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Fine-Needle Aspiration Biopsy of Salivary Glands
Abstract
Between January 1, 1973, and December 31, 1988, the authors or their associates performed 552 fine-needle aspiration biopsies on patients with clinically significant masses of the salivary glands. All patients presented at the Medical College of Virginia Hospitals or Clinics of Virginia Commonwealth University; they were followed for periods ranging from 1 to 16 years. When available, the fine-needle aspiration diagnoses were correlated with histologic diagnoses and long-term patient outcomes. The sensitivity for a neoplasm was 93.3%; the specificity for the absence of a neoplasm was 99%. Diagnostic efficiency was 96.4%, and predictive value of a positive aspiration for a neoplasm was 98.3%. With fine-needle aspiration, surgical excision of salivary gland masses is often unnecessary. In patients with primary and metastatic neoplasms involving the salivary glands, fine-needle aspiration aids the surgeon in mapping the extent of the surgical procedure and in preoperatively preparing the patient. The procedure is cost-effective.
... 20,14 In our present study parotid gland was the most commonly affected site (70%) followed by submandibular gland (23%) and minor salivary gland (7%). These findings were in accordance with the studies of Frable and Frable, Cristallini et al and Bocatto et al. [22][23][24] There was a slight female predominance in our present study which was in accordance with the studies of Frable and Frable, Stewart et al and Rajwanshi et al. 22,25,26 The p-value for FNAC and histopathological correlation between positive and negative cases for neoplasm was found to be 0.001 which was considered highly significant. Sensitivity, specificity and diagnostic accuracy of FNAC for neoplasms was found to be 74%, 100% and 89% respectively. ...
... 20,14 In our present study parotid gland was the most commonly affected site (70%) followed by submandibular gland (23%) and minor salivary gland (7%). These findings were in accordance with the studies of Frable and Frable, Cristallini et al and Bocatto et al. [22][23][24] There was a slight female predominance in our present study which was in accordance with the studies of Frable and Frable, Stewart et al and Rajwanshi et al. 22,25,26 The p-value for FNAC and histopathological correlation between positive and negative cases for neoplasm was found to be 0.001 which was considered highly significant. Sensitivity, specificity and diagnostic accuracy of FNAC for neoplasms was found to be 74%, 100% and 89% respectively. ...
... [11][12][13] However, some still require FNAC to determine benign or malignant lesions prior to surgery, as the surgical approach varies. 14,15 FS is a more invasive and resource-incentive technique conducted intraoperatively. FS provides immediate feedback and improves the surgeon's decision-making process. ...
Background: This study aims to investigate the diagnostic values of fine needle aspiration cytology (FNAC) and frozen section (FS) in evaluating parotid gland masses subjected to parotidectomy. Methods: A retrospective analysis of data from 274 patients who underwent parotidectomy for parotid gland masses was performed at the Department of Otolaryngology of the University Hospital between 2013 and 2019. We compared the preoperative FNAC and intraoperative FS records with the definitive histopathological diagnoses obtained from the surgical resection specimens. Results: The sensitivity, specificity, accuracy, positive predictive, and negative predictive value of FNAC in reaching the correct diagnosis were 65.1%, 94.1%, 88.7%, 77.1%, and 92.1%, respectively. The FS analysis values were 92.9%, 97.2%, 95.3%, 96.3%, and 94.6%, respectively. Additionally, the true-positive, true-negative, false-positive, and false-negative cases are documented and discussed. Conclusions: Although FNAC is a commonly used, easy, and reliable diagnostic method for parotid tumors, the diagnostic values observed in our study are low. FS analysis appears to be a more robust method. Therefore, we recommend a balanced use of these diagnostic tools, informed by clinical judgment, patient considerations, and available resources, to optimize outcomes in the management of parotid gland tumors.
... The accuracy of FNAC depends on important factors like the experience of the clinician performing the procedure in addition to the experience of the pathologist in assessing the cytological sample. Inadequate cellularity or smears have been reported in 2 to 10% of cases in literature, 22,21 which can be explained by needle insertion outside the target tissue or because of necrosis, haemorrhage, or cystic areas in the tumor. So, repeating the sampling may be a good option to obtain more information. ...
Introduction : Parotid gland swellings are of histologically diverse group. Fine needle aspiration cytology (FNAC) is a rapid, simple, cost effective diagnostic procedure for evaluation of such swellings. The main aim of the study is to determine specificity, sensitivity, accuracy of FNAC in parotid swellings by taking histopathological examination (HPE) as gold standard.
Materials and methods: Retrospective study done from April 2018 – July 2018. Data was collected from medical records of 50 cases who came with parotid swellings. All have undergone preoperative FNAC for swellings followed by surgery and HPE of specimen postoperatively.
Results: In FNAC most of parotid swellings were benign in nature with pleomorphic adenoma most common. The sensitivity, specificity and accuracy of FNAC for parotid swellings in our study are 62.5%; 94%; 84% respectively.
Conclusion: Even though FNAC is rapid, simple, it is may not be completely reliable deciding factor for patient counselling and for further management according to present study as it shows less sensitivity of 62.5%.The FNAC may be considered as a best possible initial investigation but may not be as to provide a definitive diagnosis on which management decisions can be made.
... These findings are consistent with published data; majority of salivary gland lesions arise from the parotid gland. [15][16][17] All cases had alcohol-fixed Papanicolaou-stained smears while only 93 cases (34.2%) had the complimentary air-dried Diff Quik-stained smears. This means that only 34.2% of the cases followed the recommendation of the MSRSGC wherein a combination of air-dried and alcoholfixed smears should be the mainstay in evaluating salivary gland FNAB. ...
Background. The Milan System for Reporting Salivary Gland Cytopathology (MSRGC) aims to increase the overall effectiveness of salivary gland FNAB by defining six general diagnostic categories with corresponding Rates of Malignancies (ROM). This study aims to use this system to categorize salivary gland FNAB in the Philippine General Hospital and stratify ROM per category. Methodology. In this study a total of 326 cases have been collected and reviewed, of which 154 (47.2%) had either surgical or clinical follow-up. The cases were assigned a Milan category by 3 cytopathologists blinded from the original diagnoses and from each other’s readings. Results. The overall sensitivity, specificity, PPV, and NPV in detecting neoplasm is at 71.6%, 90.9%, 88.3%, and 76.9%, respectively. On the other hand, the sensitivity, specificity, PPV, and NPV in detecting malignancy is at 52%, 92.9%, 59.1%, and 90.7%, respectively. The computed ROM is as follows: Category I 7.89%, Category II 9.43%, Category III 20%, Category IVa 10.53%, Category IVb 60%, Category V 75%, and Category VI 100%. Conclusion. The overall diagnostic utility of salivary gland FNAB, as well as the computed ROM per diagnostic category are comparable to internationally published literature. This study also validates the MSRSGC as a valuable tool in stratifying ROM in salivary gland lesions.
... FNAC is found to be a simple, cost-effective and rapid diagnostic tool for assessing various salivary gland lesions. [2] Preoperative cytological diagnosis of benign or malignant neoplasm will guide the surgeons to select an appropriate surgical procedure. ...
Background:
Fine-needle aspiration cytology (FNAC) is a sensitive, specific, cost-effective tool and has been widely used as a diagnostic tool for the management of various head-and-neck lesions. Salivary gland lesions constitute the most common head-and-neck lesions. These lesions can range from inflammatory to neoplastic, which can be either benign or malignant.
