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Jain S, Thiagarajan S, Shah S, Bal M, Patil A, Chaukar D. Assessing the Agreement Between Preoperative Fine-Needle Aspiration Cytology (FNAC) Done for Major Salivary Gland Neoplasm When Reported by Head and Neck Pathologists and Non-head and Neck Pathologists with Its Final Histopathology. Indian J Surg Oncol 2023; 14:53-59. [PMID: 36891451 PMCID: PMC9986184 DOI: 10.1007/s13193-022-01624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
The preoperative FNA is an important investigation in the workup of a salivary gland pathology. A preoperative diagnosis is important to plan management and counsel patients accordingly. In this study, we aimed to assess the agreement between the preoperative FNA and the final histopathology report when reported by a head and neck and a non-head and neck pathologist. All patients with major salivary gland neoplasm having undergone a preoperative FNA before surgery from January 2012 to December 2019 at our hospital were included in the study. Analysis was done to check for concordance between head and neck and non-head and neck pathologists of the preoperative FNA and final histopathology. Three hundred and twenty-five patients were included in the study. The preoperative FNA could identify the tumour as benign or malignant in the majority (n = 228, 70.1%). The agreement between the preoperative FNA, frozen section diagnosis and the reporting of grade in the frozen section and the final HPR was slightly better with the head and neck pathologist (kappa = 0.429, kappa = 0.698 and kappa = 0.257), respectively, than with the non-head and neck pathologist (kappa = 0.387, kappa = 0.519 and kappa = 0.158), all of which was statistically significant (p < 0.001). The diagnosis made with the preoperative FNA and reporting in the frozen section had a fair agreement with the final histopathology when reported by a head and neck pathologist in comparison to a non-head and neck pathologist.
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Affiliation(s)
- Siddhanth Jain
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, 400012 Maharashtra India
| | - Shivakumar Thiagarajan
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, 400012 Maharashtra India
| | | | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, 400012 Maharashtra India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, 400012 Maharashtra India
| | - Devendra Chaukar
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, 400012 Maharashtra India
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Current Salivary Glands Biopsy Techniques: A Comprehensive Review. Healthcare (Basel) 2022; 10:healthcare10081537. [PMID: 36011194 PMCID: PMC9408798 DOI: 10.3390/healthcare10081537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Biopsy is a surgical procedure performed to collect a portion of tissue or organ for diagnostic studies. The aim of the present manuscript is to describe state-of-the-art major and minor salivary gland biopsy techniques and assess the indications and complications of other salivary gland biopsy techniques. A search was performed using the following MeSH terms: biopsy, fine-needle biopsies, image-guided biopsies, frozen sections, and salivary glands disease. A current overview of major and minor salivary glands biopsy techniques was provided. In the oncological field, a comparison was made between the most widely used biopsy method, ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and an alternative method, ultrasound-guided core needle biopsy (US-guided CNB), highlighting the advantages and disadvantages of each. Finally, intra-operative frozen sections (IOFSs) were presented as an additional intraoperative diagnostic method. Minor salivary gland biopsy (MSGB) is the simplest diagnostic method used by clinicians in the diagnosis of inflammatory and autoimmune diseases. In neoplastic lesions, US-FNAB represents the most performed method; however, due to its low diagnostic accuracy for non-neoplastic specimens, US-guided CNB has been introduced as an alternative method.
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Laccourreye O, Gaultier AL, Haroun F, Lepine C, Malinvaud D, Mirghani H. Positive predictive values of MRI and ultrasound-guided fine-needle aspiration biopsy for isolated parotid swelling in adults: A STARD comparative analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139:269-274. [DOI: 10.1016/j.anorl.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Choy KCC, Bundele MM, Fu EW, Li H, Gan JYJ, Rao NCL, Lim MY. Risk stratification of parotid neoplasms based on intraoperative frozen section and preoperative fine needle aspiration cytology. Eur Arch Otorhinolaryngol 2021; 279:2117-2131. [PMID: 34342679 DOI: 10.1007/s00405-021-07015-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to determine the relationship of frozen section (FS) to final histology and determine how incorporating FS may change preoperative malignancy risk estimates based on preoperative fine needle aspiration cytology (FNAC). The secondary aim is to determine if FS is useful in influencing intraoperative decision-making. METHODS Retrospective review of 426 intraoperative FS for parotidectomies performed for primary parotid lesions. RESULTS Risk of malignancy with a benign FS was 2.5%, with indeterminate 36.1%, and with malignant 100%. Incorporating FS to fine needle aspiration for cytology helped to stratify malignancy risk especially in the Milan categories of atypia of undetermined significance, neoplasm of uncertain malignant potential and non-diagnostic categories, where a malignant FS increased malignancy risk significantly. FS was only able to identify 11% of high-risk histological subtypes for which a neck dissection would be recommended. CONCLUSIONS FS may be used to stratify malignancy risk intraoperatively but has limited utility in clinical decision-making to perform a neck dissection and more extensive parotid resection in high-risk histological subtypes.
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Affiliation(s)
- Kevin C C Choy
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Manish M Bundele
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ernest W Fu
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jereme Y J Gan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nandini C L Rao
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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Dhanani R, Iftikhar H, Awan MS, Zahid N, Momin SNA. Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases. Int Arch Otorhinolaryngol 2020; 24:e508-e512. [PMID: 33101519 PMCID: PMC7575377 DOI: 10.1055/s-0040-1709111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/19/2020] [Indexed: 10/31/2022] Open
Abstract
Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.
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Affiliation(s)
- Rahim Dhanani
- Department of Otolaryngology/Head and Neck Surgery at the University Hospital, Aga Khan University Hospital, Karachi, Pakistan
| | - Haissan Iftikhar
- Department of Otolaryngology/Head and Neck Surgery at the University Hospital, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Sohail Awan
- Department of Otolaryngology/Head and Neck Surgery at the University Hospital, Aga Khan University Hospital, Karachi, Pakistan
| | - Nida Zahid
- Department of Otolaryngology/Head and Neck Surgery at the University Hospital, Aga Khan University Hospital, Karachi, Pakistan
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Yariv O, Popovtzer A, Wasserzug O, Neiderman NC, Halperin D, Lahav Y, Lahav G, Yehuda M. Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions. Am J Otolaryngol 2020; 41:102293. [PMID: 31732301 DOI: 10.1016/j.amjoto.2019.102293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the clinical value of ultrasound (US) and fine needle aspiration (FNA) of salivary gland lesions prior to surgery, for preoperative decision-making and long-term follow-up/outcome. MATERIALS & METHODS We retrospectively analyzed the medical charts of 98 consecutive patients with major salivary gland lesions who were treated in a single medical from 2008 to 2017. Preoperative US and FNA was performed in all patients. Cytology results were compared with histopathological diagnoses. The correlation between preoperative US findings, cytology and histopathological diagnoses was assessed. RESULTS Twenty-three specimens were histopathologically malignant, and 75 were diagnosed as benign. Three false-positive results diagnosed as malignant in cytology had a final histology of sialadenitis, pleomorphic adenoma and Warthin's tumor, respectively. In six cases, cytology yielded false-negative results. The overall accuracy of FNA in distinguishing benign from malignant lesions was 91%. Sensitivity was 70% and specificity 93%. There was no significant correlation between US features and final pathology, but larger size had some correlation with malignancy (p = 0.306). No complications were observed during or after performing FNA. CONCLUSION FNA from salivary gland lesions is safe and in many cases can help in preoperative decision making or surgical planning. Hence, the results of FNA cytology should have an integral role in clinical decision-making and management of major salivary gland lesions. False-negative results do occur and therefore should be used only as an adjunctive measure.
