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

Differentiation of Salivary Gland and Salivary Gland Tumor Tissue via Raman Imaging Combined with Multivariate Data Analysis

Salivary gland tumors (SGTs) are a relevant, highly diverse subgroup of head and neck tumors whose entity determination can be difficult. Confocal Raman imaging in combination with multivariate data analysis may possibly support their correct classification. For the analysis of the translational potential of Raman imaging in SGT determination, a multi-stage evaluation process is necessary. By measuring a sample set of Warthin tumor, pleomorphic adenoma and non-tumor salivary gland tissue, Raman data were obtained and a thorough Raman band analysis was performed. This evaluation revealed highly overlapping Raman patterns with only minor spectral differences. Consequently, a principal component analysis (PCA) was calculated and further combined with a discriminant analysis (DA) to enable the best possible distinction. The PCA-DA model was characterized by accuracy, sensitivity, selectivity and precision values above 90% and validated by predicting model-unknown Raman spectra, of which 93% were classified correctly. Thus, we state our PCA-DA to be suitable for parotid tumor and non-salivary salivary gland tissue discrimination and prediction. For evaluation of the translational potential, further validation steps are necessary.

A radiologist's perspective of the value of ultrasound-guided fine needle aspiration cytology in the assessment of head and neck lesions

This viewpoint presents a radiologist's perspective of the value that can be added by close collaboration and teamwork with cytopathologist colleagues to maximise specimen quality, adequacy, and patient outcomes. Various models are discussed and service evolution through teamwork emphasised. The importance of utilising ultrasound guidance for fine needle aspiration in head and neck lesions and critical appraisal of the literature are reviewed.

The effectiveness of the Milan system for risk stratification of salivary gland lesions: The 10-year cytohistopathological correlation results of salivary gland FNA cytology at a tertiary center

BACKGROUND

The Milan system reporting salivary gland cytopathology (MSRSGC) is a tiered classification scheme that is based on risk stratification. The aim of the current study was to assess the risk of malignancy (ROM) and risk of neoplasia (RON) in each of the diagnostic categories proposed by the MSRSGC.

METHODS

A retrospective analysis and categorization according to the MSRSGC was made of salivary gland fine needle aspirations (FNA) performed from January 2007 to December 2017. The FNA cytology results were correlated with subsequent histological follow-up.

RESULTS

A total of 578 FNAs were evaluated and histopathology was available for 198 cases (34.2%). The RON and ROM for individual diagnostic categories were: Non-diagnostic: 52.2% to 13%, non-neoplastic: 21.4% to 10.7%, atypia of undetermined significance: 74% to 22.2%, benign neoplasm: 100% to 1.1%, salivary gland neoplasm of uncertain malignant potential: 93.3% to 53.3%, suspicious for malignancy (SFM): 100% to 100%, and malignant: 100% to 100%. A diagnosis of 'SFM' or 'malignant' with FNA cytology carried a 100% risk for malignancy, while a diagnosis of "non-neoplastic," "benign neoplasm" reduced the probability of malignancy to 3.4%.

CONCLUSION

The MSRSGC is useful for the management of salivary gland lesions as it can successfully differentiate between benign and malignant cases. It will bring uniformity in salivary gland FNA cytology reporting across various institutions globally.

The Milan System, from Its Introduction to Its Current Adoption in the Diagnosis of Salivary Gland Cytology

Salivary gland masses are often encountered in the everyday practice of cytopathology. It is commonly known that the cytologic interpretation of these lesions can pose diagnostic problems due to overlapping cytomorphologic features. Fine needle aspiration (FNA) of salivary lesions shows good to excellent sensitivity and specificity in differentiating a neoplastic from a non-neoplastic process and in diagnosing common tumors such as pleomorphic adenoma. However, its value is limited in diagnosing specific neoplastic entities especially those with well-differentiated morphology. In light of this gap, an international group of pathologists has proposed a management-oriented, tiered classification for reporting salivary gland FNA specimens, “The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)”. Similar to other classification systems, the MSRSGC scheme comprises six diagnostic categories, which were linked with a specific risk of malignancy (ROM) and management. In this review article, the author evaluated the published literature on FNA in diagnosing salivary gland lesions with the adoption of the Milan system since its introduction in the daily practice of salivary cytopathology.