Materials and methods:
The study was performed on 104 patients who presented with salivary gland swelling to the department of pathology at a tertiary care center from January 2016 to June 2020. FNAC was performed using a 22-24G needle, and smears were stained with Giemsa, hematoxylin and eosin and Papanicolaou stain. Histopathology was assessed on routine hematoxylin- and eosin-stained paraffin sections. The cytological and histopathological slides were studied, analyzed and correlated. Sensitivity, specificity, positive predictive value and negative predictive were calculated.
Results:
The study included 104 cases in the age range of 10-70 years and a mean of 45 years (±16 standard deviation). There was a male preponderance with a male-to-female ratio of 1.6:1. The parotid gland was the most common site 91 (87%). On cytology, 71 (68%) were neoplastic, of which 58 (81%) were benign and 13 (19%) were malignant. Histopathological correlation was available in 36 cases (50%), 24 (67%) of which were benign and the remaining 12 (33%) were malignant. The sensitivity, specificity, positive predictive value and negative predictive value of the present study are 95%, 85%, 91% and 92%, respectively.
Conclusion:
FNAC of the salivary gland is a safe, reliable and cost-effective technique which can be used as the first line of investigation in evaluating salivary gland lesions.
... [1][2][3][4] Other than lipoma, nearly all large case series of SG fine-needle aspiration (FNA) biopsy in adults fail to report either a single instance or report exceedingly few examples of mesenchymal neoplasms. [5][6][7][8][9][10][11][12][13][14][15] Even when considering mesenchymal tumor metastases to the major SG, large FNA studies show that only 2% (184 total cases), 16 7.5% (40 total cases), 17 and 8% (36 total cases) 18 of aspirates represent sarcoma. Because of the paucity of such reports, we sought to describe our own experience with mesenchymal tumors involving the PG and parapharyngeal (PP) space, to highlight possible diagnostic pitfalls associated with FNA biopsy of mesenchymal PG and/or PP tumors, and to apply the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) classification 19 to this series. ...
BACKGROUND
Mesenchymal neoplasms of the parotid gland (PG) and para‐pharyngeal (PP) space are distinctly uncommon. Fine‐needle aspiration (FNA) biopsy experience with nonlipomatous neoplasms from this site is reviewed.
METHODS
Cytopathology and surgical pathology files were examined for mesenchymal PG and PP space neoplasms. FNA biopsy was performed using standard technique.
RESULTS
Twenty‐two PG and/or PP aspirates from 20 adults (male:female = 1.1:1; age range, 19‐84 years, mean age, 50 years) and a 10‐week‐old infant met inclusion criteria. Biopsy sites included PG (17, 77%) or PP space (5, 23%). Five of 6 malignant neoplasms (83%) were called malignant cytologically. Only 7 of 11 (63%) benign neoplasms were recognized as a benign neoplasm. None of 5 solitary fibrous tumor (SFT) cases were correctly recognized. Conversion to the Milan classification showed 8 (36%) FNA cases diagnosed as benign neoplasm, 6 (27%) malignant neoplasm, 4 (18%) neoplasm of uncertain malignant potential, 2 (9%) nondiagnostic, and single cases of suspicious for malignancy and nonneoplastic. There was 1 false‐positive and no false‐negative FNA diagnoses. Ancillary testing in 10 (45%) aspirates helped substantiate a correct specific diagnosis in 3 malignant and 3 benign cases.
CONCLUSIONS
FNA biopsy of nonlipomatous mesenchymal SG neoplasms is particularly challenging. Less than half (9 of 11, 41%) had specific FNA diagnoses that correctly matched the tissue diagnoses or clinical outcome. Accurate Milan categorization was superior for malignant neoplasms (5 of 6, 83%) in contrast to benign neoplasms (7 of 11, 63%), or neoplasms of uncertain malignant potential (SFT) (2 of 5, 40%).;
... Fine needle aspiration (FNA) biopsy is a minimally invasive procedure and provides diagnostic information before the operation. Since high-grade and locally advanced malignant submandibular masses may require more extensive surgery or a multi-modality treatment, FNA biopsy may affect the type or the timing of the surgical treatment (3). However, many studies reported different outcomes in the diagnostic accuracy, and there are controversies on the clinical significance of FNA biopsy in the diagnosis of salivary gland masses (4,5). ...
... Various studies in the existing literature have shown a wide range of sensitivity and diagnostic accuracy of cytologic diagnosis. FNAC is a safe, simple, cost effective,[1][2][3][4] accurate and minimal invasive procedure for the evaluation of salivary gland lesions. FNAC is not only useful in planning denitive preoperative 2,5-6 ...
Background: Fine needle aspiration cytology (FNAC) has been used for diagnosis of salivary gland lesions for many years. Various studies in the existing literature have shown a wide range of sensitivity and diagnostic accuracy of cytologic diagnosis. FNAC is a safe, simple, cost effective, 1-4 accurate and minimal invasive procedure for the evaluation of salivary gland lesions. FNAC is not only useful in planning denitive preoperative 2,5-6 diagnosis but also can prevent unnecessary surgical intervention. Salivary gland swelling occur more commonly in 3rd decade of life with equal sex incidence. Parotid is one of the most commonly involved glands in the head & neck region swellings. FNAC appears to be highly sensitive for benign tumours and highly specic for malignant tumors and it should be the rst line of investigation in evaluating the salivary gland pathologies. 7 Early diagnosis and appropriate management carries good prognosis. Methods: Patients with suspected salivary gland enlargements, referred for FNAC, were included in this study. FNAC was performed by using the standard procedure. Cytologic diagnosis was compared with histopathologic diagnosis wherever it was available. Results: In the present study conducted in the department of pathology, Shyam Shah Medical College Rewa MP, over a period of 5 years, 152 Patients with suspected salivary gland enlargements were retrospectively appraised. The benign lesions of salivary gland were 133 (87.5%), out of which Pleomorphic adenoma was diagnosed in 75 (56.39%) cases, clinical correlation was found in 58 (77.33%) cases. 29 cases were subsequently correlated with histopathological examination 26 correctly correlated and the diagnostic accuracy of FNAC was found to be 89.65%. Inammatory lesions were proved correct in 08 out of 10 cases after histopathology. Therefore, accuracy of FNAC was 80.0%. Malignant lesions of salivary gland were found in 19 cases, out of which 15 (78.94%) cases correlated with clinical diagnosis. 13 cases were subjected to histopathology 10 correctly correlated and the diagnostic accuracy of FNAC was found to be 76.92%. Overall diagnostic accuracy of FNAC was 84.61%. Conclusion:In conclusions it can be established that FNAC is an efcient and accurate procedure with high sensitivity index, and its usefulness is enhanced due to it being a relatively easy procedure which can be carried out even on outdoor patients.
... The accuracy of FNAC depends on important factors like the experience of the clinician performing the procedure in addition to the experience of the pathologist in assessing the cytological sample. Inadequate cellularity or smears have been reported in 2 to 10% of cases in literature [22,23], which can be explained by needle insertion outside the target tissue or because of necrosis, hemorrhage, or cystic areas in the tumor. So, repeating the sampling may be a good option to obtain more information [24]. ...
Background
Salivary gland masses are considered challenging for diagnosis regarding its origin and whether benign or malignant. Unique features of FNAC as a safe and easy diagnostic procedure with little discomfort to the patient made it a favorable primary diagnostic tool. Information regarding the nature of parotid lesions whether being benign or malignant is the main objective of FNAC. We have done a restrospective study for FNAC for parotid masses performed in John Hunter hospital (Newcastle, NSW, Australia) along the peroid from 2014-2018. Histopathological correlation was done in 74 cases to test the accuracy of FNAC in diagnosis of parotid lesions.
