Parotid gland fine-needle aspiration cytology: An approach to differential diagnosis

Fine-needle aspiration cytology of salivary gland lesions

Background:

Fine-needle aspiration cytology (FNAC) is a sensitive, specific, cost-effective tool and has been widely used as a diagnostic tool for the management of various head-and-neck lesions. Salivary gland lesions constitute the most common head-and-neck lesions. These lesions can range from inflammatory to neoplastic, which can be either benign or malignant.

Materials and Methods:

The study was performed on 104 patients who presented with salivary gland swelling to the department of pathology at a tertiary care center from January 2016 to June 2020. FNAC was performed using a 22–24G needle, and smears were stained with Giemsa, hematoxylin and eosin and Papanicolaou stain. Histopathology was assessed on routine hematoxylin- and eosin-stained paraffin sections. The cytological and histopathological slides were studied, analyzed and correlated. Sensitivity, specificity, positive predictive value and negative predictive were calculated.

Results:

The study included 104 cases in the age range of 10–70 years and a mean of 45 years (±16 standard deviation). There was a male preponderance with a male-to-female ratio of 1.6:1. The parotid gland was the most common site 91 (87%). On cytology, 71 (68%) were neoplastic, of which 58 (81%) were benign and 13 (19%) were malignant. Histopathological correlation was available in 36 cases (50%), 24 (67%) of which were benign and the remaining 12 (33%) were malignant. The sensitivity, specificity, positive predictive value and negative predictive value of the present study are 95%, 85%, 91% and 92%, respectively.

Conclusion:

FNAC of the salivary gland is a safe, reliable and cost-effective technique which can be used as the first line of investigation in evaluating salivary gland lesions.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases

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.

Delayed enhancement in differential diagnosis of salivary gland neoplasm

Background

Multi-phasic Computed Tomography (CT) evaluation allows to study the enhancement features of parotid gland masses. The aim of our study was to evaluate the role of delayed enhancement in the characterization of different histologic types of parotid tumours.

Methods

Forty-eight patients (22 male and 26 female) with at least one parotid gland tumor, were included in our study. Multi-phase CT images were obtained before and 30, 120 s and 8 minutes after intravenous contrast injection. The images were evaluated by two radiologists for lesion enhancement degree. A quantitative assessment was performed using a region of interest on each lesion and density changes between different phases were compared. The tumoral enhancement ratio was calculated between the 8 minutes delayed and the early (30 s) phase. The pathological diagnosis was confirmed in all patients after surgery.

Results

All patients had unilateral lesion for a total of 48 lesions. Twenty-eight were pleomorphic adenomas, 15 Warthin's tumours and 5 carcinomas. All Warthin tumours showed a rapid contrast enhancement at the early phase (30 sec) followed by a progressive wash-out during the delayed scans. Most of pleomorphic adenomas (89.2%) showed the highest density at the 8-minutes delayed phase. Malignant tumours showed slower contrast enhancement and 3 out of 5 (60%) showed a marked decrease at the 8 minutes delayed phase while the remaining 2 (40%), did not show any density reduction. The tumoral enhancement ratio was significantly different between Warthin tumours and pleomorphic adenomas and between Warthin's and malignant tumours.

Conclusions

Multi-phasic CT examination with 8 minutes delayed acquisition has shown to be useful in parotid gland lesion differentiation.

The Value of Ultrasound-Guided Fine-Needle Aspiration Cytology by Cytopathologists in the Diagnosis of Major Salivary Gland Tumors

Because of the typical sonographic appearances of many salivary gland masses, as well as the normal appearance and anatomy of the glands, differentiation of salivary glands tumors based only on clinical and imaging criteria is difficult. We compared the utility, safety, specificity, and accuracy of ultrasound-guided fine needle aspiration cytology (UG-FNAC) in the detection of nonpalpable tumors in the major salivary glands. A retrospective review was done of a 5-year experience of 102 consecutive patients undergoing UG-FNAC. Clinical opinion, FNA results, and final pathologic findings were examined. Histological evaluation showed 29 malignant tumors and 54 benign lesions (neoplasms and nonneoplastic lesions). The cytologic findings were nondiagnostic in 19 cases (18.6%), true negative in 50 (49%), true positive in 20 (19.6%), false negative in 9 (8.8%), and false-positive in 4 (3.9%) cases for detecting malignant tumors. Six of 20 (30%) malignant tumors (true positive) and 41 of 50 (82%) benign lesions (true negative) were classified accurately. The accuracy, sensitivity, and specificity were 84.3%, 68.9%, and 92.6%, respectively. Ultrasound guided FNAC was found to be highly specific for malignancy and its sensitivity for malignancy was good. It is a reliable and accurate diagnostic technique with minimal complications and easy to perform with high specificity 92.5% (95% CI: 82.09%-97.90%). It should be the preferred primary approach for initial investigation in diagnosing salivary gland tumors.

