Fine-needle aspiration of 154 parotid masses with histologic correlation

Fine-needle Aspiration Cytology in the Management of Salivary Gland Tumors: An Australian Experience

We conducted a retrospective study of 104 cases of salivary gland tumors that were initially assessed by fine-needle aspiration biopsy (FNAB). Based on subsequent histopathologic analysis of excised specimens, we found that preoperative FNAB was highly sensitive and specific for both benign and malignant tumors—including the most common, pleomorphic adenomas and squamous cell carcinomas, respectively. Despite its possible drawbacks, we conclude that preoperative FNAB is a useful tool in the management of salivary gland tumors.

Synchronous oncocytoma and Warthin’s tumor in the ipsilateral parotid gland

We encountered an 81-year-old Japanese man with oncocytoma of the parotid gland occurring simultaneously with a Warthin's tumor in the ipsilateral parotid gland. The patient complained of swelling in the right infra-auricular region. Computed tomographic images, magnetic resonance images, and ultrasonography showed two masses in the right parotid gland. Technetium 99m pertechnetate scintigraphy revealed a high accumulation in both tumors. We performed a superficial lobectomy of the parotid gland. Preoperative diagnosis was multiple Warthin's tumor, but upon histopathological examination Warthin's tumor proved to coexist with oncocytoma. In general, the presence of synchronous, major, salivary gland tumors with different histopathology in the ipsilateral parotid gland appears to be unique. This is especially true for the combination of oncocytomas and Warthin's tumors, which is extremely rare. Only eight cases of this kind coincidence were found in our review of the literature. The similarity of oncocytomas and Warthin's tumors based on epidemiology, image diagnostics, and histopathology is discussed.

Characteristic sonographic findings of Warthin's tumor in the parotid gland

PURPOSE

The aim of this study was to define the characteristic sonographic features of Warthin's tumors in the parotid gland, thus enhancing the ability to make a preoperative diagnosis of this disease process.

METHODS

We retrospectively evaluated the sonograms of Warthin's tumors of the parotid gland that had been confirmed by histopathologic examination of surgically excised specimens from patients treated at our institution over a 2-year period. We recorded the echogenicity, shape, margin, and internal structure of the tumors and categorized them into 2 groups on the basis of size (< 5 cm versus > or =5 cm in the largest diameter).

RESULTS

Eighteen patients (16 men and 2 women) with a mean age of 57 years (range, 29-82 years) were included in the analysis. One patient had 2 tumors (1 in each parotid gland); the other 17 patients each had only 1 tumor. Our review of the sonographic findings revealed that all 19 tumors were hypoechoic compared with the normal parenchyma of the affected parotid glands. Most of the tumors were ovoid, had well-defined margins, and contained multiple irregular, small, sponge-like anechoic areas. Tumors that were 5 cm or greater in diameter had a higher proportion of cystic content than smaller lesions had and in some cases were composed almost entirely of cystic material.

CONCLUSIONS

Our evidence suggests that the sonographic appearance of a Warthin's tumor in the parotid gland is distinctive: a well-defined round or ovoid hypoechoic mass containing microcystic anechoic areas. These sonographic features constitute useful criteria in the preoperative diagnosis of Warthin's tumor in the parotid gland, although sonographically guided fine-needle aspiration biopsy may be needed to confirm the diagnosis.

Preoperative diagnostic values of fine-needle cytology and MRI in parotid gland tumors

The aim of this retrospective study was to assess and compare the diagnostic value of fine-needle cytology and MRI for the prediction of malignancy in parotid tumors. During an 11-year period, 148 patients underwent preoperative fine-needle aspiration cytology in our institution. Eighty-seven patients underwent a preoperative MRI study, and 54 had both MRI and cytology. The study compares results of cytology and MRI with histological reports. The sensitivity, specificity and accuracy for detecting malignant lesions were 87, 94 and 93% respectively for MRI, 81, 95 and 92% respectively for cytology and 100, 88 and 91% respectively for both studies combined. Fine-needle cytology provided better information than MRI concerning precise histological diagnoses. Conversely, the proportion of non-diagnostic smears reached 10%. Fine-needle cytology and MRI are simple, well-tolerated diagnostic means with an impact on the management of salivary gland tumors. The associated anatomic information obtained by MRI imaging makes it the test of first choice in an optimal medical environment.

Accuracy of fine-needle aspiration cytology of salivary gland lesions in the netherlands cancer institute

BACKGROUND

To evaluate the accuracy of fine-needle aspiration cytology (FNAC) in salivary gland lesions in a tertiary referral center.

METHODS

A cytohistologic correlation study was performed using an automated pathology database of 1023 patients diagnosed with a salivary gland lesion.