Management of Salivary Gland Malignancy: ASCO Guideline

PURPOSE

To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy.

METHODS

ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations.

RECOMMENDATIONS

When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.

Utility of ultrasound-guided fine needle aspiration cytology in assessing malignancy in head and neck pathology

OBJECTIVE

Fine needle aspiration cytology (FNAC) is a well-established diagnostic procedure for head and neck masses not clearly originating from mucosal or cutaneous surfaces. We analysed head and neck masses evaluated over a 2-year period, to assess the reliability of FNAC for the evaluation of malignancy.

METHODS

We enrolled all patients undergoing FNAC, from April 2013 to July 2015, in a single service of a large Italian university hospital. Relevant clinical data and ultrasonographic parameters of the lesions were recorded. We performed both conventional and thin-prep smears. Clinical presentation, ultrasonographic features and final cytology diagnoses were analysed and correlated with histology.

RESULTS

The series included 301 lesions in 285 patients, with a single (94.4%) or two (5.6%) lesions. Only eight samples were considered non-diagnostic/inadequate (2.6%). Among the cases, 139 FNAC (46.1%) underwent surgery. Cytological-histological correspondence was found in 89% of the cases. Concerning malignancy, we documented less than 4% false positives and less than 2.5% false negatives, with 92.7% sensitivity and 94.6% specificity.

CONCLUSION

FNAC diagnosis can be highly specific. Most importantly, it is highly reliable in assessing malignancy, thus defining the priority and guiding the management procedures.

Two-Year Experience of the Implementation of the Milan for Reporting Salivary Gland Cytopathology at a Private Medical Laboratory

This study aimed to present the 2-year experience of the implementation of the Milan System for Reporting Salivary Gland Cytopathology at Alpha Prolipsis Medical Laboratories, a private medical laboratory located in Athens, Greece. A totaI of 102 Fine Needle Aspirations (FNAs) performed since 2018 were included in the study. Reports were issued according to the Milan System for Reporting Salivary Gland Cytopathology. Aspirates were prepared with both conventional and liquid-based cytological methods and were evaluated by two or three Board-certified cytopathologists. Diagnostic reproducibility and accuracy were evaluated. All cases included in this study had histologic follow-up. The diagnostic accuracy of FNA for differentiating between benign and malignant disease according to MSRSGC classification was 93.3%, the specificity was 97.5% and the sensitivity was 82.2%. The positive and negative predictive values were 93.2 and 87.2%, respectively. Our results show that FNA is a valuable examination technique in the preoperative evaluation of salivary gland lesions. The integration of the 2018 Milan System for Reporting Salivary Gland Cytopathology is effective, with an overall accuracy around 95%.

[The importance of fine needle aspiration biopsy in the diagnosis of parotid tumors]

L'objectif de ce travail était de déterminer la valeur diagnostique de la cytoponction à l'aiguille fine (CPAF) et son apport dans la prise en charge des tumeurs parotidiennes, à travers une étude rétrospective portant sur 47 patients opérés d'une tumeur parotidienne et ayant eu une cytoponction préopératoire. Quatre-vingt-un pourcent des malades présentaient une tumeur bénigne et 19% une tumeur maligne. La sensibilité et la spécificité de la CPAF étaient respectivement de 78% et de 92%. Les tumeurs parotidiennes ont été correctement classées comme malignes ou bénignes dans 89% des cas, le taux d'exactitude globale était de 64,4%. La CPAF est un examen fiable permettant une information préopératoire sur le planning thérapeutique et les suites postopératoires.