Results
Of the total 74 FNAC done for parotid lesions in which a histopathological correlation was done, we get 46 (62.2%) benign lesions (37 neoplastic and 9 non-neoplastic) while 28 (37.8%) were malignant tumor. Pleomorphic adenoma was the most common in benign tumor side (45.7%) while SCC is the most common in malignant group (53.6%). Compatibility between FNAC and histological diagnosis was found in 74% (55/74), of which 78.3% in benign lesions (36/46) and in 68% of malignant lesions (19/28). FNA cytology was true positive in 21/74 cases (28.4%) and true negative in 41/74 (55.4%) cases. We have 5 (6.8%) false-negative and 7 (9.5%) false-positive results. As a result, we get sensitivity of 81%, specificity of 85%, and accuracy of 84%.
Conclusion
The role of FNAC in diagnosis of primary salivary gland pathology is considered with some debate about sensitivity/specificity; however, sometimes it should be repeated or correlated with clinical/histopathological confirmation.
... Thirteen studies with at least 10 cases of SMSGs were found in Pubmed with following key words (aspiration, metastatic, salivary). 6,8,[19][20][21][22][23][24][25][26][27][28][29] These studies are summarized in Immunocytochemistry is the most valuable ancillary method for salivary FNA. A wide range of variably specific immunomarkers is available for the diagnosis of SMSG. ...
Objective:
Fine-needle aspiration (FNA) is a key diagnostic method in the evaluation of salivary gland lesions. Secondary tumors of salivary glands represent only 5% of all malignancies of major salivary glands. The goal of our study was to examine the cytological and clinical features of secondary tumors sampled by FNA.
Materials and methods:
A series of 36 secondary tumors from the pathology departments of two university hospitals are presented. Clinical referrals to FNA, cytological features, immunohistochemical results, and histopathological diagnoses were reviewed in all cases.
Results:
The study population consisted of 36 cases (19 males and 17 females) with mean age 70.9 ± 13.0 years (range 41-96 years). The most common site of the metastasis was parotid gland (n = 26). The primary malignancy was known in 17 cases at the time of FNA diagnosis. The most common primary site was skin of head and neck area (11 cases) followed by lungs (n = 5) and tonsils (n = 5), kidney (n = 2) and breast (n = 2) and thyroid gland, gastrointestinal tract and soft tissue, 1 case of each. In 8 cases, the primary site remained unknown. The diagnostic or confirmatory immunocytochemistry was performed on cell blocks in 21 cases.
Conclusions:
FNA is a reliable technique in the diagnosis of salivary gland secondary malignancies. The knowledge of the personal history of malignancy is essential for the successful immunocytochemical targeted diagnosis without any delay.
... Contributing factors might have included sampling errors, inadequacy of technique, vagueness in interpretation, and underestimation of low-grade malignant tumors. In particular, mucoepidermoid carcinomas with cystic changes are difficult to diagnose due to a high incidence of failure to gain optimal material [21,22]. A limited number of mucoepidermoid carcinoma cases contains all three cell types (mucous, intermediate, and squamous cells) [23]. ...
Background:
Before publication of the new classification system named the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in 2018, there was no standard classification for salivary gland lesions obtained by fine-needle aspiration (FNA). We therefore aimed to evaluate the diagnostic utility of this system by retrospectively reviewing FNA samples using the MSRSGC and to determine their risk of developing into neoplasms and becoming malignant.
Materials and methods:
Retrospective slide review and classification of salivary gland FNAs obtained over a 6-year period (2013-2018) at a single center were performed by two pathologists. The risks of neoplasm and malignancy for each category also were calculated.
Results:
This study surveyed 374 FNAs (371 patients) performed over a six-year period and selected 148 cases that included documented surgical follow-up (39.6%). Among the surgically treated cases, the distributions of FNA categories were as follows: non-diagnostic (ND; 16.9%), non-neoplastic (NN; 2.7%), atypia of undetermined significance (AUS; 3.4%), benign (BN; 54.7%), salivary gland neoplasm of uncertain malignant potential (SUMP; 10.1%), suspicious for malignancy (SM; 6.8%), and malignant (M; 5.4%). The risk of malignancy (ROM) was 24.0% for ND, 0% for NN, 40.0% for AUS, 2.5% for BN, 46.7% for SUMP, 100% for SM, and 87.5% for M. The overall diagnostic accuracy was 95.9% (142/148 cases).
Conclusion:
The newly proposed MSRSGC appears to be a reliable system for classification of salivary gland lesions according to the associated ROM.
... Wasserman, [10] Frable and Frable [11] and Mavec et al. [12] stated that most false negative diagnoses in cytology of salivary gland lesions were related to cystic lesions and due to failure to obtain diagnostic material. Positive histocorrelation was available for one case each of Warthin's tumour and acinic cell carcinoma. ...
Objective: FNAC is a useful method for evaluating suspicious salivary gland lesions due to its low cost, minimum morbidity, rapid turnaround time, high specificity, and sensitivity. The present study was undertaken to diagnose salivary gland tumors based on the cytomorphology and to correlate with histopathology wherever available and to review the histologic and cytomorphological features in discordant cases and evaluate the possible reasons of misinterpretation. Methods: The study was both prospective and retrospective. All the cases of salivary gland tumors that had fine needle aspiration cytology reports were taken from records of Nizam’s Institute of Medical Sciences. This study was done between January 2000 to May 2008. Results: A total of 135 cases of salivary gland neoplasms were identified during 8 1/2 period of our study. 1. Histologic correlation was available for 36 cases 2. There is a concordance between cytology and histopathology in 31/36 cases (86.1%). In three cases (8.3%) diagnostic possibilities were given. 94.1% of pleomorphic adenoma cases had concordance (16/17). 3. The number of discordant cases were 5/36 (13.9%) and the discordance was due to scant cellularity and rarity of the lesions. Majority of the cases 4(80%) it was underdiagnosis and in one case (20%) it was over diagnosis. Conclusion: FNAC is a highly reliable technique for pre-operative diagnosis of salivary gland tumors in the hands of experienced pathologists. However, there still remain few cases that may be inaccurately diagnosed on cytology due to overlapping features and in these cases histopathology is the only modality for final diagnosis.
... Fine needle aspiration cytology (FNAC) being a simple and effective modality to work up salivary gland masses, its efficacy in diagnosing this particular entity is still questionable. [3][4][5] Plasmocytic and lymphocytic periductal infiltrate which eventually lead to the encasement of ducts with thick fibrous tissue of the salivary glands are the characteristic features of Kuttner's tumor. ...
Background: Kuttner’s tumour is a condition of the submandibular gland which is underreported as a distinct entity. Also called as the chronic sclerosing sialadenitis it resembles a plasmocytic and lymphocytic inflammatory process and presents as a hard and painful mass which clinically mimics a malignancy and raises significant concerns. The objective of the present study was to evaluate cases of Kuttner’s tumor and discuss its clinical and pathological aspects to distinguish it from a definite malignancy and create a grown acceptance of the presence of such an entity in our setting.Methods: We collected 170 cases of submandibular swellings and evaluated in detail the clinical and pathological aspects of eight cases out of them which were later diagnosed to as Kuttner’s tumour.Results: The age of the patients varied between 23 to 61 years (mean age 42.5 years) with 3 males and 5 females. 6 patients reported with a firm to hard painless submandibular mass (5 left sided; 3 right sided) while 2 patients experienced intermittent discomfort. The mean duration of presentation of symptoms was 5.3 months. Fine needle aspiration cytology was done in 6 cases preoperatively. Following submandibular sialadenectomy histopathology showed salivary gland tissue with preserved lobular architecture, but with marked fibrosis, acinar atrophy, and a dense lymphoplasmacytic infiltrates.Conclusions: Kuttner’s tumor may be pre operatively distinguished from a malignancy with improved imaging and a good image guided FNA Cytology saving the clinician and the patient from a lot of dilemma. However, histopathology and immunohistochemistry would be the key in establishing the diagnosis.
