological diagnosis was almost corroborative with final histopathological diagnosis in all cases, with very few exceptions, exhibiting high diagnostic accuracy.


  1. Yu CJ, Yang PC, Shun CT, et al (1996). Overexpression of MUC5 genes is associated with early post-operative metastasis in non-small-cell lung cancer. Int J Cancer, 69, 457-65.<457::AID-IJC7>3.0.CO;2-3
  2. Cramer H, Lampe H, Downing P (1995). Intraoral and transoral fine needle aspiration. A review of 25 cases. Acta Cytol, 39, 683-8.
  3. Daskalopoulou D, Rapidis AD, Maounis N, Markidou S (1997). Fine-needle aspiration cytology in tumors and tumor-like conditions of the oral and maxillofacial region. Cancer Cytopathol, 81, 238-52<238::AID-CNCR6>3.0.CO;2-L
  4. Deshpande A, Umap P, Munshi M (2000). Granular cell ameloblastoma of the jaw.A report of two cases with fine needle aspiration cytology. Acta Cytol, 44, 81-5.
  5. Devesh S, Sinha BK, Geeta S, et al (2008). Efficacy of fine needle aspiration cytology in the diagnosis of oral and oropharyngeal tumors. Int Archives Otorhinolaryngol, 12, 1.
  6. Gandhi S, Lata J, Gandhi N, (2011). Fine needle aspiration cytology: a diagnostic aid for oral lesions. J Oral Maxillofac Surg, 69, 1668-77.
  7. Gunhan O, Dogan N, Celasun B, et al (1993). Aspiration cytology of oral cavity and jaw bone lesions.A report of 102 cases. Acta Cytol, 37, 135-41.
  8. Gunjan HS, Panwar SK, Chaturvedi PP, Kane SN (2011). Isolated primary extranodal lymphoma of the oral cavity: A series of 15 cases and review of literature from a tertiary care cancer centre in India. Indian J Med Paediatr Oncol, 32, 76-81.
  9. Jaber MA (2006). Intraoral minor salivary gland tumours: a review of 75 cases in Libyan population. Intl J Oral Maxillofac Surg, 35, 150-4.
  10. Kocjan G (2006). Fine needle aspiration cytology, diagnostic principles and dilemmas. Schroder, G. and Blasig, E. (Eds). Springer Berlin Heidelberg Newyork.
  11. Liliemark J, Tani E, Mellstedt H, Skoog L (1989). Fine-needle aspiration cytology and immunocytochemistry of malignant non-Hodgkin's lymphoma in the oral cavity. Oral surg Oral med Oral pathol; 68: 599-603.
  12. Manor E, Sion-Vardy N, Joshua BZ, Bodner L (2011). Oral lipoma: analysis of 58 new cases and review of the literature. Ann Diagon Pathol, 15, 257-61.
  13. Orell SR, Sterrett GF, Whitaker D (2005). Fine Needle Aspiration Cytology. 4th edition. Edinburgh: Churchill Livingston-Elsevier.
  14. Rehman B, Mamoon N, Jamal S, et al (2008). Malignant tumours of minor salivary glands in northern Pakistan: a clinicopathological study. Hematol Oncol Stem Cell Ther, 1, 90-3.
  15. Seetharam S, Ramachandran C (1998). Fine needle aspiration cytology as a diagnostic test for oral squamous cell carcinoma. Oral Dis, 4, 180-6.
  16. Singh S, Garg N, Gupta S, et al (2011). Fine needle aspiration cytology in lesions of oral and maxillofacial region: Diagnostic pitfalls. J Cytol, 28, 93-7.
  17. Tilakarante WM, Jayasooria PR, Tennakoon TM, Saku T (2009). Epithelial salivary tumours in Sri Lanka: a retrospective study of 713 cases. Oral Surg Oral Med Oral Pathol Oral radiol Endod, 108, 90-8.