A Call for Universal Acceptance of the Milan System for Reporting Salivary Gland Cytopathology

OBJECTIVES

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) established a standardized, tiered reporting system for salivary gland fine-needle aspiration (FNA) that has gained international acceptance among cytologists. Our goal was to review the key features of the MSRSGC to familiarize the surgical community with this system and its application to the FNA evaluation of salivary gland masses.

METHODS

A comprehensive review of the MSRSGC and its application in clinical practice.

RESULTS

The MSRSGC consists of six major diagnostic categories: 1) nondiagnostic, 2) non-neoplastic, 3) atypia of undetermined significance, 4) neoplasm (benign or salivary gland neoplasm of uncertain malignant potential), 5) suspicious for malignancy, and 6) malignant. Each diagnostic category is associated with an implied risk of malignancy with implications for clinical management.

CONCLUSIONS

The MSRSGC is similar to the system used for reporting thyroid FNA, which is familiar to most otolaryngologists and head and neck surgeons. As this reporting system continues to gain popularity among pathologists, widespread understanding by surgeons will be important to standardize communication and classification of salivary gland cytopathology to improve clinical care. Laryngoscope, 130:80-85, 2020.

Clinicopathological Behavior and Oncological Outcomes of Malignant Parotid Tumors in a Pakistani Population

Introduction

The incidence of salivary gland tumors is influenced by geographical and racial factors resulting in diverse histology.  While salivary gland tumors account for a low proportion of head and neck cancers, most malignant tumors of the salivary gland are located in the parotid gland. The goals of this study are to describe the clinicopathological behavior of malignant parotid tumors and explore oncological outcomes related to survival in our Pakistani tertiary care cancer hospital.

Methods

We conducted a retrospective analysis of 209 patients diagnosed with malignant parotid tumors from 2004 to 2016. Data such as demographics, age, gender, histology, grade, clinical and pathological stage, surgical treatment types and adjuvant modalities used were analyzed using SPSS software version 20. We used Kaplan Meier curves to analyze survival data.

Results

The median patient age at diagnosis was 40 years, and the ratio of men to women was 1.2:1. Mucoepidermoid carcinoma was the most common histological variant (with a 50% incidence rate) followed by adenoid cystic carcinoma (13%), and adenocarcinoma (10%). Histology has further categorized these malignant tumors into low (34%), intermediate (28%), and high (21% ) grades. The American Joint Committee on Cancer, seventh edition, clinical staging was Stage I (21%), II (28%), III (15%), and IV (34%). The 5-year survival was 68%, and the 10-year survival was 45%.

Conclusion

Mucoepidermoid carcinoma is the most common malignant parotid histology in our patient population. Advanced age, increased T stage (size > 4 cm), high-grade histology, and cervical nodal involvement decrease overall survival. Open biopsies, piecemeal excisions, and delayed presentation for radiotherapy post-surgery may also have role in adverse outcomes in these malignancies.

[Cyto-histological correlation in the management of parotid gland tumors: A retrospective study of 160 cases]

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.

Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification

BACKGROUND

Fine-needle aspiration (FNA) cytology of salivary glands is a well-established technique that plays a critical role in the preoperative diagnosis of lesions. A risk stratification of FNA diagnostic categories has been recently proposed to be useful in reporting. The aims of this study were to evaluate the diagnostic accuracy of salivary gland FNA and to apply the proposed Milan system for reporting salivary gland lesions.

METHODS

A retrospective audit of FNA specimens of salivary gland lesions reported from 2014 to 2016 was performed. A correlation with the follow-up histopathology, wherever it was available, was performed. The aspirates were then categorized according to the Milan system as follows: nondiagnostic, nonneoplastic, atypical, benign neoplasm, neoplasm of uncertain malignant potential (NUMP), suspicious for malignancy, or positive for malignancy. Furthermore, the risk of malignancy and the risk of high-grade malignancy were calculated for all diagnostic categories.