... The situation remained essentially static till the 5th decade of this century when improvement of surgical technique, better anaesthesia, transfusion services and the advent of antibiotics revived the role of surgery for both benign and malignant tumours of the salivary gland. In the last 30 years considerable progress has been made in the management of parotid tumours with the advent of better investigation like FNAC and CT scan and proper surgical technique [4] . ...
... Its accuracy in detecting malignancies widely varies through different series and still remains a subject of debate [1]. While some studies showed that patient management is not heavily influenced by FNAC results [2], a recent systematic review and meta-analysis demonstrated its high specificity and cost-effectiveness in differentiating benign from malignant neoplasms, helping proper surgical planning and preoperative counseling of patients [1]. Important reasons accounting for the extreme heterogeneity in the reported FNAC accuracy are the high proportion of nondiagnostic results, especially in peripheral facilities and the widespread confusion among "inconclusive", "indeterminate", "inadequate", and "non-diagnostic" outcomes through published series [3]. ...
Purpose
Fine needle aspiration cytology (FNAC) is a commonly performed procedure for parotid masses, although its accuracy in detecting malignancies widely varies through different series. We evaluated our single-center cohort of parotidectomies to highlight possible limitations of preoperative FNAC.
Methods
Seven hundred and eighteen consecutive patients submitted to parotid surgery at San Raffaele Scientific Institute (Milan) were retrospectively evaluated (2002–2018). Five hundred and fifty four FNAC were analyzed. FNAC accuracy was assessed with and without inclusion of “inconclusive” results. The peculiar role of lower grade primary parotid cancers was investigated.
Results
FNAC reports were “diagnostic” in 502 cases (90.4%) and “inconclusive” in 52 (9.6%). Histopathology revealed 488 benign lesions (88.1%) and 66 malignancies (11.9%). FNAC sensitivity, specificity, PPV, NPV and accuracy in detecting malignancies were 59%, 99%, 89%, 95%, and 95%, respectively. Sensitivity fell to 48%, when “inconclusive” FNAC was computed. Within 66 parotid cancers, FNAC could discriminate malignancy in 32 cases (48.5%), provide proper grading in 21 (31.8%), and precise histopathological diagnosis in 15 (22.7%). Malignancy was more likely in patients with “inconclusive” FNAC than in those with “diagnostic” cytologies (23.1% vs 10.8%, p = 0.003). Low-intermediate-grade primary parotid cancers were associated to a higher rate of FNAC failure in comparison with high-grade ones (86.4% vs 19.0%; p < 0.001).
Conclusion
FNAC is an important tool for preoperative assessment of parotid masses, though its sensitivity in detecting malignancy remains poor. “Inconclusive” FNAC results could further jeopardize FNAC accuracy and should elicit resorting to additional tests, especially when a lower grade parotid cancer is suspected.
... Tüm hastalarda yanlış negatiflik 2 hastada (%2,7) görülmüştür, bu literatürle uyumludur (6). Literatürde yetersiz materyal %2 ile %10 arasında değişmektedir (7,8). Bizde ve diğer bir çok çalışmada (3,9,10) yüksek orandaki yalancı negatiflik bir sorun oluşturmaktadır. ...
Bu retrospektif çalışmada 5 yıllık süreç içinde tedavi B edilen 74 tane parotis bezi neoplazmında, preoperatif ince iğne aspirasyon biyopsisinin (İİAB) donuk kesit biyopsi (frozen) ve postoperatif patoloji sonuçları ile korelasyonunu araştırıldı. Olgular retrospektif olarak, yaş, cinsiyet, lezyonun bölgesi ve histolojik tipten oluşan klinikopatolojik veriler açısından incelendi. İİAB ve donuk kesit biyopsinin doğruluğu postoperatif patolojik verilerle kıyaslanarak değerlendirildi. Benign tümörlerde frozen sonuçları %100 doğruluk gösterdiği ancak malign lezyonlarda %27 yanlış negatiflik gösterdiği saptandı. SUMMARY n this retrospective study, the results and correlations of I preoperative FNA and postoperative pathology in 74 parotid gland neoplasms received treatment were investigated in a 5 year period of time. The cases were retrospectively examined in terms of their clinical pathology data such as age, sex, lesion site and histological types. The accurateness of frozen section and FNA in parotid tumor was evaluated by comparing postoperative pathological data. Frozen test results were accurate at 100 %, nevertheless, it showed false negativeness in 27 % of the patients with malign lesions. GİRİŞ u retrospektif çalışmanın amacı hastanemizde 5 yıllık süreç B içinde tedavi edilen 74 tane parotis bezi neoplazmında, preoperatif ince iğne aspirasyon biyopsisinin (İİAB) donuk kesit biyopsi (frozen section) ve postoperatif patoloji sonuçları ile korelasyonunu araştırmak.
... Podatak o osjetljivosti od 90 % za postavljanje ispravne dijagnoze zloćudnog tumora u ovoj studiji korelira s drugim studijama gdje se osjetljivost kreće u rasponu od 57 do 93 % 25,26 . U ovom istraživanju postavljanje dijagnoze benignog tumora ima specifičnost od čak 100 %, dok je u drugim istraživanjima specifičnost nešto niža te iznosi 81 % pa do 100 % 24,25,27,28 . Vrijednosti pozitivne i negativne prediktivne vrijednosti značajno variraju između različitih studija. ...
Cilj: Tumori žlijezda slinovnica su rijetke neoplazme glave i vrata, no histološki čine vrlo heterogenu skupinu tumora. Važna metoda njihove dijagnostike je ultrazvučna pretraga žlijezda slinovnica uz citopunkciju tumorske promjene. Cilj rada je odrediti učestalost pojedine vrste tumora, specifičnost i senzitivnost citološkog nalaza te utvrditi stupanj podudarnosti između citološkog i patohistološkog nalaza. Ispitanici i metode: Ovim istraživanjem obuhvaćeno je 49 pacijenata operiranih zbog tumora velikih žlijezda slinovnica između 2015. i 2017. godine. Uključeni su samo pacijenti s prijeoperativnim citološkim nalazom i postoperativnim patohistološkim nalazom koji su međusobno uspoređeni. Rezultati: Najzastupljenija skupina pacijenata je ona iznad 60 godina (57 %). Doušna žlijezda bila je najčešće sijelo tumora u 94 % pacijenata. Prema citološkom nalazu dijagnosticirano je 40 dobroćudnih i 9 zloćudnih tumora. Patohistološkom analizom utvrđeno je 39 dobroćudnih i 10 zloćudnih tumora. Najčešće patohistološke dijagnoze bile su Warthinov tumor (cistadenolimfom) u 52,5 % i pleomorfni adenom u 37,5 % pacijenata. Senzitivnost citološkog nalaza iznosila je 90 %, dok je specifičnost bila 100 %. Kappa (κ) koeficijent bio je 0,93 (95 % CI = 0.687 – 0.979). Zaključak: U ovoj studiji citološka punkcija i analiza pokazala se kao vrlo dobra metoda u dijagnostici tumora velikih žlijezda slinovnica s visokom osjetljivošću i specifičnošću te izvrsnim stupnjem podudarnosti između citološkog nalaza i krajnje dijagnoze.
