Ultrasound-Guided Versus Freehand Fine Needle Aspiration: A Comparative Study in Diagnosing Non-Salivary, Non-Thyroidal Head, and Neck Masses

Background Fine needle aspiration cytology (FNAC) is widely used to evaluate head and neck masses, with both ultrasound (US)-guided and freehand techniques being employed. While US-guided FNAC is thought to enhance accuracy, freehand FNAC remains commonly used due to its practicality and speed. This study compares the diagnostic performance of US-guided and freehand FNAC, evaluating their sensitivity, specificity, accuracy, inconclusive rates, and time to histological confirmation. Aim of the study The aim of this study is to compare the inconclusive rates and time to histological confirmation of US-guided versus freehand FNAC in assessing non-salivary, non-thyroidal head, and neck masses. Methods A retrospective analysis of 439 FNAC reports (2012-2016) was conducted. Diagnostic metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, inconclusive rates, and median time to histological confirmation, were analyzed. Results Among 439 FNAC procedures, 294 were US-guided and 145 were freehand. US-guided FNAC had a lower inconclusive rate (11.6% vs. 17.9%; p = 0.068) and higher specificity (61% vs. 38%), while sensitivity was comparable (91% vs. 95%). Accuracy was 81.6% for US-guided FNAC and 86.3% for freehand FNAC. Freehand FNAC had a shorter median reporting time (29 vs. 42 days). Conclusions Both techniques demonstrated similar diagnostic accuracy. While US-guided FNAC reduced inconclusive rates and improved specificity, freehand FNAC provided faster results, aiding quicker clinical decision-making. These findings suggest that both techniques have distinct benefits, and their use should be tailored to individual patient needs and clinical settings.