Pleomorphic adenoma of the accessory parotid gland: case report and reappraisal of intraoral extracapsular dissection for management

Pleomorphic adenoma is the most common tumor of the major and minor salivary glands. Rarely is it found evolving from an ectopic location of major salivary glandular tissue in the mid cheek. A healthy 56-year-old woman presented to our institution with a 20-year duration of a slowly growing right cheek soft tissue mass that was causing facial asymmetry. No significant functional or neurosensory dysfunction was appreciated. Radiologic examination showed a heterogeneous, hyperintense, well-delineated mass within the region of the right buccal fat pad. Fine-needle aspiration biopsy showed benign salivary gland elements consistent with pleomorphic adenoma. The decision was made to perform intraoral extracapsular dissection for removal. Discussion of the clinical assessment and magnetic resonance imaging evaluation with an emphasis on intraoral extracapsular dissection for definitive surgical therapy of longstanding benign salivary gland tumors is emphasized.

High diagnostic accuracy and reproducibility of fine-needle aspiration cytology for diagnosing salivary gland tumors: cytohistologic correlation in 182 cases

OBJECTIVE

The purpose of this study was to assess the efficacy and reproducibility of the cytologic diagnosis of salivary gland tumors (SGTs) using fine-needle aspiration cytology (FNAC). The study aimed to determine diagnostic accuracy, sensitivity, and specificity and to evaluate the extent of interobserver agreement.

STUDY DESIGN

We retrospectively evaluated SGTs from the files of the Division of Pathology at the Clinics Hospital of São Paulo and Piracicaba Dental School between 2000 and 2006.

RESULTS

We performed cytohistologic correlation in 182 SGTs. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 94%, 100%, 100%, 100%, and 99%, respectively. The interobserver cytologic reproducibility showed significant statistical concordance (P < .0001).

CONCLUSIONS

FNAC is an effective tool for performing a reliable preoperative diagnosis in SGTs and shows high diagnostic accuracy and consistent interobserver reproducibility. Further FNAC studies analyzing large samples of malignant SGTs and reactive salivary lesions are needed to confirm their accuracy.

Diagnostic difficulties in fine needle aspiration of benign salivary glandular lesions

Background

The diagnostic accuracy of fine needle aspiration cytology (FNAC) of salivary lesions is relatively high, but cytologic interpretation might be confusing if the sample is lacking typical cytologic features.

Methods

There were 77 cases of benign salivary lesions, consisting of pleomorphic adenoma (PA) in 61 cases, Warthin's tumor (WT) in 12 cases, and other benign lesions in 4 cases. The causes of the discrepancies between the FNAC and the histologic diagnoses were evaluated.

Results

Major discrepancies were noted in 4 of the 61 PA cases, and in 1 of 12 WT cases. The causes of the major discrepancies were a mislabeled site in 1 PA and 1 WT case, and an interpretation error in 3 PA cases. Minor discrepancies were more common in the WT cases (7 of 12 cases) than in the PA cases (11 of 61 cases). The causes of the minor discrepancies were a mislabeled site in 1 PA and 1 WT case, an inadequate sample in 7 PA and 2 WT cases, a lack of typical cytomorphology in 2 PA and 2 WT cases, and an interpretation error in 1 PA and 2 WT cases.

Conclusions

To increase the diagnostic accuracy in the benign salivary lesions, recognition of both characteristic and less typical cytomorphology is needed.

Diagnostic accuracy of fine needle aspiration cytology in parotid lesions

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.

Correlation between cytology and histopathology of the salivary glam

BACKGROUND

Salivary gland swellings can result from tumours, an inflammatory process, or cysts. It can sometimes be difficult to establish whether pathology arises from the salivary gland itself or adjacent structures. Fine needle aspiration cytology (FNAC) is a simple, rapid and safe method to diagnose salivary gland swelling. FNAC has high sensitivity, specificity and accuracy. The aims of this study are to correlate FNAC diagnoses with histopathology and to establish the sensitivity and specificity of FNAC in diagnosis of salivary gland swellings in our institution.

