Prevalence of cystic metastases in a consecutive cohort of surgically removed branchial cleft cysts

Abstract

Background

Solitary cystic lesion of the neck may often be the only initial presenting symptom for branchial cleft cysts and cystic metastases.

Aims/objectives

To analyse the malignancy rate detected in patients undergoing surgical treatment for lateral branchial cleft cyst.

Material and methods

The records of all patients with surgical procedure code ENB40 (Excision of lateral branchial cleft cyst- or fistula) between 2003 and 2019 were reviewed. After excluding 150 patients, 436 patients were included for final analysis. Re-evaluation of the cytology including HPV-analysis was performed in those who had a malignant cyst.

Results

Cystic metastases were demonstrated histologically after surgical excision in 13 patients (3%). In patients over 18 years of age, the prevalence of cystic metastasis regardless of the primary tumour type was 3.3%.

Conclusion and significance

When the investigation protocol for solitary cystic lesions of the neck is followed, the negative predictive value for malignancy is 97%. All adult patients with a cytologic verified diagnosis of branchial cyst should be examined with HPV-analysis of the cystic sample before excision of the cyst. Failure of predicting a malignancy is often associated with cytology of poor cellularity which may be improved by more frequent use of ultrasound guided fine-needle aspiration cytology (FNAC).

Chinese Abstract

背景：颈部孤立性囊性病变通常可能是鳃裂囊肿和囊性转移瘤的唯一初始症状。

目的：分析对接受手术治疗的侧鳃裂囊肿患者所检测到的恶性肿瘤率。

材料和方法：对所有2003 年至 2019 年间接受代码为 ENB40的手术（切除侧鳃裂囊肿或瘘管）的患者进行了审查。排除了150名患者后, 436 名纳入最终分析。对患有恶性囊肿的患者进行了细胞学的重新评估, 包括 HPV 分析。

结果：13 名患者（3%）在手术切除后的经组织学分析证实存在囊性转移。在 18 岁以上的患者中, 无论原发肿瘤类型为何, 囊性转移的患病率为 3.3%。

结论和意义：按照颈部孤立性囊性病变的调查规则, 恶性肿瘤的阴性预测值为 97%。所有经细胞学证实诊断为鳃囊肿的成年患者, 均应在切除囊肿前对囊性样本进行 HPV 分析。预测恶性肿瘤的失败通常与细胞性差的细胞特征有关, 这可以通过更频繁地使用超声引导的细针抽吸来改善（FNAC）。

Keywords:

• Branchial cleft cyst
• HNSCC
• cystic metastasis
• HPV
• cytology

Acknowledgements

The authors would like to thank Jeremy Wales MD, for editing and reviewing this manuscript for English language.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by grant from The ACTA Otolaryngologica Foundation.