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Sirviö M, Aro K, Naukkarinen M, Mäkitie A, Tarkkanen J, Kelppe J, Atula T. Clinical decision making when cytology indicates a Warthin tumor. Sci Rep 2024; 14:8832. [PMID: 38632256 PMCID: PMC11023945 DOI: 10.1038/s41598-024-58892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Warthin tumor (WT) is a benign tumor usually affecting the parotid gland. The main diagnostic tool remains ultrasound combined with fine-needle aspiration cytology (FNAC). This study aims to examine how reliably FNAC indicates WT for clinical decision making regarding surgical versus conservative management. We included all patients who underwent FNAC from a parotid gland lesion between 2016 and 2018 at our institution, and whose FNAC revealed WT suspicion. The FNACs were divided into three groups based on the cytology report: certain, likely, and possible WT. The patients were divided into two groups based on having had either surgery or follow-up. We sent a questionnaire to patients who had not undergone surgery in order to obtain follow-up for a minimum of four years. Altogether, 135 FNAC samples, from 133 tumors and 125 patients, showed signs of WT. Of the 125 patients, 44 (35%) underwent surgery, and 81 (65%) were managed conservatively. Preoperative misdiagnosis in FNAC occurred in three (7%) surgically treated tumors. Their FNACs were reported as possible WTs, but histopathology revealed another benign lesion. In the conservatively treated group, two patients underwent surgery later during the follow-up. Cytological statements of WT were seldom false, and none were malignant. The majority of the patients were only followed-up and rarely required further treatment. A certain or likely diagnosis of WT in the FNAC report by an experienced head and neck pathologist is highly reliable in selecting patients for conservative surveillance.
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Affiliation(s)
- Minna Sirviö
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland.
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Mira Naukkarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Pathology, Helsinki University Hospital Diagnostic Center, Helsinki, Finland
| | - Jetta Kelppe
- Pathology, Helsinki University Hospital Diagnostic Center, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Fois P, Mureddu L, Manca A, Varrucciu S, Crescio C, Gallus R, Rizzo D, Cossu A, Bussu F. Preoperative Diagnosis of Warthin Tumors Combining Cytological, Clinical and Ultrasonographic Information within a Multidisciplinary Approach in a Lump Clinic. J Pers Med 2023; 13:1075. [PMID: 37511688 PMCID: PMC10381898 DOI: 10.3390/jpm13071075] [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: 05/16/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.
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Affiliation(s)
- Paolo Fois
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Luca Mureddu
- U.O.C. Otorinolaringoiatria, Università degli Studi di Cagliari, Policlinico Universitario Duilio Casula, 09042 Monserrato, Italy
| | - Alessandra Manca
- Institute of Pathology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Simona Varrucciu
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Claudia Crescio
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Roberto Gallus
- Otolaryngology, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Davide Rizzo
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Antonio Cossu
- Institute of Pathology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Francesco Bussu
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
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Kasinathan B, Manohar B, Ganapathy H. Diagnostic Accuracy of Fine Needle Aspiration Cytology (FNAC) in Salivary Gland Lesions with Histopathological Examination (HPE) Correlation in a Tertiary Care Centre in Southern India. Indian J Otolaryngol Head Neck Surg 2023; 75:871-879. [PMID: 37275112 PMCID: PMC10234911 DOI: 10.1007/s12070-023-03550-6] [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: 02/03/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
This study aimed to determine the diagnostic yield of fine-needle aspiration cytology (FNAC) in salivary gland lesions compared to histopathological diagnosis. The present study was done on patients above 18 years of age, with a palpable swelling, who are clinically diagnosed as salivary gland lesions were evaluated. A total of 31 patients were evaluated in this study. The mean age of the patients was 41 years ± 16.08. The male to female ratio of patients evaluated in our study was 1: 1.066, with a marginal preponderance in the female population. There was a higher incidence of carcinoma in females than males. Parotid gland lesions comprised 83.9% of all the salivary gland lesions analyzed, while submandibular gland lesions comprised 16.1%. In our study, the distribution between non-neoplastic, neoplastic benign, and neoplastic malignant lesions was 9.6%, 83.8%, and 6.4%. The overall diagnostic accuracy for non-neoplastic and neoplastic lesions is 90.3%, with a sensitivity of 89% and a specificity of 100%. The segregation of the results into the positive and negative class of diagnostic outcomes shows 80.6% for true positive, 9.7% for true negative, 0% for false-positive, and 9.7% for false-negative reports. Diagnostic accuracy in differentiating non-neoplastic and neoplastic lesions is 90.3%, with a sensitivity and specificity of 89.0% and 100%, respectively. The diagnostic accuracy of FNAC in differentiating benign from malignant lesions in our study is 93.5% (29 out of 31), the sensitivity of FNAC in our study for diagnosing malignancy is poor, and the specificity is 100%. It can be concluded that FNAC is more accurate in diagnosing benign lesions and more specific than sensitive in diagnosing malignant lesions.