RESULTS

A total of 631 salivary gland aspirates were evaluated: 2.2% were nondiagnostic, 55.8% indicated nonneoplastic lesions, and 40.4% indicated neoplastic lesions. Histopathology was available for 94 cases (14.9%). FNA had a sensitivity of 79.4% and a specificity of 98.3% with an overall diagnostic accuracy of 91.4% for differentiating malignant tumors from benign tumors. The overall risk of malignancy was 17.4% for the nonneoplastic category, 100% for the atypical category, 7.3% for the benign neoplasm category, 50% for the NUMP category, and 96% for the positive-for-malignancy category.

CONCLUSIONS

Salivary gland FNA continues to have high diagnostic accuracy and is thus helpful for guiding management. Neoplasms with classic cytomorphology are easily diagnosed; however, in difficult cases showing overlapping features, the use of the Milan system could be beneficial. Cancer Cytopathol 2017;125:767-75. © 2017 American Cancer Society.

Cytological features of the Warthin-like variant of salivary mucoepidermoid carcinoma

Warthin-like mucoepidermoid carcinoma is a recently proposed variant of musoepidermoid carcinoma. Histologically, it is characterized by its close resemblance to Warthin tumor, including dense lymphocytic infiltration, flattened intermediate epithelium resembling squamous metaplasia, and cystic change. Given its histologic similarity to Warthin tumor, confirmatory testing for MAML2 rearrangement is often required for this diagnosis. Here we present the first cytologic reports of two 53-year-old female patients with parotid masses. In both cases, the fine needle aspirations showed fragments of bland epithelium with a squamous appearance, mucinous cyst content, and focal lymphocytic background. Neither frank keratinization nor mucinous cells were identified in the smears. Fluorescence in situ hybridization (FISH) study confirmed MAML2 rearrangement on the resection specimens in both. Other cytologic differential diagnoses, including Warthin tumor with metaplasia, lymphadenoma, and lymphoepithelial cyst, were briefly discussed.

The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses: a clinicopathological study of 114 patients

Objective

Fine-needle aspiration cytology is a valuable method for preoperative assessment of head and neck tumors. However, its accuracy in detection of salivary gland masses is controversial compared with other methods. The aim of this work was to evaluate the effectiveness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses.

Material and Methods

Over a 10-year period, 126 parotid gland masses were resected. Retrospective chart reviews of 114 patients were performed. The results of FNAC and final histological diagnosis were compared and the accuracy of FNAC was determined.

Results

Final histological evaluation revealed 11 malignant tumors and 103 benign lesions. Pleomorphic adenoma was the most common neoplasm (63%), followed by Warthin’s tumor (17.5%). The sensitivity of FNAC in detecting malignant tumors was 73% and the specificity was 97%. Positive predictive value (PPV) was 73% and negative predictive value (NPV) was 97%. The overall accuracy of FNAC in detecting parotid masses was 95%. False-negative diagnosis was found in mucoepidermoid carcinoma, acinic cell carcinoma, and epithelial-myoepithelial carcinoma whereas there was false-positive diagnosis in cases of pleomorphic adenoma and normal parotid gland tissue.

Conclusion

FNAC is a reliable minimally invasive diagnostic method with a high sensitivity in diagnosis of lesions in parotid glands. The sensitivity of detection of malignant tumors in parotid glands was low due to the biopsy technique used, and depended on tumor location. Postoperative complications decreased after superficial parotidectomy.

Salivary gland pleomorphic adenoma in the Netherlands: A nationwide observational study of primary tumor incidence, malignant transformation, recurrence, and risk factors for recurrence

INTRODUCTION

Whereas salivary gland pleomorphic adenoma (SGPA) is the most common type of salivary gland tumor, little is known about its epidemiology because national cancer registries do not register this disease.

OBJECTIVES

To establish SGPA incidence trends, rates of secondary malignant transformation and recurrence and associated factors in the Netherlands.

MATERIALS AND METHODS

Data on incidence, epidemiology, secondary malignant transformation and recurrence were retrieved from the Dutch pathology registry (PALGA) for the years 1992, 1997, 2002, 2007, and 2012. Multivariate analysis was performed to discover the risk factors for recurrence.