... In addition, studies on submandibular neoplasms are often integrated within larger studies on parotid gland tumors. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] The frequency and distribution of pathologic conditions of the submandibular gland are different from those of parotid gland. Up to 80% of salivary gland neoplasms originate in the parotid gland, whereas only 7% to 11% occur in the submandibular glands. ...
Background
The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6‐tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fine‐needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs.
Methods
Submandibular gland FNA cytology specimens from 15 international institutions (2013‐2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow‐up was performed, and the ROM was calculated for each MSRSGC diagnostic category.
Results
The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%‐50%); nonneoplastic, 24.2% (9.1%‐53.6%); AUS, 6.7% (0%‐14.3%); benign neoplasm, 18.3% (0%‐52.5%); SUMP, 12% (0%‐37.7%); SM, 3.5% (0%‐12.5%); and malignant, 13.9% (2%‐31.3%). The histopathologic follow‐up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%.
Conclusions
This multi‐institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA.
... 4,5 Parotis bezinin en sık görülen malign tümörü mukoepidermoid karsinomdur. 6 Literatürde, malign parotis tümörleriyle ilgili yapılan geniş serilerden Lima ve ark.nın 126 olguluk serisinde, 40 (%31,7) olguda mukoepidermoid karsinom bulunmuştur. 7 Yılmaz ve ark. ...
... In addition, studies on submandibular neoplasms are often integrated within larger studies on parotid gland tumors. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] The frequency and distribution of pathologic conditions of the submandibular gland are different from those of parotid gland. Up to 80% of salivary gland neoplasms originate in the parotid gland, whereas only 7% to 11% occur in the submandibular glands. ...
... It has previously been shown that the specificity of the test is higher than the sensitivity for malignant PTs [8,23,24]. In the literature, the specificity of FNA varies from 56% up to 100% and the sensitivity of FNA biopsy varies from 57% up to 98% [8,9,[25][26][27][28][29][30][31][32]. These variable rates in the literature may have a few causes. ...
Objective:
To present the results of patients who underwent superficial or total parotidectomy because of parotid gland tumors in our tertiary care clinic.
Methods:
The data of 362 patients who underwent parotid surgery from January 2008 to November 2015 were collected and analyzed in demographic, histopathological features, and complications.
Results:
Three hundred sixty-nine cases (performed in 359 patients) were analyzed and we assessed complications of parotid surgery such as transient or permanent facial paralysis and Frey's syndrome. Pleomorphic adenomas and Warthin's tumors consisted 74% of all parotid gland tumors. These tumors were generally located in the superficial lobe and tail of the parotid gland (81%). Also, tumor size in the positive surgical margin group was larger than in the negative surgical margin group (p=0.012).
Conclusions:
Most of parotid gland tumors are benign. However, the frequency of malignancy increases in deep lobe of parotid gland. High grade malignant tumors have more tendency to have positive surgical margin during surgery, and facial paresis preoperatively.
... Furthermore misdiagnosis could result in both hazardous under-treatment, and potentially avoidable overtreatment with permanent facial static and dynamic disfigurement. Fine-needle aspiration cytology (FNAC) guided by ultrasound (US) imaging is widely used to evaluate both neoplastic and inflammatory lesions of the salivary glands, albeit with variable success; sensitivity ranges from 57% to 98%, specificity from 56% to 100%, and accuracy from 78% to 98% [5][6][7][8][9][10][11][12][13][14][15][16] which also depends on the expertise and experience of the pathologist. FNAC is obtained in all salivary gland nodules, and normally performed in reference centers dealing with parotid gland tumors. ...
Aims:
To assess the diagnostic value of elasticity contrast index (ECI) elastography, in comparison with conventional ultrasound for the differentiation of benign and malignant parotid lesions.
Material and methods:
Sixty-three consecutive patients with parotid gland tumors, treated surgically at a single tertiary center were enrolled. Ultrasound evaluation consisted of B-mode, color-Doppler and quasistatic ultrasound elastography (USE), conducted with the ECI technique. For each lesion the echogenicity, margins, vascularization, and capsulation were considered to determine benign or malignant lesions. Histology was considered the gold standard.
Results:
Using conventional parameters, the observer suggested malignant lesions in 20 cases and benign lesions in 43 cases (accuracy: 61.8%). ECI>3.5 alone was the most accurate parameter (accuracy: 90.5%), with sensitivity of 93.7% and specificity of 89.4%. However, when combined with the other US criteria, no statistically significant diagnostic accuracy improvement was achieved.
Conclusions:
Our results show that USE with ECI index measurement can help to discriminate preoperatively benign from malignant lesions, with the exception of pleomorphic adenoma which is stiff. We suggest that USE can be used as an additional tool to conventional US evaluation of salivary gland lesions.
Background: Fine Needle Aspiration Cytology (FNAC) has been widely accepted as an accurate and minimally invasive diagnostic procedure in the investigations of salivary gland masses. The aim of this study was to determine the accuracy of FNAC in the diagnosis of pleomorphic adenoma. Materials and methods: A cross sectional comparative study was carried out on a total of 28 patients with salivary gland swellings who underwent preoperative FNA examination. After surgical excision of tumours, all FNAC findings were subsequently verified with histopathological examination. All the necessary and relevant data were recorded methodically and meticulously and statistical analysis was done by computer software device (SPSS-18 version). Results: On preoperative FNA examination, among the 28 cases, 19 (67.9%) cases were pleomorphic adenomas. On histopathological examination, out of 28 cases, 20 (71.4%) cases were pleomorphic adenomas. Out of 19 cases of pleomorphic adenomas diagnosed by cytology, 17 cases were confirmed by histopathology. Remaining two cases revealed different diagnosis. In three cases of pleomorphic adenomas diagnosed by histopathology, the cytology revealed different diagnosis. In six cases of tumours other than pleomorphic adenoma there was agreement between cytological and histological diagnosis. The diagnostic sensitivity, specificity and accuracy of preoperative FNAC of pleomor phic adenoma were 85%, 75% and 82.1% respectively. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of FNAC were 89.5% and 66.7% respectively. Conclusion: Fine needle aspiration cytology is a useful preoperative diagnostic tool in evaluating Pleomorphic adenoma of salivary gland.
Background
Metastatic lesions to the salivary gland are rare and mostly affect the parotids. Metastases represent 8% of all malignant lesions of the parotid gland. Around 80% originate from squamous cell carcinomas (SCC) of the head and neck region. Fine needle aspiration (FNA) plays a crucial role in distinguishing primary salivary gland lesions from metastases. Herein we describe our series of metastases to the parotid glands.
Materials and Methods
We analysed 630 parotid gland FNAs over a decade including conventional and liquid‐based cytology specimens. Ancillary techniques such as immunocytochemistry (ICC) were conducted on cell blocks.