METHOD

The study was conducted in the department of pathology, Sri Venkateshwara Medical college Hospital and research Centre, Pondicherry, India. Data was collected retrospectively for the time period 2007-2008 and prospectively for that obtained between January 2009 and June 2010. Results of cytologicial assessment were compared with histopathological data where possible to establish sensitivity and specificity of FNAC.

RESULTS

During the study period, 1309 FNAC were undertaken of which 96 FNAC were of salivary gland swellings. Correlation of cytology from FNAC with histopathology tissue was possible in 56 cases. Of the 96 cases for which FNAC data was available, 38.56% were from male and 61.45% were from female patients. The age of the patients ranged from 8 to 69 years. 48.95% cases were benign swellings, 13.54% were malignant, 6.25% were cysts and 31.25% had an inflammatory aetiology. Comparison of FNAC findings with histopathology specimens was available for 56 (58.33%) cases, following which the sensitivity and specificity of cytology were found to be 76.9% and 97.1% respectively.

CONCLUSION

FNAC is highly sensitive and specific technique for diagnosis of most of the salivary gland swelling. FNAC can be used preoperatively to avoid unnecessary surgery and discomfort associated with open biopsy.

Accuracy of Fine Needle Aspiration (FNA) in Diagnosis of Major Salivary Gland Tumors

Salivary glands tumors consist a major part of human tumors which their differentiation and treatment are very different. In addition to clinical experiments, biopsy is helpful method to obtain an accurate diagnosis. The biopsy of oral lesions is provided in different ways and one of them is Fine Needle Aspiration (FNA) which is a non-invasive, easy, quick and low cost experiment. The aim of this study was to define the accuracy of FNA in identifying major salivary glands tumors. The study was descriptive, retrospective. The medical records of Department of Pathology, Amir Alam Hospital were reviewed from 1994-2004. Data including age, gender, lesion site and FNA reports of all cases were registered. Histopathologic results of FNA samples and surgical gross reports were matched. Descriptive data was used for registered data analyzing. The SPSS 11.5 software was used for statistical analysis. From 656 specimen of FNA, there were 235 cases with both results of FNA and excisional biopsy. About 55 cases in gross experiment had not been shown tumor like lesion and 11 cases in FNA had not a definite diagnosis because of non sufficient of specimen; all these cases were rejected from study. Next study was for other 169 specimen. Considering negative for benign and positive for malignant, 37, 104, 10 and 18 cases were true positive, true negative, false positive and false negative, respectively. Sensitivity, specificity and accuracy were obtained about 67, 91 and 83%, respectively. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) also were computed 78 and 85%, respectively. FNA is a safe, useful and quick method for identifying tumors of major salivary glands.

Sonographic diagnosis of parotid gland lesions: correlation with the results of sonographically guided fine-needle aspiration biopsy

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.

Fine-needle aspiration of dedifferentiated acinic cell carcinoma: Report of a case with cyto-histological correlation

Dedifferentiated Acinic Cell Carcinoma (DAcCC) is a rare salivary gland malignancy. It has a high tendency to recur and metastasize and thus has a poor prognosis. So far, to our knowledge, only one case of DAcCC has been reported in the cytology literature. Herein, we describe a second case of DAcCC from a fine-needle aspiration (FNA) along with its subsequent histological correlation.

Value of the cytological diagnosis in the treatment of parotid tumors

Objective: A cytological diagnosis is frequently used in the management of parotid tumor to distinguish benign from malignant tumors before surgery. The aim of this study was to evaluate the value of the cytological diagnosis in parotid tumors.

Study Design: Fine-needle aspiration cytology was performed in 110 patients undergoing a parotidectomy. The results were compared with the definitive histopathological findings, which are considered the standard diagnostic reference for comparative analysis.

Setting: University hospital.

Results: Correlation with histopathological results was observed in 83 (82.1%) cases. Discordance was observed in eight (8.2%) cases. The sensitivity and the specificity of the cytological diagnosis in the detection of malignant tumors were 67 and 96 percent, respectively.

Conclusions: The cytological diagnosis performed in parotid tumors permits differentiation of a benign from a malignant tumor in the majority of cases; however, it underestimates the diagnosis of malignant tumors.