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Affiliation(s)
- Orly Yariv
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel.
| | - Aron Popovtzer
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Oshri Wasserzug
- Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Narin Carmel Neiderman
- Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel.
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
| | - Gil Lahav
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot 76100, Israel
| | - Moshe Yehuda
- Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
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Grasl S, Kadletz L, Janik S, Riedl A, Erlacher B, Formanek M, Grasl MC, Erovic BM. Fine-needle aspiration cytology and intraoperative frozen section in parotid gland tumour surgery: A retrospective multicenter analysis of 417 cases. Clin Otolaryngol 2019; 44:461-465. [PMID: 30779480 DOI: 10.1111/coa.13314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/26/2018] [Accepted: 02/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Stefan Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Lorenz Kadletz
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Riedl
- Department of Otorhinolaryngology and Phonetics, Hospital of St. John of God, Vienna, Austria.,Department of Laryngology, Sigmund Freud Private University, Medical School, Vienna, Austria
| | - Birgit Erlacher
- Department of Otorhinolaryngology and Phonetics, Hospital of St. John of God, Vienna, Austria.,Department of Laryngology, Sigmund Freud Private University, Medical School, Vienna, Austria
| | - Michael Formanek
- Department of Otorhinolaryngology and Phonetics, Hospital of St. John of God, Vienna, Austria.,Department of Laryngology, Sigmund Freud Private University, Medical School, Vienna, Austria
| | - Matthaeus C Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
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Hung DSW, Lai EYL. Ultrasound-guided versus free-hand fine-needle aspiration cytology of the parotid gland: A single-centre, retrospective review. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Gavín-Clavero MA, Usón-Bouthelier T, Jariod-Ferrer ÚM, Fernández-Larrañaga A, Pantilie B, Lobera-Molina F, Simón-Sanz MV, Cristóbal BN. Accuracy of FNAC and CT in the Differentiation of Benign and Malignant Parotid Tumours in a Case Series. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pommier A, Lerat J, Orsel S, Bessede JP, Aubry K. [Cyto-histological correlation in the management of parotid gland tumors: A retrospective study of 160 cases]. Bull Cancer 2017; 104:850-857. [PMID: 29031506 DOI: 10.1016/j.bulcan.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/09/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this study was to correlate the cytological and histological results and evaluate the diagnostic performance of fine-needle aspiration cytology (FNAC) in the management of parotid gland tumors. METHODS This retrospective study included 160 patients with a parotid gland tumor who underwent fine-needle aspiration and parotidectomy surgery between January 2005 and August 2016 at the Limoges university hospital center. RESULTS On 160 fine-needle aspirations performed, fine-needle aspiration diagnoses were: 77 benign lesions, 35 malignant lesions and 48 non-diagnostic cases. Final histological diagnosis revealed there were 113 benign lesions and 47 malignant lesions. A hundred and one cytological diagnoses were accurate over 112 contributive fine-needle aspirations: seven false-negative cases and 4 false-positive cases were observed. The sensitivity, specificity, and accuracy were 82, 95 and 90% respectively for fine-needle aspiration, and 83, 95 and 92% respectively for association of fine-needle aspiration and magnetic resonance imaging. Diagnostic concordance between fine-needle aspiration and final histology for malignant lesions was 78%. A greater number of contributive fine-needle aspirations was observed among experimented operators. DISCUSSION Fine-needle aspiration is a reliable, safe and effective diagnostic tool that allows good differentiation between malignant and benign diagnosis in the preoperative management of parotid gland tumors. The association of fine-needle aspiration and magnetic resonance imaging (MRI) can improve diagnostic performance.
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Affiliation(s)
- Auriane Pommier
- CHU Dupuytren, service d'ORL et de chirurgie cervicofaciale, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - Justine Lerat
- CHU Dupuytren, service d'ORL et de chirurgie cervicofaciale, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Stéphane Orsel
- CHU Dupuytren, service d'ORL et de chirurgie cervicofaciale, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Jean-Pierre Bessede
- CHU Dupuytren, service d'ORL et de chirurgie cervicofaciale, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Karine Aubry
- CHU Dupuytren, service d'ORL et de chirurgie cervicofaciale, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Accuracy of FNAC and CT in the differentiation of benign and malignant parotid tumours in a case series. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:25-29. [PMID: 28844507 DOI: 10.1016/j.otorri.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/13/2017] [Accepted: 05/10/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Parotid tumours, in addition to the wide variety of types, are histologically complex. Differentiating between benign and malignant tumours in preoperative diagnosis is important in deciding the type of surgery required. Fine needle aspiration cytology (FNAC) is a simple, quick, low-cost, low-invasive and well-tolerated tool used in the preoperative diagnosis of these tumours. MATERIAL AND METHODS we calculated the sensitivity, specificity, predictive positive value (PPV) and negative predictive value (NPV) of FNAC and computed tomography (CT) in the differentiation of benign and malignant parotid tumours operated between 2010 to 2014 in the oral and maxillofacial surgery department of the University Hospital Miguel Servet. RESULTS The sensitivity of FNAC is 50%, while the specificity is high, at 98.7%. FNAC offers high reliability in the diagnosis of malignant tumours, despite its low sensitivity. However, when the diagnosis is indeterminate or benign, other than pleomorphic adenoma or Whartin tumour, the reliability to exclude malignancy decreases. CONCLUSION The low sensitivity of FNAC to differentiate malignant from benign parotid tumours, means that we cannot rule out other diagnostic tests, clinical symptoms and especially the intraoperative vision of each surgeon. Especially when the diagnosis is indeterminate. Nevertheless, it is a technique used in a systematised way and helps in pre-surgical decision-making.
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Staging and follow-up of high-grade malignant salivary gland tumours: The role of traditional versus functional imaging approaches – A review. Oral Oncol 2016; 60:157-66. [DOI: 10.1016/j.oraloncology.2016.04.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/19/2016] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
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Abstract
Common usage of fine-needle aspirate (FNA) for salivary gland lesions is the preoperative determination of whether a lesion is neoplastic, its lineage, and if neoplastic, whether it is low grade/benign, or high grade. Immunohistochemical stains can be performed on cell blocks to determine lineage and help refine diagnosis, although their performance is not always equivalent to that seen in surgical specimens. Several characteristic translocations have been described in various entities in these categories, and these can be evaluated using fluorescence in situ hybridization. In the future, high-throughput next-generation sequencing panels may further refine cytologic diagnosis in salivary tumors.
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Affiliation(s)
- Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, A614.X PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Wong DSY, Wong LY. “Cystic” Parotid Swelling on FNA: Significance on Clinical Management. Otolaryngol Head Neck Surg 2016; 130:593-6. [PMID: 15138426 DOI: 10.1016/j.otohns.2003.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The clinical significance of a cystic aspirate, defined as an aspirate yielding fluid of any nature, on fine needle aspiration cytology (FNA) of parotid masses was studied. A total of 464 FNA from 236 patients over a 4-year period in a university head and neck department was analyzed. The incidence of cystic aspirates was 17.4%. The gross appearance of the aspirated fluid was consistent between sessions. Aspirated fluids could be blood-related, serous, or purulent, and these were associated with the pathological nature of lesions. Volume and viscosity were not useful features in predicting pathology. Cysts that could be completely emptied may not recur, but the pathology should still be noted. There was no difference in pathology between cystic and noncystic swellings. The incidental finding of fluid on FNA carries very limited clinical implication and parotid masses should be fully worked up and treated as in the noncystic swelling.