Results
Eighty (12.4%) cases were malignant lesions, of which 53 (63.75%) were metastases including 24% melanoma, 22.6% SCC, 19% renal carcinomas, 7.5% breast carcinomas, 11.3% lung, 9% intestinal and 1.8% testicular, malignant solitary fibrous tumour and Merkel cell carcinoma. The 53 cases, classified according to the Milan system for salivary cytopathology, belonged to 5 Suspicious for malignancy (SFM) and 48 malignant (M) categories. Forty had a known history of primary malignancy (75.4%), while 13 were suspicious to be a metastatic localisation (24.5%), distributed as 5SFM (2SCC and 3Melanoma) and 8 M. A combination of clinical history, cytomorphology and ICC identified 100% of them.
Conclusions
Fine needle aspiration plays a central role in the diagnostic workup of patients with metastatic lesions to their parotid glands, thereby defining the correct management. Diagnostic accuracy may be enhanced by applying ICC. Although melanoma and SCC are the most common histological types, several other malignancies may also metastasize to the parotid glands and should be kept into consideration.
The usage of real-time ultrasound-guided fine-needle aspiration biopsy by cytopathologists has increased the utility of biopsy in management of patients with salivary gland neoplasms. There is significant overlap between cytologic features of salivary gland neoplasms, and likewise, there is analogous overlap between ultrasound radiologic features of these lesions. However, ultrasound radiologic evaluation can provide important information for the cytopathologist when performing and interpreting a biopsy of a salivary gland neoplasm, including the specific anatomic location and structure of a target lesion. We present a practical guide for using ultrasound evaluation in the biopsy of the salivary glands for the practicing cytopathologist including common pitfalls, common lesional characteristics, and relevant lymph node morphological findings.
Herein we briefly review the anatomy of the major salivary glands as well as common benign and malignant pathologic processes. The salivary glands are critical to oral health, facilitating mastication, digestion, dental hygiene, and immunoprotection. The most common benign salivary neoplasms are pleomorphic adenomas and Warthin tumors, while the most common malignant masses are mucoepidermoid carcinoma and adenoid cystic carcinoma. While treatment is primarily surgical; adjuvant radiation plays an important role in certain pathologies and oncologic circumstances. In resecting such tumors, particular attention must be paid to the facial nerve. The marginal mandibular branch is at risk during submandibular gland resection, while all branches are at risk during parotidectomy. Pre-styloid parapharyngeal space tumors are frequently deep lobe parotid tumors that have extended through the stylomandibular tunnel.KeywordsSalivary glandParotid glandSubmandibular glandBenign salivary neoplasmsMalignant salivary neoplasms
Objective: The aim of our study was to determine the specificity and sensitivity criteria of parotid fine needle aspiration biopsy in the diagnosis of parotid gland masses in our instution, and guide the physician by using FNAB before surgery. Study design: Retrospective chart review Methods: Retrospective analysis was conducted by comparing the fine needle aspiration biopsy results of 80 patients with complete data and postoperative histopathological diagnoses of 90 patients who underwent fine needle biopsy in our clinic between 2015 and 2022 and were subsequently operated. Correlation of preoperative FNB results to final surgical pathology was performed and measures of diagnostic accuracy computed. Results: Of all patients, 56.3% were male and 43.7 were female. The mean age was 48 (range 19-87). 56.2% of them were right-sided and 43.8% were left-sided. When the fine needle aspiration biopsies of the patients were examined, 47 were reported as benign (58.8%), 2 as malignant (2.5%), 21 as suspicious (26.3%), and 10 as insufficient (12.5%). Of 80 patients, 34 were diagnosed as pleomorphic adenoma, 14 as whartin tumor, and 7 as sialoadenitis. Conclusion: FNAB is one of the most important diagnostic tools in the diagnosis of parotid gland masses when applied knowing its advantages and given treatment without ignoring the deficiencies. It should be kept in mind that subtyping with FNAB in cases with malignant histopathological diagnosis will reduce the secondary surgical needs of the cases.
To study the usefulness of clinical features, histopathological and radiological features in diagnosis and management of salivary gland lesions. Prospective study conducted at the department of ENT of a tertiary care centre in central India. A total of 162 patients who were treated over a period of 2 years for salivary gland lesions were studied with regards to correlation between clinical diagnosis, cytological examination and radiological features with histopathological diagnosis. Mean age group was 23.94 (± 15.43) years. There was slight male preponderance. Commonest presenting complaint was swelling. The most common gland involved was minor salivary glands followed by parotid gland. Sensitivity of clinical diagnosis, USG and FNAC for neoplastic lesions was found to be 80%, 95.65% and 79.61% respectively. Specificity of clinical diagnosis, USG and FNAC for neoplastic lesions was found to be 100%, 100% and 97.23% respectively. At the end of the study we concluded that combination of thorough clinical examination, radiological and cytological examination help in proper diagnosis, but it should always be confirmed on histopathology because some surprises are expected with regards to the nature of salivary gland lesions.
A protocol was developed to obtain mature lymphocytes from freshly harvested tonsils by a combination of 5-, 10-, and 20- cm ³ syringes and 21-, 23-, and 27-gauge needles. The cells were then suspended in Earle's balanced salt solution and counted with an automated cell counter. Cell counts for each study group was compared as a function of needle and syringe size. The range of harvested cells was 900 to 2800 cells per cubic millimeter, allowing adequate cellular material for diagnostic purposes. The amount of negative pressure for each syringes/needle combination was measured with a manometer. Pressures ranged from –500 to –700 cm of H 2 O pressure. In this particular study, fine-needle aspiration with a 20-cm ³ syringe and 21-gauge needle yielded the best results.
Background: Salivary gland tumours are relatively uncommon and constitute 3% to 10% of all head & neck neoplasms. The majority of salivary gland tumours arise in the parotid gland. Objectives: To search the clinicopathological presentation of salivary gland tumours. Methods: This was a cross sectional study. Results: The highest incidence of benign tumors was in the 3rd and 4th decade, whereas for malignant tumor it was the 5thdecade of life. Among 47 male patients, 72.3% had benign and 27.7% cases had malignant tumours. Out of 40 female patients 45% cases had benign and 55% cases had malignant tumours. With overall male: female ratio was 1.2:1. Among parotid gland tumours 62.32% had benign and 37.68% cases had malignant tumours. Out of 12 submandibular gland tumours 41.67% cases had benign and 58.33% cases had malignant tumours. Among 35 malignant tumours, 12 Mucoepidermoid carcinoma, the majority occurred in the parotid gland 10(83.3%) followed by submandibular gland 1(8.3%) and minor salivary glands 1(8.3%). Out of 11 cases reported as Adenoid cystic carcinoma, the majority involved submandibular gland 6(54.5%) followed by parotid gland 4(36.4%). Conclusion: Benign salivary gland tumours are more common than malignant ones. There is male preponderance in the incidence of salivary gland tumours. Pleomorphic adenoma is the most frequently encountered tumour among all salivary gland tumours. Bangladesh J Otorhinolaryngol 2022; 28(1): 96-102
In this paper, we studied about the cytological criteria for diagnosis of salivary glands.
Objective: Fine Needle Aspiration Cytology (FNAC) is a valuable tool in rapid diagnosis of salivary gland tumours. This study investigated the accuracy of fine needle aspiration cytology of parotid tumours in comparison to the histopathology result. Design: Retrospective study Materials and Methods: A total of 57 parotid gland tumour cytology samples were collected from January 2007 till December 2012 and were compared with their respective histopathological findings of the resected parotid tumour as the diagnostic stan dard. Results: Accuracy of FNAC was found to be 94.7%, sensitivity 80.0%, specificity 96.2%, positive predictive value (PPV) 66.7% and negative predictive value (NPV) 98.3%. There were 2 false positive cases and 1 false negative case. Conclusion: Fine needle aspiration cytology (FNAC) is a fairly sensitive and specific test in assessing type of parotid growth, namely between benign and malignant tumours. This means of assessment, together with surgeon's experience and findings, will help reduce wrong diagnoses and effective management of parotid lesions.