RESULTS

3506 cases of SGPA were recorded implying an overall European standardized rate of 4.2-4.9 per 100,000 person-years. Our figures showed a female preponderance (1:1.43) with an annual 1% rise in female incidence (95% confidence interval [CI]: 0.2-1.8) and a bimodal age distribution in women (p<0.0001). The overall 20-year recurrence rate was 6.7%, and median time to first recurrence was 7years. Positive and uncertain resection margins and younger age at diagnosis were risk factors for recurrence, with odds ratios (ORs) of 4.62 (95%CI 2.84-7.51), 4.08 (95%CI 2.24-7.43), and 0.42 (95%CI 0.29-0.63) respectively. Tumor locations in the minor salivary glands had lower odds of recurrence than tumors in the parotid (OR 0.24; 95% CI: 0.07-0.77; p<0.016). Malignant transformation occurred in 0.15% of SGPAs (3.2% of recurrences).

CONCLUSION

This first nationwide study clearly showed sex differences in SGPA epidemiology, possibly suggesting some underlying hormonal mechanism. Long-term recurrence risks were low, and secondary malignant transformation risks were very low.

Cervical lymph node metastasis in adenoid cystic carcinoma of the major salivary glands

Objective:

To verify the prevalence of cervical lymph node metastasis in adenoid cystic carcinoma of major salivary glands, and to establish recommendations for elective neck treatment.

Methods:

A search was conducted of the US National Library of Medicine database. Appropriate articles were selected from the abstracts, and the original publications were obtained to extract data.

Results:

Among 483 cases of major salivary gland adenoid cystic carcinoma, a total of 90 (18.6 per cent) had cervical metastasis. The prevalence of positive nodes from adenoid cystic carcinoma was 14.5 per cent for parotid gland, 22.5 per cent for submandibular gland and 24.7 per cent for sublingual gland. Cervical lymph node metastasis occurred more frequently in patients with primary tumour stage T3–4 adenoid cystic carcinoma, and was usually located in levels II and III in the neck.

Conclusion:

Adenoid cystic carcinoma of the major salivary glands is associated with a significant prevalence of cervical node metastasis, and elective neck treatment is indicated for T3 and T4 primary tumours, as well as tumours with other histological risk factors.

The Utility of Fine Needle Aspiration in Parotid Malignancy

OBJECTIVE: To determine clinical utility of fine needle aspiration (FNA) in parotid neoplasia.

STUDY DESIGN AND SETTING: Retrospective cohort study.

METHODS: FNA and final pathology data were reviewed for patients who underwent parotidectomy for malignancy. Surgical outcomes were compared between patients with malignant cytology versus nonmalignant/nondiagnostic cytology.

RESULTS: Twenty-seven of 33 primary malignant parotid lesions underwent FNA. Seventeen (63.0%) patients were diagnosed with cancer on FNA. The remaining 16 patients did not undergo FNA (n = 6), had a nondiagnostic FNA specimen (n = 5), or were incorrectly diagnosed with a benign lesion (n = 5). Patients who went on to parotidectomy with intent to treat malignancy based on FNA had significantly higher rates of upfront neck dissections (47.1% vs 12.5%, P = 0.036) as well as clear pathological margins (70.6% vs 31.3%, P = 0.027) vs those with nonmalignant FNA diagnoses.

CONCLUSIONS: Preoperative FNA diagnosis of malignancy improves surgical treatment of parotid cancer.

SIGNIFICANCE: FNA in the evaluation of parotid masses should strongly be considered.

Diagnosis of Salivary Gland Lesions By Fine Needle Aspiration Cytology and Its Histopathological Correlation in A Tertiary Care Center of Southern India

BACKGROUND

Salivary glands may enlarge either due to inflammation or neoplastic conditions and the diagnosis is possible by fine needle aspiration cytology (FNAC).

AIM

The present study was undertaken to determine utility of FNAC in the diagnosis of salivary gland lesions.

MATERIALS AND METHODS

In this retrospective study, a total of 186 FNACs of salivary gland lesions were retrieved and evaluated. Of these, 146 cases had follow-up histopathological diagnosis. FNAC diagnoses were compared to histopathological diagnoses.