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Affiliation(s)
- David Sau Yan Wong
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, People's Republic of China.
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Ghantous Y, Naddaf R, Barak M, Abd-Elraziq M, Abu Eln-Naaj I. The Role of Fine Needle Aspiration in the Diagnosis of Parotid Gland Tumors. J Craniofac Surg 2016; 27:e192-6. [DOI: 10.1097/scs.0000000000002446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rodriguez CP, Parvathaneni U, Méndez E, Martins RG. Salivary Gland Malignancies. Hematol Oncol Clin North Am 2015; 29:1145-57. [DOI: 10.1016/j.hoc.2015.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tyagi R, Dey P. Diagnostic problems of salivary gland tumors. Diagn Cytopathol 2015; 43:495-509. [DOI: 10.1002/dc.23255] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 12/17/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Ruchita Tyagi
- Department of Cytopathology and Gynecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Pranab Dey
- Department of Cytopathology and Gynecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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Spindel S, Sapsford KE. Evaluation of optical detection platforms for multiplexed detection of proteins and the need for point-of-care biosensors for clinical use. SENSORS (BASEL, SWITZERLAND) 2014; 14:22313-41. [PMID: 25429414 PMCID: PMC4299016 DOI: 10.3390/s141222313] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 11/16/2022]
Abstract
This review investigates optical sensor platforms for protein multiplexing, the ability to analyze multiple analytes simultaneously. Multiplexing is becoming increasingly important for clinical needs because disease and therapeutic response often involve the interplay between a variety of complex biological networks encompassing multiple, rather than single, proteins. Multiplexing is generally achieved through one of two routes, either through spatial separation on a surface (different wells or spots) or with the use of unique identifiers/labels (such as spectral separation-different colored dyes, or unique beads-size or color). The strengths and weaknesses of conventional platforms such as immunoassays and new platforms involving protein arrays and lab-on-a-chip technology, including commercially-available devices, are discussed. Three major public health concerns are identified whereby detecting medically-relevant markers using Point-of-Care (POC) multiplex assays could potentially allow for a more efficient diagnosis and treatment of diseases.
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Affiliation(s)
- Samantha Spindel
- Division of Biology, Chemistry, and Materials Science Office of Science and Engineering Laboratories; U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Kim E Sapsford
- Division of Biology, Chemistry, and Materials Science Office of Science and Engineering Laboratories; U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
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Schmidt RL, Jedrzkiewicz JD, Allred RJ, Matsuoka S, Witt BL. Verification bias in diagnostic accuracy studies for fine- and core needle biopsy of salivary gland lesions in otolaryngology journals: a systematic review and analysis. Head Neck 2014; 36:1654-61. [PMID: 24114985 DOI: 10.1002/hed.23495] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/08/2013] [Accepted: 09/09/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Diagnostic test accuracy (DTA) studies for needle biopsy are frequently published in otolaryngology journals, but this body of literature has not been assessed for verification bias. METHODS We conducted a systematic review of DTA studies on needle biopsy of salivary gland lesions appearing in otolaryngology journals. Studies were assessed by 2 reviewers for verification bias. RESULTS We identified 95 DTA studies for needle biopsy of salivary gland lesions. Eighty-one studies (84%) had verification bias. Five of the biased studies provided sufficient data to estimate the extent of bias. Verification bias was associated with an overestimate of sensitivity and an underestimate of specificity. Studies on core needle biopsy (CNB) had a lower rate of verification bias than fine-needle aspiration (FNA) studies. CONCLUSION Verification bias is common in DTA studies of needle biopsy for salivary gland lesions published in ear, nose, and throat (ENT) journals. Such studies overestimated sensitivity and underestimated specificity.
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Affiliation(s)
- Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, Utah
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Bajwa MS, Mitchell DA, Brennan PA. Is it time we adopted a classification for parotid gland cytology? Br J Oral Maxillofac Surg 2013; 52:99-101. [PMID: 24332173 DOI: 10.1016/j.bjoms.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Mandeep S Bajwa
- ST3 Oral and Maxillofacial Surgery, St. Richard's Hospital, Cichester PO19 6SE, United Kingdom.
| | | | - Peter A Brennan
- Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom.
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Mallon DH, Kostalas M, MacPherson FJ, Parmar A, Drysdale A, Chisholm E, Sadek S. The diagnostic value of fine needle aspiration in parotid lumps. Ann R Coll Surg Engl 2013; 95:258-62. [PMID: 23676809 PMCID: PMC4132499 DOI: 10.1308/003588413x13511609958370] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Fine needle aspiration (FNA) is a safe and quick method of diagnosing superficial lumps, which aids preoperative planning. However, FNA of the parotid gland has not gained the widespread acceptance noted in other head and neck lumps. The aim of this study was to determine the ability of FNA of the parotid gland to differentiate benign and malignant disease, and to determine the impact on surgical outcome. METHODS A retrospective analysis of 201 consecutive parotid operations with preoperative FNA in a large district hospital in the UK was performed. The diagnostic characteristics were calculated for benign and malignant disease, and the impact on surgical procedure was determined. RESULTS In identifying benign disease, FNA has a sensitivity of 85% and a specificity of 76%. In detecting malignant disease, FNA has a sensitivity and specificity of 52% and 92% respectively. A false positive on FNA was associated with a higher incidence of neck dissection. CONCLUSIONS FNA is a useful diagnostic test. However, owing to low sensitivity, it is necessary to interpret it in the context of all other clinical information.
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Affiliation(s)
- D H Mallon
- Cambridge University Hospitals NHS Foundation Trust, UK.
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Nguansangiam S, Jesdapatarakul S, Dhanarak N, Sosrisakorn K. Accuracy of fine needle aspiration cytology of salivary gland lesions: routine diagnostic experience in Bangkok, Thailand. Asian Pac J Cancer Prev 2013; 13:1583-8. [PMID: 22799371 DOI: 10.7314/apjcp.2012.13.4.1583] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Fine needle aspiration (FNA) cytology is well accepted as a safe, reliable, minimal invasive and cost-effective method for diagnosis of salivary gland lesions. This study evaluated the accuracy and diagnostic performance of FNA cytology in Thailand. A consecutive series of 290 samples from 246 patients during January 2001-December 2009 were evaluated from the archive of the Anatomical Pathology Department of our institution and 133 specimens were verified by histopathologic diagnoses, obtained with material from surgical excision or biopsy. Cytologic diagnoses classified as unsatisfactory, benign, suspicious for malignancy and malignant were compared with the histopathological findings. Among the 133 satisfactory specimens, the anatomic sites were 70 (52.6%) parotid glands and 63 (47.4 %) submandibular glands. FNA cytological diagnoses showed benign lesions in 119 cases (89.5 %), suspicious for malignancy in 3 cases (2.2 %) and malignant in 11 cases (8.3%). From the subsequent histopathologic diagnoses, 3/133 cases of benign cytology turned out to be malignant lesions, the false negative rate being 2.2 % and 1/133 case of malignant cytology turned out to be a benign lesion, giving a false positive rate was 0.8%. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 97.0% (95% CI, 70.6%-99.4%), 81.3% (95% CI, 54.4%-96.0%), 99.1% (95% CI, 95.4%-100%), 92.9% (95% CI, 66.1%-99.8), 97.5% (95% CI, 92.8%-99.5%), respectively. This study indicated that FNA cytology of salivary gland is a reliable and highly accurate diagnostic method for diagnosis of salivary gland lesions. It not only provides preoperative diagnosis for therapeutic management but also can prevent unnecessary surgery.