RESULTS

In 388 cases, both cytology and histology were available. Using cytologic confirmation of malignancy as the starting point, the sensitivity, specificity, and accuracy of FNAC in this study were 88%, 99%, and 96%, respectively. Exact type-specific concordance of the malignant diagnosis was achieved in 66 (88%) of 75 cases and in 211 (95%) of 223 benign cases. Of the 19 cases with a cytologic diagnosis "cyst," four proved to be malignant. A non-neoplastic lesion at cytology proved to be correctly classified in 53 (68%) of 80 patients.

CONCLUSIONS

Our data show that cytology is a reliable and accurate technique to assess lesions of the salivary glands. The cytologic diagnosis of "cysts" and "non-neoplastic lesions" should be interpreted with caution.

Acinic-cell carcinoma, papillary-cystic variant: a diagnostic dilemma in salivary gland aspiration

Fine-needle aspiration (FNA) plays a pivotal role as the initial diagnostic modality of choice when dealing with salivary gland (SG) lesions. Due to the heterogeneous nature of most SG neoplasms, cytologic interpretation on FNA can be quite challenging. This is particularly valid when dealing with rare tumor types, such as the papillary-cystic variant of acinic-cell carcinoma (ACC-PCV), resulting in a high rate of false-negative cytologic diagnoses. Seven cases of ACC-PCV diagnosed on tissue resection with a prior FNA performed in cytology were studied. Material consisted of Diff-Quik and Papanicolaou stained cytologic smears, as well as hematoxylin-eosin stained cell block and histopathologic sections. In no case did the FNA performed prior to the surgical resection eventuate in a cytopathologic diagnosis of cancer. A retrospective morphologic review of the smears disclosed several characteristics common to all 7 cases, i.e., mostly tightly cohesive fragments of neoplastic epithelium seen as monolayered sheets or with a prominent papillary architecture, high nuclear:cytoplasmic ratio ductal-type epithelium, cystic material and degenerated cellular debris, histiocytes, cells with squamoid and metaplastic oncocytic changes, vacuolated and pigmented histiocyte-like tumor cells, and lack of a predominant single-cell component or naked neoplastic cell nuclei. ACC-PCV represents a rare yet significant cause of false-negative results for cancer on SG aspirations. An erroneous interpretation may occur due to lack of experience in dealing with this tumor type, the rarity of published literature on ACC-PCV, and a predominantly cystic, somewhat variegated appearance of the tumor mimicking other benign and malignant SG lesions.

Preoperative computed tomography scans for parotid tumor evaluation

OBJECTIVE

We sought to determine whether an advantage is obtained in the routine use of computed tomography (CT) scans in preoperative assessments of parotid tumors.

METHODS

A prospective study of 32 consecutive cases of patients who underwent evaluation for parotidectomies was performed. Twenty-nine received preoperative CT scans. The scans were systematically reviewed to see if they correlated with the clinical findings. Specifically, we compared clinical and CT assessments of tumor size, location, density, and malignancy. Further comparisons were performed based on postoperative tissue pathology.

RESULTS

In our series of patients, routine preoperative CT scans resulted in the discovery of details not revealed on clinical examination: some masses were found to be extra-parotid rather than primary parotid tumors, some tumors deemed to be deep were superficial, tumor density was more clearly identified, and certain pathology correlates were clarified. Most importantly, there were instances of detection of additional tumors in the same lobe, and in one instance in the opposite lobe, that were not otherwise noticed.

CONCLUSIONS

To reduce errors of omission in the treatment of suspected parotid tumors, it would seem appropriate to consider the inclusion of CT scans for the routine preoperative evaluation of all parotid masses.

Value of fine-needle aspiration cytology of parotid gland masses

OBJECTIVE

To evaluate the usefulness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses.

STUDY DESIGN

Retrospective chart review of patients undergoing FNAC.

METHODS

Between January 1990 and December 1998, 410 parotid glands were resected at the Department of Otorhinolaryngology-Head and Neck Surgery at the University of Berne, Inselpital (Berne, Switzerland). Included in the study were 228 cases with preoperative FNAC. In a retrospective study the results of FNAC were analyzed and compared with the corresponding histopathological diagnosis.

RESULTS

Histological evaluation revealed 65 malignant tumors and 163 benign lesions (150 neoplasms and 13 nonneoplastic lesions). The cytological findings were nondiagnostic in 13 (5.7%), true-negative in 146 (64%), true-positive in 39 (17%), false-negative in 22 (9.8%) and false-positive in 8 (4.5%) cases in detecting malignant tumors. Nineteen of 39 (49%) malignant tumors (true-positive) and 123 of 146 (84%) benign lesions (true-negative) were classified accurately. The accuracy, sensitivity, and specificity were 86%, 64%, and 95% respectively.

CONCLUSIONS

Fine-needle aspiration cytology is a valuable adjunct to preoperative assessment of parotid masses. Preoperative recognition of malignant tumors may help prepare both the surgeon and patient for an appropriate surgical procedure.