RESULTS

The parotid glands were more commonly involved than others. Among the various diagnostic categories used in FNAC reports, Non neoplastic category was seen in 24 (16.4%), benign category in 86 (58.9%) and malignant category in 30 (20.6%) and unsatisfactory category in 6 (4.1%) of 146 cases. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNAC in the diagnosis of salivary gland lesions were 86.6%, 94.6%, 93.6%, 88.3%, and 94.6% respectively.

CONCLUSION

The present study concluded that FNAC in the diagnosis of salivary gland lesions is highly sensitive, specific and accurate method. Hence, FNAC is a useful, quick and reliable diagnostic tool. It also appears to be a safe, cost effective and minimally invasive procedure, which provides information for management of salivary gland lesions.

Verification bias in diagnostic accuracy studies for fine- and core needle biopsy of salivary gland lesions in otolaryngology journals: a systematic review and analysis

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.

Facelift approach for parotidectomy: an evolving aesthetic technique

OBJECTIVE

To systematically review the literature on the modified facelift incision for parotidectomy and to identify the scope and safety of this approach, along with cosmetic outcomes. Where available, a direct comparison was made with Blair's incision (BI).

DATA SOURCES

Medline, PubMed, Cochrane, and CINHAL databases for English-language studies published between 1960 and 2011 on the facelift approach for parotidectomy.

REVIEW METHODS

Exclusion criteria were studies reporting on concurrent facelift, studies that used synthetic material for reconstruction of the surgical bed, descriptive studies, and studies with duplicate patient data. Outcome measures were candidacy for surgery, variations in incision, cosmetic outcomes, surgical time, complication rates, and limitations.

RESULTS

Of the initial 139 studies, 11 studies encompassing 628 patients were included. Male-to-female ratio was 0.49:1, and average age was 47.1 years. In total, 582 surgeries were performed for benign lesions. Only 10 studies specified the extent of surgery: 8 authors used it for performing superficial/partial parotidectomy, and 2 described 17 cases of total parotidectomy. Tumors up to 8 cm have been excised, with a median value of 4 cm. Operative time, formally analyzed in 3 studies, was not significantly different when compared with BI. Complication rates were not increased with this approach. Aesthetic outcomes pertaining to postoperative scar were good, as reported by the patients.

CONCLUSION

The facelift approach is a cosmetically superior approach to parotid tumors as proven by objective data. Most publications in the literature pertaining to the modified facelift incision for parotidectomy have been in the past decade, lending credence to its rising popularity.

Diagnosis and treatment outcomes for patients with lymphoma of the parotid gland

OBJECTIVES/HYPOTHESIS

Lymphoma of the parotid gland (LPG) is a rare disease. Clinical diagnosis is difficult, due to a lack of specific symptoms and findings. The aim of this study is to evaluate the diagnostic workup based on the analysis of our cases of LPG and to present the stage-dependent treatment outcome.

STUDY DESIGN

Retrospective case-control study.

METHODS

From 1992 to 2008, 697 patients at our institution underwent surgery because of a parotid tumor. Among 246 malignancies, an LPG was found histologically in 28 cases (4%). Staging was performed according to the Ann Arbor classification, and treatment was performed by radiotherapy and/or chemo/immunotherapy. The patients were retrospectively analyzed.

RESULTS

No specific symptoms were found, with the main finding being a unilateral, painless, slowly progressing parotid mass. The sensitivities of imaging and fine-needle aspiration cytology in detecting LPG were 41% and 12%, respectively. Histology was the key to diagnosis, and frozen sections often revealed the diagnosis during surgery, which obviated the need for more extensive surgery in 89% of cases. The 5-year disease-specific survival estimates were 100% and 75% for early tumor stages (I and II) and advanced stages (III and IV), respectively.