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Affiliation(s)
- Sudarat Nguansangiam
- Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis, Bangkok, Thailand.
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Inançlı HM, Kanmaz MA, Ural A, Dilek GB. Fine needle aspiration biopsy: in the diagnosis of salivary gland neoplasms compared with histopathology. Indian J Otolaryngol Head Neck Surg 2012; 65:121-5. [PMID: 24427627 DOI: 10.1007/s12070-012-0608-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022] Open
Abstract
Fine needle aspiration biopsy is commonly used for pre operative evaluations of salivary gland masses. We would like to focus on this diagnostic tool for the salivary gland lesions by reviewing Ankara Oncology Hospital's case lists. Cytological and postoperatively histological reassessment is done for 115 cases. Fine needle aspiration biopsy's sensitivity was 80.8 %, specificity 95.1 %, positive predictive value was 84 % and negative predictive value was 93.9 %. False positive range was 4.9 % and false negative range was 19.2 %. Salivary gland masses can be assessed by cytology preoperatively.
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Affiliation(s)
- Hasan Mete Inançlı
- Department of Otorhinolaryngology, Faculty of Medicine, Yakin Doğu Bulvarı, Near East University, Nicosia, Northern Cyprus, Mersin 10 Turkey
| | - Mahmut Alper Kanmaz
- Otorhinolaryngology Clinic, Sanli Urfa Birecik State Hospital, Sanli Urfa, Turkey
| | - Ahmet Ural
- Department of Otorhinolaryngology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gulay Bilir Dilek
- Department of Pathology, Ankara Oncology Education and Research Hospital, Ankara, Turkey
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Fakhry N, Antonini F, Michel J, Penicaud M, Mancini J, Lagier A, Santini L, Turner F, Chrestian MA, Zanaret M, Dessi P, Giovanni A. Fine-needle aspiration cytology in the management of parotid masses: evaluation of 249 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:131-5. [PMID: 22626640 DOI: 10.1016/j.anorl.2011.10.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/06/2011] [Accepted: 10/18/2011] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The role of fine-needle aspiration cytology (FNAC) in the management of parotid tumours is still the subject of controversy. The purpose of this study was to determine the diagnostic value of FNAC in our institution in order to define its place in the diagnostic strategy. PATIENTS AND METHODS This retrospective study was based on 249 patients who had undergone preoperative FNAC before being operated in our institution between 2001 and 2008. All examinations were performed and interpreted by the same experienced pathologist. RESULTS Among the 249 patients included in this study, 187 (75%) had a benign tumour and 62 (25%) had a malignant tumour. No complications of FNAC were observed. Cytological findings were non-contributory in 47 patients (18%). The sensitivity of FNAC for the diagnosis of malignancy was 80% with a specificity of 89.5%. Among the 11 false-negative results, lymphomas and low-grade mucoepidermoid carcinomas were the most common histological types. Among the 16 false-positive results, Warthin's tumours, pleomorphic adenomas and lymphoepithelial lesions were the most common histological types. Accurate histological classification of the tumour was reported in 79.5% of cases (86% for benign tumours and 44% for malignant tumours). CONCLUSION FNAC is a reliable examination providing important information to the surgeon in the preoperative diagnostic assessment.
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Affiliation(s)
- N Fakhry
- Service ORL et chirurgie cervico-faciale, Assistance publique-Hôpitaux de Marseille, centre hospitalier universitaire La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
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Huang YC, Wu CT, Lin G, Chuang WY, Yeow KM, Wan YL. Comparison of ultrasonographically guided fine-needle aspiration and core needle biopsy in the diagnosis of parotid masses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:189-194. [PMID: 21953076 DOI: 10.1002/jcu.20873] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 08/12/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND To retrospectively compare the accuracies of ultrasound-guided fine-needle aspiration (USFNA) and ultrasound-guided core needle biopsy (USCNB) in the diagnosis of parotid masses. METHODS A total of 171 patients (aged 17-86 years, mean 54 years) with parotid masses (35 malignant and 136 benign lesions) underwent either USFNA (n = 107) or USCNB (n = 64). The diagnostic accuracies for differentiating benign from malignant lesions of both examinations were compared. Surgical histopathology (n = 104) and clinical diagnosis (n = 67) were used to establish the final diagnoses. RESULTS USCNB had a significantly higher sensitivity (94.1%) than USFNA (55.6%) (p < 0.05) in differentiating benign lesions from malignant conditions. The specificity and overall accuracy of USCNB were higher than those of USFNA (100% and 98.4% versus 93.3% and 86.9%, respectively). USCNB provided more specific diagnosis than USFNA (100% versus 93.3%, p < 0.05). All six patients with lymphomas who underwent USCNB were accurately diagnosed, whereas all four patients with lymphomas who underwent USFNA were not. CONCLUSIONS USCNB should be preferred to USFNA when a definite diagnosis of a parotid solid mass is needed.
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Affiliation(s)
- Yu-Chieh Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, 5 Fushing Road, Taoyuan, Taiwan
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Berg N, Ryscavage P, Kulesza P. The utility of fine needle aspiration for diagnosis of extrapulmonary coccidioidomycosis: a case report and discussion. Clin Med Res 2011; 9:130-3. [PMID: 21562136 PMCID: PMC3251489 DOI: 10.3121/cmr.2011.993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coccidioidomycosis typically presents as pneumonia, but rarely manifests as extrapulmonary disease. We describe a case of coccidioidal infection that presented as a neck mass and was diagnosed by fine needle aspiration (FNA). Initial clinical suspicion was for mycobacterial infection. Several modalities are available for the detection of Coccidioides species, but culture has been the mainstay of diagnosis. FNA provides a relatively noninvasive and effective modality for tissue-based diagnosis based on characteristic histological findings. It allows the additional advantage of early on-site identification, allowing for triage of the specimen, notification of laboratory staff and prompt initiation of treatment. The case herein described is intended to demonstrate an atypical presentation of extrapulmonary coccidioidomycosis and highlight the utility of FNA for diagnosis of such lesions. Clinicians should be aware of the unique advantages of FNA for evaluation of lesions of infectious etiology.
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Affiliation(s)
- Natasha Berg
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Patrick Ryscavage
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Piotr Kulesza
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Corresponding Author: Piotr Kulesza, MD, PhD, Northwestern Memorial Hospital, Department of Pathology, 303 East Chicago Avenue, Ward 3-140 W127, Chicago, IL 60611, Tel: (312) 926-7002, Fax: (312) 926-6037,
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Sonographically guided fine-needle aspiration biopsy of major salivary gland masses: a review of 245 cases. AJR Am J Roentgenol 2011; 196:1160-3. [PMID: 21512086 DOI: 10.2214/ajr.10.4256] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the diagnostic accuracy of sonographically guided fine-needle aspiration biopsy (FNAB) for major salivary gland tumors by comparing the biopsy results for 245 salivary gland masses with the final pathologic diagnosis after surgical excision. MATERIALS AND METHODS This retrospective study included a total of 245 major salivary gland tumors from 244 patients who had undergone sonographically guided FNAB followed by surgical excision. To evaluate the diagnostic accuracy of FNAB, we compared the histopathologic diagnoses with the preoperative cytology results obtained from FNAB. False-negative diagnoses based on the FNAB results were reviewed. RESULTS Two hundred fifteen aspirates (87.8%) yielded adequate cytology results. In the 215 masses from which adequate material was obtained and an unequivocal cytology result was obtained, the overall sensitivity, specificity, and accuracy of sonographically guided FNAB in differentiating malignant from benign tumors was 75.7%, 100%, and 95.8%, respectively. The false-negative diagnostic rate was 4.2% (9/215), but there were no false-positive diagnoses of malignancy. Among the 47 malignancies, only 28 cases (59.6%) were detected preoperatively by FNAB. CONCLUSION For the preoperative evaluation of major salivary gland tumors, sonographically guided FNAB is feasible for distinguishing between benign and malignant salivary gland tumors in the subset of patients with satisfactory cytologic diagnoses. However, negative or nondiagnostic cytologic results cannot always guarantee benignity of the final diagnosis, and therefore careful consideration of the sonographic features and cytologic results is necessary to avoid false reassurance.
