*5.2.1 Cytology*

As stated before, diagnosis is based on imaging and tissue histology. However, cytology obtained through a fine needle aspiration (FNA) has been described and could be useful to make a first diagnostic approach to a high-grade sarcoma. On a series reported by Fleshman et al. [20], with 91 patients who had an FNA reporting a high-grade sarcoma, despite only 4% were head and neck tumors, the diagnosis was confirmed by core needle biopsy, open biopsy, or excision with 8% of them being osteosarcoma and an overall diagnostic accuracy of FNA of 91%, an VPP 97%, and sensitivity of 94%. Nonetheless, current practice normally states that FNA biopsy could be used to confirm or rule out local disease recurrence or metastasis in a known sarcoma patient, but never for an initial sarcoma diagnosis or to perform a major resection based on FNA diagnosis.