CONCLUSIONS

When the precise nature of a parotid mass remains obscure after fine-needle aspiration cytology and imaging, but LPG is clinically suspected, surgical tissue sampling with frozen sections appears to be a valid option and can prevent the need for more extensive surgery. The treatment outcome for LPG is favorable.

Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery?

BACKGROUND

Optimal surgery for pleomorphic adenoma of the parotid is controversial. In the present review, we discuss the advantages and disadvantages of the various approaches after addressing the surgical pathology of the parotid pleomorphic adenoma capsule and its influence on surgery.

DATA SOURCES

PubMed literature searches were performed to identify original studies.

CONCLUSIONS

Almost all pleomorphic adenomas can be effectively treated by formal parotidectomy, but the procedure is not mandatory. Extracapsular dissection is a minimal margin surgery; therefore, in the hands of a novice or occasional parotid surgeon, it may result in higher rates of recurrence. Partial superficial parotidectomy may be a good compromise. The tumor is removed with a greater cuff of healthy parotid tissue than in extracapsular dissection. This may minimize the recurrence rate. On the other hand, the removal of healthy parotid tissue compared with formal parotidectomy is limited, thus minimizing complications such as facial nerve dysfunction and Frey syndrome.

Fine-needle aspiration cytology in the management of parotid masses: evaluation of 249 patients

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.

Diagnostic accuracy of fine-needle aspiration cytology in Warthin tumors

BACKGROUND

Our aim was to evaluate the diagnostic accuracy of fine-needle aspiration cytology (FNAC) for Warthin tumors of the parotid gland.

METHODS

All cytologic diagnoses of Warthin tumor between 1990 and 2007 were correlated with available histology. In addition, our results were compared to current literature.

RESULTS

In 310 cases, Warthin tumor was diagnosed by FNAC. In 133 cases, (43%) both cytology and histology were available. In 127 of these 133 cases (95.5%), the diagnosis Warthin tumor was confirmed by histology. In 4 cases (3%), a benign lesion was diagnosed and 2 (1.5%) revealed a malignant lesion. On review, those cytologic diagnoses were not certain. In the literature, 11 missed malignancies (5.4%) in 202 cases were reported.

CONCLUSION

The diagnostic accuracy of FNAC for the diagnosis of Warthin tumor is high and the percentage of missed malignant tumors is very low. Our results imply that a cytologic diagnosis of Warthin tumor may justify conservative treatment.

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.

Selective fine needle aspiration of parotid masses. FNA should be performed in all patients older than 60 years

OBJECTIVES

The exact role of fine needle aspiration in the pre-operative assessment of patients presenting with parotid masses is controversial. Some surgeons propose that fine needle aspiration be performed only selectively in those patients with likely malignant disease, whilst others recommend it for all patients presenting with such a mass. Intuitively, one would expect older patients to be more likely to suffer from primary malignant parotid tumours and secondary deposits of malignant skin tumours. Therefore, we hypothesised that older patients with a parotid mass should undergo fine needle aspiration regardless of their medical history.

DESIGN

We retrospectively reviewed 197 consecutive parotidectomies to test this hypothesis.

RESULTS

One hundred and twenty-one patients (61.4 per cent) were diagnosed with benign disease, whilst 76 (38.6 per cent) were diagnosed with malignant disease. Eighty-three per cent of patients aged 60 years or younger had benign disease, as opposed to 35.6 per cent of patients aged more than 60 years. Malignant disease occurred more commonly in patients older than 60 years (odds ratio 8.962, 95 per cent confidence interval 4.607-17.434).

CONCLUSION

In patients with a parotid mass, fine needle aspiration should be performed on all those aged 60 years or older.

Value of fine-needle aspiration biopsy of salivary gland lesions

BACKGROUND

The aim of this study was to assess the utility of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment planning of the lesions of the salivary gland.

METHODS

Eight hundred seventy-nine aspiration biopsies of the lesion of the salivary gland over a 10-year period, from 1997 to 2006, were reviewed with special reference to its value in the clinical treatment of patients.