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Ultrasound-Guided Fine Needle Aspiration of Major Salivary Gland Masses and Adjacent Lymph Nodes. Ultrasound Q 2011; 27:105-13. [DOI: 10.1097/ruq.0b013e31821c1177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ali NS, Akhtar S, Junaid M, Awan S, Aftab K. Diagnostic accuracy of fine needle aspiration cytology in parotid lesions. ISRN SURGERY 2011; 2011:721525. [PMID: 22084773 PMCID: PMC3200214 DOI: 10.5402/2011/721525] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 04/12/2011] [Indexed: 11/23/2022]
Abstract
Objective. Histopathology of parotid gland tumors is extremely varied and complex due to heterogeneous cellular composition. Preoperative diagnostic tools include fine needle aspiration cytology, the role of which remains controversial. The aim of this paper is to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of parotid gland tumors. Methods. We retrospectively reviewed charts of 129 patients who underwent parotidectomy for parotid lesions at Aga Khan University Hospital from 2002 to 2010. We compared the results of preoperative FNAC with final histopathological diagnosis. Results. Concordance with histological results was observed in 86%, specificity was 98%, sensitivity was 84%, and diagnostic accuracy was 94%. Conclusion. Our results demonstrate that preoperative cytology in parotid lesions is fairly accurate and useful in diagnosing benign from malignant and in planning appropriate approach for treatment.
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Affiliation(s)
- Naeem Sultan Ali
- Division of Otorhinolaryngology-Head and Neck Surgery, Aga Khan University Hospital, Karachi 74800, Pakistan
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Kovacević DO, Fabijanić I. Sonographic diagnosis of parotid gland lesions: correlation with the results of sonographically guided fine-needle aspiration biopsy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:294-298. [PMID: 20544864 DOI: 10.1002/jcu.20704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The aim was to assess the value of ultrasound (US) in differentiating benign from malignant parotid gland lesions. METHODS During a 3-year period, US-guided fine-needle aspiration biopsy was performed on 89 parotid lesions with a size > or = 5 mm in 68 patients. In 80 (90%) lesions, specimens were adequate for cytologic analysis. We recorded the seven following US parameters: size, number, echogenicity, echotexture, margins' clarity, distal acoustic enhancement, and regional lymph node enlargement. RESULTS Fine-needle aspiration biopsy revealed 18 (22%) malignant tumors, 30 (38%) benign tumors, and 32 (40%) nonneoplastic lesions. The mean size of the malignant tumors was 25 +/- 17 mm versus 27 +/- 17 mm for benign tumors versus 21 +/- 12 mm for nonneoplastic lesions (p > 0.05). Among 33 solitary tumors, 9 were malignant tumors and 24 were benign tumors. The majority of the parotid lesions were hypoechoic. The US feature that was most often associated with a benign lesion was distal acoustic enhancement. The US features that suggested malignancy were a heterogeneous echotexture, indistinct margins, and regional lymph node enlargement. CONCLUSION US can aid in the differentiation of parotid gland tumors, although benign and malignant parotid tumors often have a similar sonographic appearance.
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Affiliation(s)
- Dragica Obad Kovacević
- Department of Diagnostic and Intervention Radiology, University Hospital "Merkur", University School of Medicine, Zajceva 19,10 000 Zagreb, Croatia
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Lee SK, Rho BH, Won KS. Parotid incidentaloma identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography: findings at grayscale and power Doppler ultrasonography and ultrasound-guided fine-needle aspiration biopsy or core-needle biopsy. Eur Radiol 2009; 19:2268-74. [PMID: 19396445 DOI: 10.1007/s00330-009-1407-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 02/17/2009] [Accepted: 03/01/2009] [Indexed: 10/20/2022]
Abstract
Twelve parotid incidentalomas in 10 consecutive subjects (nine with a known malignancy elsewhere and one presumptively healthy subject) identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography (18F-FDG PET/CT) were investigated, with the aim of calculating maximum standardized uptake value (SUV(max)) of each FDG-avid focus, and identifying corresponding sonographic and pathologic findings. The results of ultrasound-guided fine-needle aspiration biopsy (FNAB) (n = 9) and core-needle biopsy (CNB) (n = 3) were Warthin tumor in 10 cases, and pleomorphic adenoma and chronic inflammation in one each. SUV(max) was 7.0-21.0 g/mL (average 13.7 g/mL) for Warthin tumor, 6.8 g/mL for pleomorphic adenoma, and 7.3 g/mL for chronic inflammation. Each FDG-avid focus corresponded to ovoid (n = 11) or lobulated (n = 1) hypoechoic mass on grayscale ultrasonography (US) and hypervascular mass, except one with chronic inflammation, on power Doppler (PD) US. Parotid incidentaloma identified by 18F-FDG PET/CT during workup of various malignancies elsewhere does not necessarily signify primary or metastatic malignancy, but indicates a high likelihood of benign lesions, particularly Warthin tumor. Such lesions should be evaluated thoroughly by US and ultrasound-guided FNAB or CNB if parotid disease would change the patient's treatment plan.
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Affiliation(s)
- Sang Kwon Lee
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu 700-712, South Korea.
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Habermann CR, Arndt C, Graessner J, Diestel L, Petersen KU, Reitmeier F, Ussmueller JO, Adam G, Jaehne M. Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible? AJNR Am J Neuroradiol 2009; 30:591-6. [PMID: 19131405 DOI: 10.3174/ajnr.a1412] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to determine the value of echo-planar diffusion-weighted MR imaging (epiDWI) in differentiating various types of primary parotid gland tumors. MATERIALS AND METHODS One hundred forty-nine consecutive patients with suspected tumors of the parotid gland were examined with an epiDWI sequence by using a 1.5T unit. Image analysis was performed by 2 radiologists independently, and the intraclass correlation coefficient was computed. Histologic diagnosis was obtained in every patient. For comparison of apparent diffusion coefficients (ADCs), a paired 2-tailed Student t test with a Bonferroni correction was used. RESULTS In 136 patients, a primary parotid gland tumor was confirmed by histology. Among the observers, a high correlation was calculated (0.98). ADC values of pleomorphic adenomas were significantly higher than those of all other entities, except for myoepithelial adenomas (P = .054). ADC values of Warthin tumors were different from those of myoepithelial adenomas, lipomas, and salivary duct carcinomas (P < .001, 0.013, and .037, respectively). Mucoepidermoid carcinomas, acinic cell carcinomas, and basal cell adenocarcinomas were not differentiable from Warthin tumors (P = .094, .396, and .604, respectively). CONCLUSION epiDWI has the potential to differentiate pleomorphic adenoma and myoepithelial adenomas from all other examined entities. Due to an overlap not only within the group of benign and malignant lesions but also between groups, diagnoses should not be addressed on the basis of ADC values solely. Therefore, further studies combining DWI, morphologic criteria, and probably other MR imaging techniques seem warranted.
