Cytological Evaluation of Non Thyroidal Neck Swellings: A Prospective Cross-sectional Study from a Tertiary Care Centre in Krishnagiri, Tamil Nadu, India

Introduction: Non thyroidal neck lesions represent a heterogeneous group of pathologies arising from lymph nodes, salivary glands, softtissues, and other cervical structures. Fine Needle Aspiration Cytology (FNAC) is a minimally invasive and cost-effective diagnostic tool, but its accuracy in differentiating benign from malignant lesions requires continuous evaluation against histopathology, the gold standard. Aim: To evaluate the spectrum of non thyroidal neck lesions using FNAC, categorise them cytologically, and assess the diagnostic accuracy of FNAC by correlating it with histopathology. Materials and Methods: This prospective, cross-sectional study was conducted in the Department of Pathology, Government Medical College, Krishnagiri, Tamil Nadu, India from April 2024 to March 2025. A total of 210 consecutive cases of non thyroidal neck lesions underwent FNAC, of which 103 cases had subsequent histopathological evaluation. Cytological diagnoses were classified into inflammatory, benign, and malignant categories. Histopathological specimens were processed using routine paraffin embedding and Haematoxylin and Eosin (H&E) staining. Concordance between FNAC and histopathology was assessed, and diagnostic indices—sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and overall diagnostic accuracy—were calculated. Statistical analysis was performed using Pearson’s Chi-square test (χ²) with IBM Statistical Package of Social Sciences (SPSS) Statistics Version 25.0. Results: Of the 210 cases, 115 (54.76%) were inflammatory, 51 (24.29%) benign, and 44 (20.95%) malignant. Histopathological correlation in 103 cases revealed 21 inflammatory (20.4%), 51 benign neoplastic (49.5%), and 31 malignant neoplastic (30.1%) lesions. FNAC–histopathology concordance was 92.2% (95/103), with discordance in 7.8% (8/103). Diagnostic performance metrics were: sensitivity 92.68%, specificity 90.48%, PPV 97.43%, NPV 76.00%, and overall diagnostic accuracy 92.23%. Conclusion: FNAC is a highly sensitive and specific preliminary diagnostic modality for non thyroidal neck lesions, showing excellent concordance with histopathology. While it can reliably guide initial clinical management, histopathological confirmation remains essential in inconclusive or suspicious cases.