In this paper, we studied about the salivary glands masses by cytology and confirmed by histology, and an evaluation of complication with FNAC.
Objective
To evaluate the precision and utility of Fine‐needle aspiration (FNA) in differentiating between benign and malignant parotid tumors, and the implications of FNA results on management and outcomes.
Design
Retrospective case series.
Setting
Tertiary medical center.
Participants
All adults who underwent preoperative FNA, followed by postoperative histological examination, between 1986‐2014.
Main outcome measures
Differences in clinical management and outcomes of patients with parotid masses in light of FNA results.
Results
We analyzed 505 samples from 485 patients. According to histopathological results, preoperative FNA successfully identified benign tumors in 89% of the cases (362/405), and only 59% of malignant tumors (59/100). Overall sensitivity and specificity of FNA in distinguishing between different subtypes of benign lesions were 80% and 99%, respectively, whereas positive predictive value (PPV) and negative predictive value (NPV) were 85% and 98%. Moreover, malignant lesions subtyping had high false‐positive and false‐negative rates with sensitivity, specificity, PPV and NPV of 44%, 100%, 75% and 99%, respectively. Additionally, when FNA falsely classified malignant tumors as benign, surgeries were inappropriately delayed and the durations of surgeries and hospitalizations were shorter, compared to true malignant‐FNA results. Interestingly, survival was not affected in falsely benign lesions that were mostly low‐grade, conversely non‐diagnostic FNA for malignant tumors resulted in decreased survival.
Conclusions
Our findings highlight the limitations of FNA as a decision‐making tool in preoperative evaluation of parotid masses. Clinicians should take into account that FNA is inaccurate for identifying specific subtypes of malignant lesions, which may eventually delay treatment and influence outcome.
A useful conceptual framework for organizing information and theories pertaining to head and neck masses has been presented. Specific steps and implementation of this require a thorough grasp of a concise and orderly evaluation including appropriate studies to aid in a correct diagnosis and appropriate treatment plan.
The management of patients with head and neck tumors can be very complex and must be individualized. The concept of a health care team reaches its ultimate goal in the management of these patients. This requires the cooperation of various specialties and an understanding of how each area best can contribute, in order to obtain the ultimate goal of treatment—cure.
This chapter outlines practical approach to rapid on-site assessment of fine needle aspiration of salivary gland lesions. It discusses the important diagnostic considerations in the assessment of salivary gland lesions. The lesions are divided into four broad categories: nonneoplastic conditions, cystic lesions, benign neoplasms, and malignant neoplasms. Cytomorphologic features and diagnostic pitfalls of the different entities are discussed.
Background
We evaluated the diagnostic accuracy of fine‐needle aspiration cytology (FNAC) in a large series of benign and malignant parotid tumors.
Methods
The FNAC diagnosis of 821 benign and 175 malignant parotid tumors managed at our department between 1999 and 2017 was correlated with the final histology.
Results
FNAC made a correct histopathological diagnosis in 72% of the benign parotid tumors; however, FNAC provided a correct grade in only 34% of the malignant tumors. FNAC correctly identified the histology of 94% of pleomorphic adenomas subsequently confirmed by histopathological examination. The sensitivity, specificity, and diagnostic accuracy of FNAC for detecting malignancy were 82.3%, 98.7%, and 95.9%, respectively.
Conclusion
FNAC generally provided the correct histological diagnosis for benign tumors. However, the histological evaluation and grading of malignant tumors were poor. Although FNAC showed good sensitivity, specificity, and accuracy, its sensitivity decreased when nondiagnostic cases were included in the analysis.
Introduction
Fine needle aspiration (FNA) has been widely utilized in establishing the nature of salivary gland lesions and guiding the clinical management. This study aimed to determine the accuracy of FNA in detecting salivary gland neoplasms and malignancies, employing the “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC).
Method
A systematic search was conducted. The data on FNA and histologic diagnosis were extracted and categorized based on the MSRSGC and risk of malignancy (ROM) was calculated. The risk of publication bias and level of heterogeneity were evaluated. A mixed‐effects model was used to estimate FNA accuracy. Meta‐regression was conducted to assess the potential effect of different variables on FNA accuracy.
Results
Ninety‐two studies with a total of 16 456 FNA with surgical follow‐up were included. ROM was estimated as 17%, 8%, 34%, 4%, 42%, 58%, and 91%, in nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant groups, respectively. High level of heterogeneity was detected (P‐value <.001). Including cases with definite FNA diagnosis of neoplasm or malignancy, summary estimates of FNA sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratio in detecting neoplasms and malignancies were 96.9%, 95.3%, 636.8, 20.5, and 0.03, and 80.5%, 97.9%, 189.5, 37.8, and 0.2, respectively. Meta‐regression showed several variables significantly impacting FNA accuracy; however, subgroup analysis did not reduce the level of heterogeneity.
Conclusion
FNA can be used as a reliable diagnostic tool in the preoperative evaluation and management of salivary glands lesions. Concise of abstract is using Milan system for reporting salivary gland FNA could increase FNA reliability, facilitate communication, and improve patient care.
Background
Recently a new system for reporting salivary gland fine‐needle aspiration (FNA) cytology was proposed, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Herein, we evaluated diagnostic accuracy of salivary gland FNA, comparing the system previously used in our hospital with the Milan system.
Methods
Salivary gland specimens obtained between 2011 and 2017 were reclassified according to MSRSGC. Risk of malignancy for each diagnostic category was determined. Diagnostic yield of both classifications was evaluated.
Results
The cases (n = 388) were classified according to the old system: nondiagnostic (n = 28), benign (n = 246), atypical (n = 36), neoplastic (n = 57), suspicious for malignancy (n = 7) and malignant (n = 14). The lesions were distributed according to the MSRSGC: nondiagnostic (n = 28), non‐neoplastic (n = 89), atypia of undetermined significance (n = 39), benign neoplasm (n = 156), neoplasm of uncertain malignant potential (n = 55), suspicious for malignancy (n = 7) and malignant (n = 14). When considering only benign and malignant cases, both classifications showed the same sensitivity (62.5%), specificity (100%) and similar accuracy (95.8%). Comparison between the two systems showed no significant difference.
Conclusions
Salivary gland FNA has high diagnostic accuracy and assists clinical management independently of the reporting system used, however, in some cases, the use of Milan system could be beneficial, since it allows an enhanced category stratification.
BACKGROUND
The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been proposed to standardize salivary gland fine‐needle aspiration (FNA) diagnoses. This study assessed salivary gland FNA results and risk of malignancy (ROM) rates at the University of North Carolina as well as the interobserver reliability (IOR) of the atypia of undetermined significance (AUS) and salivary gland neoplasm of uncertain malignant potential (SUMP) categories.
METHODS
The electronic medical record was searched for FNA cases from 2010 to 2017 with subsequent surgical resections. Histologic diagnosis was used for gold‐standard comparison. The original cytologic results were then converted into MSRSGC categories (nondiagnostic, nonneoplastic, AUS, benign neoplasm, SUMP, suspicious, and malignant). For the assessment of IOR, 23 cases were selected with enrichment for cases diagnosed as AUS (n = 11) or SUMP (n = 9). Six boarded cytopathologists and 1 cytopathology fellow assessed representative slides and provided an MSRSGC diagnosis for each case. Fleiss' κ coefficients were calculated to determine IOR.