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Affiliation(s)
- C R Habermann
- Department of Diagnostic and Interventional Radiology, Diagnostic Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Burgess AN, Serpell JW. PAROTIDECTOMY: PREOPERATIVE INVESTIGATIONS AND OUTCOMES IN A SINGLE SURGEON PRACTICE. ANZ J Surg 2008; 78:791-3. [DOI: 10.1111/j.1445-2197.2008.04651.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shah VN, Branstetter BF. Oncocytoma of the parotid gland: a potential false-positive finding on 18F-FDG PET. AJR Am J Roentgenol 2007; 189:W212-4. [PMID: 17885033 DOI: 10.2214/ajr.05.1213] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Vinil N Shah
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop St., PUH Room D-132, Pittsburgh, PA 15213, USA
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Lim CM, They J, Loh KS, Chao SS, Lim LHY, Tan LKS. ROLE OF FINE-NEEDLE ASPIRATION CYTOLOGY IN THE EVALUATION OF PAROTID TUMOURS. ANZ J Surg 2007; 77:742-4. [PMID: 17685949 DOI: 10.1111/j.1445-2197.2007.04222.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the accuracy of fine-needle aspiration cytology in the diagnosis of parotid tumours. METHODS A retrospective review was conducted to examine the preoperative cytological and final histological results of patients who underwent parotidectomies at our institution. RESULTS Sensitivity and specificity for diagnosing malignant and benign tumours were 80%, 100%, and 98.5%, 87.5%, respectively, and 85.1% of benign tumours were accurately typed on fine-needle aspiration cytology compared with only 40% in the malignant group. Using the clinical parameters of associated facial nerve palsy or presence of cervical lymphadenopathy to indicate the presence of malignancy, the diagnostic yield was only 30%. CONCLUSION Fine-needle aspiration cytology is useful in the preoperative assessment of parotid tumours as it is more reliable than clinical examination to diagnose malignant parotid tumours. Although it may not accurately type the malignant tumours, the diagnosis of malignant tumours preoperatively may allow for appropriate surgical planning by the surgeon.
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Affiliation(s)
- Chwee Ming Lim
- Department of Otolaryngology--Head and Neck Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
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Cermik TF, Mavi A, Acikgoz G, Houseni M, Dadparvar S, Alavi A. FDG PET in Detecting Primary and Recurrent Malignant Salivary Gland Tumors. Clin Nucl Med 2007; 32:286-91. [PMID: 17413575 DOI: 10.1097/01.rlu.0000257336.69537.cb] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to assess the role of PET in the management of patients with primary malignant salivary gland (SG) tumor. MATERIAL AND METHODS Sixty-one FDG PET studies in 48 patients (median age 58, range 28-89 years, 20 female, 28 male) who were diagnosed with malignant SG tumors were retrospectively analyzed. Thirteen were referred for initial diagnosis and staging while there was a suspicion of recurrence and/or metastatic disease in 48 patients during the follow-up period. RESULTS On PET examinations of 13 patients on initial presentation, 12 showed increased uptake in the primary lesion, while conventional methods (CT, MRI) were positive in 11 and were equivocal for 2 patients. Six patients with multiple nodal and 2 patients with distant metastases were detected by PET. Conventional methods demonstrated lymph node metastases in 5 of these patients. In the follow-up patient group, PET was inaccurate (false-negative or positive) in 4 (8%) patients with local recurrence, and in 4 (8%) with metastatic disease. However, 15 (31%) studies for recurrence and 7 (15%) for metastasis were false-negative with conventional radiologic methods. The sensitivity, specificity, and positive and negative predictive values for the detection of recurrent disease were 83%, 93%, 63%, and 98% for PET; 67%, 69%, 24%, and 94% for conventional methods, respectively. Overall sensitivity, specificity, positive and negative predictive values of PET for detecting metastatic disease were 93%, 96%, 82%, and 99%, while those of conventional methods were 80%, 95%, 75%, and 96%, respectively. CONCLUSION These results demonstrate that FDG PET is not only superior to CT and/or MRI for staging at the initial presentation but also superior to conventional imaging methodologies for detecting local recurrence and regional lymph node and distant metastases in patients with malignant SG tumor.
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Affiliation(s)
- Tevfik Fikret Cermik
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Aversa S, Ondolo C, Bollito E, Fadda G, Conticello S. Preoperative cytology in the management of parotid neoplasms. Am J Otolaryngol 2006; 27:96-100. [PMID: 16500471 DOI: 10.1016/j.amjoto.2005.07.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluates the diagnostic role of preoperative cytology of parotid neoplasms. The method is particularly useful in the evaluation of the parotid diseases in which the same clinical features may be treated variously. Fine-needle aspiration biopsy is a simple and well-tolerated diagnostic tool, which provides accurate information for diagnosis and follow-up of the disease. The accuracy of the method partly depends on the operator skill. MATERIALS AND METHODS From a series of 452 subjects who underwent parotidectomy, preoperative cytological evaluation was available in 310 and compared with histological diagnosis in a retrospective review. RESULTS The agreement between histotype determination using fine-needle aspiration biopsy and final histological diagnosis was 79%, specificity was 100%, sensitivity was 83%, and diagnostic accuracy was 97%. CONCLUSION These findings demonstrated that, given the low complication rate, preoperative cytology is particularly useful in diagnosing parotid disease and in planning the surgical strategy and approach.
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Affiliation(s)
- Salvatore Aversa
- Department of Otolaryngology, University of Turin, San Luigi Hospital, Orbassano, Torino, Italy
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Maier H, Frühwald S, Sommer S, Tisch M. Kann die präoperative Feinnadelpunktion bei Parotistumoren die definitive histologische Diagnose erschweren? HNO 2006; 54:166-70. [PMID: 16091908 DOI: 10.1007/s00106-005-1303-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Fine-needle aspiration cytology (FNAC) is a minimally invasive procedure that offers high specifity and acceptable sensitivity in the preoperative diagnosis of parotid tumors. FNAC provides information that can be particularly valuable in surgical planning and patient education. In some cases, it may even help prevent unnecessary surgery. After an FNA procedure, on rare occasions, morphological changes in the tumor may be observed and can make a definitive histological examination difficult or even impossible. METHODS Histopathological changes in parotid tumors after preoperative FNAC are described on the basis of a case report and a survey of the literature. RESULTS In rare cases, puncture-induced histopathological changes, such as hyalinization of the subepithelial stroma, necrosis and squamous metaplasia, so extensive that a definitive histological diagnosis is difficult, are observed. In the present case report, fine-needle aspiration of a 3 x 2 cm tumor, which had been classified as malignant on the basis of cytological findings, resulted in complete necrosis and made a definitive histological diagnosis impossible. Similar cases have been described by other authors in recent years. DISCUSSION In rare cases, histological changes in the tumor tissue can occur after an FNA procedure, making a definitive histological examination difficult or even impossible. When a preoperative FNAC is performed, the pathologist in charge should be advised accordingly. In addition, patients should be informed about this infrequent risk before undergoing the procedure.