RESULTS

Cytologic as well as histologic diagnoses of 382 patients were available. In these diagnoses, the sensitivity of malignancy was 83% and specificity was 99%. The positive predictive value was 98%, and the negative predictive value was 97%. The overall accuracy was 93%. The correct subtyping of the benign lesions was 97%, and the exact type-specific concordance of the malignant lesions was 71%.

CONCLUSION

Considerable benefit to the patient may result from the cautious use of FNAB of lesions of the salivary gland. The close co-operation between pathologist and surgeon can improve individual treatment.

An update on the use of ultrasound imaging in oral and maxillofacial surgery

Ultrasound is a relatively inexpensive, non-invasive, and readily available technique that is well tolerated by patients. It is particularly useful in the examination of superficial structures where the use of a high frequency linear probe (7.5-12 MHz) produces high definition multi-planar images. The spatial resolution achieved is superior to other methods of cross-sectional imaging and, when combined with tissue biopsying techniques such as fine needle aspiration cytology (FNAC) or core biopsy samples, it is rendered a highly specific diagnostic tool. This article provides an overview of the use of ultrasound for common head and neck conditions, including its use in salivary gland disease, and for the assessment of cervical lymphadenopathy.

Superficial Parotidectomy via Facelift Incision

The stigma of a visually prominent facial scar following parotid surgery can be distressing to a young patient. The surgical technique of parotidectomy via a facelift incision is described and evaluated. Thirty patients with a benign lesion of the parotid gland underwent a partial superficial parotidectomy via a modified facelift incision. After operation, all patients had excellent cosmesis and complete function of the facial nerve. The facelift incision provides adequate exposure of the parotid gland for (partial) superficial parotidectomy. It can be offered as an alternative to a select group of patients who present with a small, mobile tumor in the tail of the parotid gland and an explicit request for an invisible postoperative scar.

Carcinoma ex pleomorphic adenoma: diagnostic difficulty and outcome

OBJECTIVE

To analyze a series of carcinoma ex pleomorphic adenoma (CXPA) and to assess the diagnostic difficulties.

STUDY DESIGN

The clinical presentation of 24 CXPAs was compared with 300 pleomorphic adenomas (PAs). Furthermore, pathohistological findings and follow-up results of CXPAs were evaluated.

RESULTS

Eight of 24 (33%) CXPAs versus 41 of 300 (14%) PAs were localized in the deep lobe (P < 0.05). Forty-two percent of CXPAs versus 6 percent of PAs, respectively, were greater than 4 cm (P < 0.05). The sensitivity in detecting CXPA by fine-needle aspiration cytology (FNAC) was 47 percent. The tumor was known to be malignant preoperatively in 10 (42%) patients. Six of 24 (25%) patients with CXPA developed a tumor recurrence. The overall 5-year survival rate of CXPA was 76 percent.

CONCLUSION

CXPAs are difficult to identify preoperatively. FNAC has a low accuracy and sensitivity. CXPAs versus PAs are significantly more frequently localized in the deep lobe and are significantly greater in size.

Submandibular Gland Excision: 15 Years of Experience

PURPOSE

The surgical management of submandibular gland diseases has always been a challenge because it carries a considerable risk of nerve injury. The aim of this study was to review a single institution's experience of a nonselected case series of submandibular gland excision over 15 years.

MATERIALS AND METHODS

We retrospectively analyzed 258 unselected submandibular excisions of a tertiary university center for the histopathologic diagnosis and postoperative morbidity; 119 patients (46%) with sialolithiasis, 88 patients (34%) with sialadenitis, and 51 patients (20%) with submandibular tumors were operated.

RESULTS

We found a high rate of malignant tumors (42%) in the group of submandibular gland tumors. A low rate of transient palsies of the mandibular branch of the facial nerve (9%) and lingual nerve (2%) was observed. One patient developed a permanent paresis of the mandibular branch (<1%).

CONCLUSION

Our large series has shown that standardized submandibular sialadenectomy is a safe operation with a low rate of complications. Malignant disease is frequent in tumors of the submandibular gland.