RESULTS
The ROM was 33% for both AUS and SUMP cases; however, the risk of neoplasia was 56% for AUS cases and 100% for SUMP cases. Fleiss' κ for the AUS category was 0.217 (P < .05), and Fleiss' κ for the SUMP category was 0.024 (P = .74).
CONCLUSIONS
In this study assessing the IOR of MSRSGC categories, fair agreement and slight agreement were found for the AUS and SUMP categories, respectively. Observers preferentially used the AUS or benign neoplasm category for SUMP cases, perhaps because of unfamiliarity with SUMP as a diagnostic option. The initial adoption of a new reporting system will require a quality assessment to ensure that the system is reliable and useful for clinicians. Cancer Cytopathol 2018. © 2018 American Cancer Society.
Salivary gland diseases usually present as a swelling of the affected gland. These lesions are commonly encountered in day to day practice. A salivary gland swelling can present in a variety of locations, depending on the salivary gland affected. The purpose of the study is to know the incidence of salivary gland swellings and the usefulness of FNAC in evaluating these swellings. The present study is a time bound prospective study of fifty consecutive cases of salivary gland swellings admitted in our hospital during the period November 2014–August 2016. Most of the patients underwent pre-operative work up with FNAC and patients indicated for surgery underwent surgery and HPE. Salivary gland swelling occurred more commonly in 3rd decade of life and equal number of cases were seen in both genders. Most of the patients presented with salivary gland swelling (98%). 21 (42%) were non neoplastic, 29 (58%) were neoplastic swellings, 18 (36%) were benign of which pleomorphic adenoma was the most common and 11 (22%) were malignant of which adenoid cystic carcinoma was the most common. Parotid gland was the most common gland involved. Fine needle aspiration cytology was highly sensitive for benign tumours and highly specific for malignant tumours. FNAC should be first choice of investigation in evaluating the salivary gland pathologies. Early diagnosis and subsequent appropriate management carries good prognosis.
We report a case of an oncocytic lipoadenoma of the submandibular gland, which is a very rare benign tumor of the salivary gland. The patient was a 36-year-old man with a right submandibular mass measuring 29 × 1.3 × 1.2 cm. When the preoperative diagnostic tools were insufficient to rule out malignancy and for definite diagnosis, total removal of the gland was performed. Histopathologically, microscopic examination revealed a well-circumscribed tumor that is surrounded by a thin, fibrous capsule. The majority of the tumor consisted of adipocytes and normal components of salivary gland tissue. Oncocytic cells were observed only focally. Physicians should keep in mind that salivary glands may rarely exhibit this special tumor growth pattern.
A descriptive, longitudinal and applied study was performed, with a universe composed of 31 patients who visited maxillofacial surgery service at Manuel Ascunce Domenech Provincial Hospital of Camagüey, they had volume increase in the neck region within the period from January to December 1999. Tumors coming from thyroids and acute septic processes were excluded. Data given by clinics and aspirative cytology with fine needle applied to all patients, were taken. Variables obtained were correlated among them and with the histology results, selected as reference; a statistical analysis was done through various systems, which confirmed the effectiveness of the diagnosed methods studied. Aspirative cytology presented a sensitivity of 81, 82 %, specificity 91, 67 %, positive and negative predictive vales of 100 and 91 ,67 %, respectively, and an effectiveness of 93, 94 %.
Fine needle aspiration cytology (FNAC) is a safe diagnostic tool that has a reliable sensitivity and specificity for the assessment of salivary gland pathology. It is applicable particularly in the initial assessment of parotid masses, and can play an important role in treatment planning and in the conservative management of non-neoplastic lesions, and it may be useful for the accurate confirmation of tumour recurrence. Ultrasound (US) is a useful technique for the assessment of superficial masses of the parotid and submandibular glands, and is increasingly becoming the method of choice for initial evaluation of the salivary glands. Currently, salivary gland malignancies are classified according to the 2005 WHO classification. There is four malignancies: mammary analogue secretory (MASC), mucoepidermoid (MEC), adenoid cystic carcinoma (AdCC), and hyalinising clear cell (HCCC) carcinomas. In each, the gene rearrangement is found in 80% or more of cases.
Since its inception more than 50 years ago at Memorial Hospital for Cancer (New York), needle aspiration biopsy has traveled to its present popularity over a torturous road. The early influence of Stewart on the interpretation of aspiration smears and the use of this biopsy method is still worthy of review, particularly the importance of close cooperation between clinician and pathologist. While cytology has been profoundly influenced by individual cell interpretation as practiced by Papanicolaou, it is really pattern recognition that dominates successful diagnosis by the aspiration biopsy smear method. Present concerns over technical variation in procurement of the biopsy and staining methods should be of less importance than identification of the aspiration methodology that produces the best-quality microscopic image. Reliability of diagnosis by aspiration smear must also be judged by a suitable and reproducible standard, something that is not necessarily fulfilled by tissue pathology, although many would believe otherwise. The author proposes that aspiration may also now be judged, like tissue pathology, by clinical outcome. The application and ease of procuring cell samples from tumors for cell image analysis, for flow cytometry and ploidy studies, and for gene rearrangement place this biopsy method in the forefront of the integration of biologic research and clinical medicine. Aspiration biopsy has caused us to explore how the human eye and brain analyze microscopic images and may even assist in the design of useful artificial intelligence diagnostic systems in the future.
Thin-needle aspiration biopsy was performed in 84 patients with head and neck lesions for definitive diagnosis. There were 53 cases of lymph nodes, 47 in the cervical area and six in the supraclavicular area. There were 10 salivary gland lesions and 10 thyroid masses. No false positive diagnoses of malignant tumors occurred in this entire series. The false negative rate for malignant tumors was 4.0 percent. No delay in therapy occurred in any case because the aspiration biopsy technique was used. The thin-needle technique as described is non-traumatic and is an out-patient office procedure. A 22-guage narrow diameter needle is used attached to a disposable 20 ml. plastic syringe. The syringe is held in a metal syringe holder which allows the operator to hold the syringe and apply vacuum with one hand. The other hand is used to fix the mass. Small masses, 1.0 cm. or larger are easily aspirated by this technique. The material obtained is smeared on glass slides in the manner of making a blood smear. The aspirate is semi-fluid and should not be diluted with blood. This is accomplished by stopping the aspiration when material becomes visable in the hub of the syringe. The smears are either air-dried or fixed immediately in 95 percent ethyl or methyl alcohol. We have found the metachrome B and Papanicolaou stain to be of most value. The metachrome B stain is done on the air-dried smears and the diagnosis can be made in many cases in a matter of a few minutes, thus providing a rapid solution to the patient's clinical problem. Review of this and other series indicates no complications with this technique and no evidence that cells are implanted in the needle tract following aspiration of malignant tumors.
Between November 1972 and December 1981, 1303 fine needle aspiration biopsies were performed on pntients with head and neck masses at the Medical College of Virginia, Virginia Commonwealth University. The results of 649 lymph node, 227 salivary gland, 286 thyroid, and 41 miscellaneous aspiration biopsies are reviewed. No radical treatment resulted from false positive diagnoses and no patient delay in treatment occurred because of false negative reports.
Techniques for performing the procedure are briefly reviewed. Cost containment is stressed, particularly the savings that occur when the diagnosis is not neoplastic.
Future developments and uses of the procedure are discussed.
New Math in the Laboratory
- Galen R.