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Affiliation(s)
- H Maier
- Abteilung Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Ulm, Germany.
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David O, Blaney S, Hearp M. Parotid gland fine-needle aspiration cytology: An approach to differential diagnosis. Diagn Cytopathol 2006; 35:47-56. [PMID: 17173301 DOI: 10.1002/dc.20581] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parotid glands can undergo a wide range of pathologic changes that may be difficult to characterize by clinical features alone. No single diagnostic modality is currently accepted unequivocally as the definitive approach to parotid gland enlargement or tumors. Although it is generally accepted that fine-needle aspiration (FNA) biopsy is useful in the preoperative setting, the accuracy is highly dependent on both operator experience and the interpretative skills of the cytopathologist. Results of FNA biopsy must be considered in a global context, in conjunction with clinical and radiographic findings. The objectives of this paper are threefold: (1) to define the clinical role of parotid FNA, such that pathologists performing and/or interpreting such specimens have a clearer understanding of the expectations of our surgical colleagues; (2) to clearly describe a protocol for the performance of parotid FNA biopsy, including a discussion of complications and pitfalls; and (3) to present the cytologic differential diagnoses of diverse clinicopathologic parotid gland processes that may present as generalized enlargement, cystic lesions, or discrete masses.
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Affiliation(s)
- Odile David
- Department of Pathology, University of Illinois, College of Medicine, Chicago, Illinois 60612, USA.
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Al Salamah SM, Khalid K, Khan IAR, Gul R. Outcome of surgery for parotid tumours: 5-year experience of a general surgical unit in a teaching hospital. ANZ J Surg 2005; 75:948-52. [PMID: 16336383 DOI: 10.1111/j.1445-2197.2005.03580.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most of the recent reports on the surgical management of parotid gland disorders come from specialist divisions of otolaryngology, head and neck, or faciomaxillary surgery. The aim of the present study was to evaluate the outcome of surgery for parotid tumours in a general surgical unit of a teaching hospital. METHOD A prospective clinicopathological study was undertaken over a 5-year period for consecutive patients operated on for parotid gland tumours in the King Saud University Unit of Riyadh Medical Complex. Parameters analyzed were demographic details, clinical presentation, diagnostic work-up, type of surgery, and outcome in terms of early and late morbidity. RESULTS Thirty seven parotid operations were performed on 36 consecutive patients. All patients presented with parotid gland swelling. Mean age was 51.6 years with a male preponderance. Fine-needle aspiration diagnosed the pathology in 33 out of 37 lesions. Pleomorphic adenoma was the commonest pathology observed in 24 patients (64.9%). Warthin's tumour was more common among male patients and was the only pathology with bilateral involvement. Malignant tumour was found in five patients (13.5%). Superficial conservative parotidectomy was the most frequently performed operation (84%). Overall postoperative morbidity was 13.5%. Transient facial nerve palsy was observed in seven cases (19%). There was no recurrence identified in patients with benign diseases during the mean follow up of 38.5 months. CONCLUSION Parotid gland surgery can still be performed in a general surgery unit with comparable outcome. However, the operation should be performed in units with special interest and experience in surgery for parotid gland disorders.
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Affiliation(s)
- Saleh M Al Salamah
- Department of General Surgery, College of Medicine, King Saud University Unit, Riyadh Medical Complex, Kingdom of Saudi Arabia
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Balakrishnan K, Castling B, McMahon J, Imrie J, Feeley KM, Parker AJ, Bull PD, Johnston A. Fine needle aspiration cytology in the management of a parotid mass: a two centre retrospective study. Surgeon 2005; 3:67-72. [PMID: 15861939 DOI: 10.1016/s1479-666x(05)80064-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There is a diversity of opinion regarding the role of fine needle aspiration cytology (FNAC) in the pre-operative evaluation of the parotid mass. This study further investigates the role of FNAC from the standpoint of the clinician attempting to resolve one or more clinical issues. METHODS A retrospective study conducted at two UK Hospitals with no overlap of cytopathologists or surgeons. Patients undergoing parotidectomy at each institution were identified from Pathology department databases. The definitive histopathological diagnosis was compared with any pre-operative FNAC diagnosis. Cytology results were classified as suggestive, non-diagnostic, sampling error, or misleading. SETTING The study was conducted in a District General Hospital and a University Teaching Hospital providing secondary care for each community. RESULTS For the University Teaching Hospital the sensitivity in distinguishing malignant from benign disease was 79% (95% CI 61-97%) with a specificity 84% (95% CI 73-95%). However, three of eight patients with a primary parotid salivary gland malignancy were reported as having benign disease on FNAC. For the participating District General Hospital the sensitivity in distinguishing malignant from benign disease was 38% (95% CI 13-63%) and specificity 95% (95% CI 73-95%). CONCLUSIONS Fine needle aspiration cytology does not reliably distinguish a benign from a malignant primary salivary gland neoplasm in the participating institutions. Where clinical teams use FNAC in an attempt to resolve this clinical problem, the results should be interpreted with caution and an ongoing audit of performance is required.
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Uchida Y, Minoshima S, Kawata T, Motoori K, Nakano K, Kazama T, Uno T, Okamoto Y, Ito H. Diagnostic value of FDG PET and salivary gland scintigraphy for parotid tumors. Clin Nucl Med 2005; 30:170-6. [PMID: 15722820 DOI: 10.1097/00003072-200503000-00005] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to examine the diagnostic value of the combination of F-18 fluorodeoxyglucose (FDG) PET and Tc-99m pertechnetate salivary gland scintigraphy in parotid tumors. MATERIALS AND METHODS Seventy-two patients with benign parotid gland tumors (n = 52), malignant parotid tumors (n = 12), and inflammation (n = 8) underwent both FDG PET and salivary gland scintigraphy within 1 week, and 66 of the patients also underwent gallium scintigraphy. All patients were negative on their first fine-needle aspiration (FNA). RESULTS Malignant parotid tumors showed significantly higher FDG uptake (standard uptake values [SUVs]) than both benign tumors and inflammation, except in Warthin's tumor (5.82 +/- 3.95 vs. 2.07 +/- 1.33; P <0.01). Although the SUV values of Warthin's tumor and malignant parotid tumors overlapped somewhat, Warthin's tumor did demonstrate increased radiotracer uptake, and it was reliably distinguished from other parotid gland tumors by the use of salivary gland scintigraphy. Considering a SUV value >3 as being positive for malignancy and excluding Warthin's tumor on the basis of salivary gland scintigraphy, sensitivity and specificity of FDG PET were 75% and 80%, respectively. These results were superior to those of gallium scintigraphy (58% and 72%, respectively). CONCLUSIONS Although the diagnostic value of FDG PET in the differentiation of malignant from benign parotid gland tumors was limited because of the high FDG uptake in some benign tumors, and particularly pleomorphic adenomas, combining salivary gland scintigraphy with FDG PET may help to negate this drawback, and this combination may be a more promising approach for differentiation of various parotid gland tumors in patients compared with nondiagnostic needle aspiration.
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Affiliation(s)
- Yoshitaka Uchida
- Department of Radiology, Chiba University School of Medicine, Chiba, Japan.