Fine-needle aspiration biopsy

OBJECTIVES

Fine-needle aspiration biopsy (FNAB) is a technique in which a fine needle is introduced into a mass, cellular material is aspirated, and a cytological diagnosis is rendered. It separates reactive and inflammatory processes that do not require surgical intervention from neoplasia and benign from malignant tumors. FNAB lends itself to the diagnosis of palpable head and neck masses, in particular, those that persist following antibiotic treatment.

STUDY DESIGN/METHODS

This clinical state-of-the-art review article is intended to provide an overview of the clinical use of FNAB in the management of head and neck masses. Relevant case histories are used to illustrate this point.

RESULTS

Fine-needle aspiration biopsy has a high overall diagnostic accuracy of 95% for all head and neck masses, 95% for benign lesions, and 87% for malignant ones.

CONCLUSIONS

There are virtually no contraindications, and complications are minimal. Advantages of FNAB are that it is safe and simple, it can be performed as an outpatient procedure, and it is well tolerated by patients. In the present managed care environment, it also proves cost-effective. The diagnosis is readily known to the clinician, and appropriate treatment modalities can be discussed with the patient. It is recommended as a first line of investigation in palpable head and neck masses.

Fine-needle aspiration cytology of salivary gland: a review of 341 cases

Three hundred and forty-one salivary gland fine-needle aspiration (FNA) cytology specimens taken over a 6-yr period were reviewed and correlated with clinical and/or histological findings. The aspirates were derived from parotid gland (212 cases), submandibular gland (124 cases), and minor salivary gland (5 cases). The major diagnostic categories were unsatisfactory (10 cases), normal (100 cases), sialadenitis (74 cases), cyst (34 cases), lipoma (5 cases), pleomorphic adenoma (55 cases), Warthin's tumor (36 cases), and malignancy (27 cases). The latter included 14 primary salivary neoplasms (4 lymphomas of mucosa-associated lymphoid tissue (MALT) type, 3 adenocarcinomas, 2 squamous carcinomas, 2 adenoid cystic cacinomas, and one case each of carcinoma ex pleomorphic adenoma, undifferentiated carcinoma, and high-grade mucoepidermoid carcinoma), and 13 metastases, 9 of which were derived from squamous carcinomas of head and neck origin. Clinicopathological review showed that 88 of 91 (97%) benign epithelial tumors and 27 of 31 (87%) malignant neoplasms with adequate FNA sampling were accurately diagnosed cytologically. False-negative results were caused by sampling error (7 cases), most notably in cystic tumors, or were due to misinterpretation of uncommon neoplasms (3 cases). The overall sensitivity, specificity, and accuracy were 92%, 100%, and 98%, respectively. FNA cytology provides accurate diagnosis of most salivary gland lesions and contributes to conservative management in many patients with nonneoplastic conditions.

Fine Needle Aspiration Biopsies of the Head and Neck: The Surgical Pathologist's Perspective

Masses of the head and neck comprise a variety of benign and malignant tumors and tumor-like conditions, which may present diagnostic challenges to the surgical pathologist and surgeon. Fine needle aspiration cytology is an increasingly popular technique in the initial evaluation of such lesions. The high diagnostic accuracy of this technique makes it generally preferable to traditional surgical biopsy. It is particularly useful in the sampling of histologically uniform neoplasms of the salivary glands, identification of classical papillary carcinoma and medullary carcinoma of the thyroid, separation of colloid goiter from follicular neoplasms, and confirmation of clinically suspicious lymph node metastases in cases with already documented malignant diseases. Despite its usefulness, aspiration cytology of head and neck lesions has certain inherent pitfalls, and these are briefly examined in this review. Int J Surg Pathol 8(1):17-28, 2000

Fine-needle sampling findings in 26 carcinoma ex pleomorphic adenomas: diagnostic pitfalls and clinical considerations

Preoperative fine-needle samplings (FNS) of 26 histologically proven carcinoma ex pleomorphic adenomas (24 primary tumors and 2 local recurrences in 24 patients) were retrospectively reviewed in order to evaluate their cytologic characteristics. Histologically, 17 were high-grade and 9 were low-grade carcinomas; 10 carcinomas were intratumoral (in situ), and 16 were infiltrative. A cytologic diagnosis of malignancy was established in 13 (50%) cases, 2 (7.7%) were suspicious, and 11 (42.3%) were negative for malignancy (10 pleomorphic adenomas, 1 inflammation). The majority (76.5%) of high-grade carcinomas were correctly diagnosed by FNS, regardless of invasiveness. Paradoxically, most (77.8%) negative results were encountered in low-grade carcinomas. Accurate diagnosis of malignancy on FNS is achieved in high-grade tumors and low sensitivity may cause interpretative difficulties in low-grade tumors. Diagn. Cytopathol. 1999; 21:163-166.