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Siewert B, Kruskal JB, Kelly D, Sosna J, Kane RA. Utility and safety of ultrasound-guided fine-needle aspiration of salivary gland masses including a cytologist's review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:777-783. [PMID: 15244301 DOI: 10.7863/jum.2004.23.6.777] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the utility and safety of ultrasound-guided fine-needle aspiration of the salivary glands for diagnosis of focal masses in the salivary glands, including the prevalence of nondiagnostic sampling, the impact of the presence of a cytologist during the procedure, and the usefulness of flow cytometry. METHODS A retrospective analysis of 43 ultrasound-guided fine-needle aspirations of the salivary glands from 36 lesions in 33 patients was performed. Fine-needle aspirations were obtained under sonographic guidance, and 1 to 6 punctures were made with 20- to 25-gauge needles. Ultrasound-guided fine-needle aspirations obtained in the presence of a cytologist were compared with those performed without a cytologist regarding the adequacy of the specimen and the number of punctures performed. Postprocedural complications and the frequency with which flow cytometry was performed were noted. Cytopathologic diagnosis was correlated with clinical follow-up (n = 33) and surgical pathologic findings (n = 10). RESULTS Cytologic diagnosis was made in 31 (94%) of 33 patients, confirming a neoplastic process in 18 (50%) of 36 and a non-neoplastic process in 16 (44%) of 36. Although the presence of a cytologist at the bedside resulted in a higher prevalence of diagnostic sampling (P < .05), it did not alter the number of punctures performed (mean, 3 punctures). No complications were encountered except for pain in 2 patients. Flow cytometry was helpful in 8 (22%) of 36 patients. CONCLUSIONS Ultrasound-guided fine-needle aspiration of the salivary glands is a safe procedure with a low prevalence of nondiagnostic sampling. Approximately 44% of patients can be spared surgical intervention through diagnosis of a non-neoplastic process. The presence of a cytologist increases the likelihood of obtaining a diagnostic sample. Flow cytometry was helpful in 22% of patients.
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Affiliation(s)
- Bettina Siewert
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115, USA.
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Zbären P, Nuyens M, Loosli H, Stauffer E. Diagnostic accuracy of fine-needle aspiration cytology and frozen section in primary parotid carcinoma. Cancer 2004; 100:1876-83. [PMID: 15112268 DOI: 10.1002/cncr.20186] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The low incidence and histologic heterogeneity of primary parotid carcinomas makes it difficult to evaluate the value of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen section (FS) analysis. In the current study, the authors reviewed a single institution's experience regarding the preoperative and intraoperative diagnostic value of FNAC and FS in primary salivary gland carcinomas. METHODS Between January 1990 and December 2002, 108 primary parotid carcinomas were resected at the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Berne, Inselspital (Berne, Switzerland). Included in the study were a total of 101 carcinomas with preoperative FNAC results in 88 tumors and/or intraoperative FS results in 45 tumors. In a retrospective study, the results of FNAC and FS were analyzed and compared with the corresponding histopathologic diagnoses. RESULTS The cytologic findings were true-positive for malignancy in 63 tumors (72%), false-negative in 22 tumors (25%), and nondiagnostic in 3 tumors (3%). The tumor grading was correct in 29 of 63 tumors (46%), and the exact tumor typing was correct in 27 of 63 (43%) true-positive tumors. The FS findings were true-positive for malignancy in 43 of 45 tumors (96%), the tumor grading was correct in 35 of 45 tumors (78%), and the tumor typing was correct in 32 of 45 tumors (71%). Overall, at the time of surgery, of the 101 parotid carcinomas, the tumor was known to be malignant in 83 tumors (82%), and the correct grade and the exact tumor type were known in 55 tumors (54%) and 48 tumors (48%), respectively. CONCLUSIONS FNAC recognized malignancy in 72% of tumors, but it could not be relied upon to provide an accurate tumor grading or typing. Therefore, FNAC alone is not prone to determine the surgical management of primary parotid carcinomas. The current analysis showed the statistically significant superiority of FS compared with FNAC regarding the diagnosis of malignancy, tumor grading, and tumor typing in primary parotid carcinomas.
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Affiliation(s)
- Peter Zbären
- Department of Otolaryngology, Head and Neck Surgery, University of Berne, Inselspital, Berne, Switzerland.
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Postema RJ, van Velthuysen MLF, van den Brekel MWM, Balm AJM, Peterse JL. Accuracy of fine-needle aspiration cytology of salivary gland lesions in the netherlands cancer institute. Head Neck 2004; 26:418-24. [PMID: 15122658 DOI: 10.1002/hed.10393] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
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.
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Affiliation(s)
- Rolf J Postema
- Department of Head & Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Capone RB, Ha PK, Westra WH, Pilkington TM, Sciubba JJ, Koch WM, Cummings CW. Oncocytic neoplasms of the parotid gland: a 16-year institutional review. Otolaryngol Head Neck Surg 2002; 126:657-62. [PMID: 12087334 DOI: 10.1067/mhn.2002.124437] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Oncocytic neoplasms of the parotid gland are a rare collection of salivary gland tumors that include oncocytosis, oncocytoma, and oncocytic carcinoma. Mounting evidence has linked the presence of oncocytes to acquired mitochondrial dysfunction. OBJECTIVES The study goals were to further delineate this poorly understood group of salivary gland tumors and to search for genetic alterations indicative of mitochondrial dysfunction. METHODS Cases were identified by search of the surgical pathology archival files from 1984 through 2000. Corresponding medical records were reviewed. Tumor mitochondrial DNA (mtDNA) was evaluated for mtDNA mutations within the control region (C-tract). RESULTS Twenty-one parotid oncocytic neoplasms were identified. Oncocytoma was the most frequent morphology (62%), followed by oncocytosis (28.5%) and oncocytic carcinoma (9.5%). One specimen displayed synchronous oncocytic morphologies (oncocytoma, oncocytosis, and oncocytic metaplasia). One oncocytoma specimen displayed the mtDNA C-tract alteration. CONCLUSIONS Oncocytic neoplasia of the parotid gland is a rare form of salivary gland disease with obscure etiology. The presence of multiple oncocytic morphologies in a single specimen is suggestive of transition between forms. Although oncocytic tumorigenesis secondary to acquired mitochondrial dysfunction is a plausible mechanism, few of these tumors actually harbor mtDNA alterations within the control region.
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Affiliation(s)
- Randolph B Capone
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Wong DSY. Frozen section during parotid surgery revisited: efficacy of its applications and changing trend of indications. Head Neck 2002; 24:191-7. [PMID: 11891949 DOI: 10.1002/hed.10072] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Efficacy of frozen sections was assessed in terms of its various applications. The changing role of frozen sections in parotid surgery was examined. METHOD Records of parotid operations over a 15-year period in a University Department of Head & Neck Surgery were reviewed. RESULTS Of 241 operations, frozen sections were performed on 32. Applications of frozen sections included diagnosis, margin clearance, and checking suspicious lymph nodes and nerve invasion. The false-positive rate for malignancy was 12.5%. Margins may still be involved despite correct tissue diagnosis from sampling error. No inappropriate surgery resulted from the information obtained. With the advent of fine-needle aspiration, frozen sections were less often called for and a shift from a diagnostic role to margin checking was seen. Frozen sections picked up all unsuspected malignant tumors. CONCLUSION Frozen sections are helpful when interpreted cautiously, but clinical assessment and fine-needle aspiration are also important components in the workup.
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Affiliation(s)
- David Sau Yan Wong
- Division of Head & Neck/Plastic & Reconstructive Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Center, Pokfulam, Hong Kong, China.
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Abstract
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.
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Affiliation(s)
- A Urquhart
- Department of Otolaryngology-Head & Neck Surgery, Marshfield Clinic, Marshfield, Wisconsin, USA.
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