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Affiliation(s)
- Banumathi Kasinathan
- Department of ENT, Apollo (Main) Hospitals, Chennai, 600006 India
- Department of ENT, SIMS Hospital, Vadapalani, Chennai, 600026 India
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Taniuchi M, Terada T, Kawata R. Fine-Needle Aspiration Cytology for Parotid Tumors. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111897. [PMID: 36431032 PMCID: PMC9693155 DOI: 10.3390/life12111897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
Fine-needle aspiration (FNA) cytology is widely used in clinical practice as a simple and minimally invasive test for parotid tumors that allows for preoperative estimation of benignancy and malignancy, histological type, and malignancy grade and can be performed on an outpatient basis. In recent years, cell blocks prepared with core needle biopsy (CNB) and liquid-based cytology (LBC) have increased the reliability of immunostaining and molecular biological testing, leading to improved diagnostic accuracy. In 2018, the Milan System for Reporting Salivary Gland Cytology was introduced, but it does not include malignancy grade or histological type, so we proposed the Osaka Medical College classification as a more clinically based cell classification that includes both types of information, and we have reported on its usefulness. This review gives an overview of the history and use of FNA and describes CNB and LBC and the two classification systems.
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Higuchi K, Urano M, Akiba J, Nogami M, Hirata Y, Zukeran Y, Moriyoshi K, Tada Y, Fukushima M, Obayashi M, Sakamoto S, Kuraoka K, Kira K, Kawahara A, Kato T, Tanigawa M, Nakaguro M, Yamamoto H, Nagao T. A multi-institutional study of salivary gland cytopathology: Application of the Milan System for Reporting Salivary Gland Cytopathology in Japan. Cancer Cytopathol 2021; 130:30-40. [PMID: 34478237 PMCID: PMC9290724 DOI: 10.1002/cncy.22505] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022]
Abstract
Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a risk‐stratification reporting system that was introduced in 2018. The objective of this multi‐institutional study was to evaluate the utility of the MSRSGC in Japan. Methods In total, 1608 fine‐needle aspiration samples with matching histologic diagnoses were retrieved from 12 large institutions in Japan. The diagnostic categories of the MSRSGC were assigned prospectively or retrospectively, and the results were compared with the histologic diagnoses. Results The cases were classified as follows: nondiagnostic, 18.1%; non‐neoplastic, 4.1%; atypia of undetermined significance, 11.5%; neoplasm‐benign, 43.7%; salivary gland neoplasm of uncertain malignant potential, 9.6%; suspicious for malignancy, 3.6%; and malignant, 9.4%. The risk of neoplasm and the risk of malignancy in each MSRSGC category were as follows: nondiagnostic, 72.9% and 13.4%, respectively; non‐neoplastic, 15.2% and 9.1%, respectively; atypia of undetermined significance, 77.9% and 24.9%, respectively; neoplasm‐benign, 99% and 1.8%, respectively; salivary gland neoplasm of uncertain malignant potential, 94.8% and 37%, respectively; suspicious for malignancy, 100% and 89.7%, respectively; and malignant, 100% and 99.3%, respectively. The accuracy of the MSRSGC for diagnosing neoplasms was 97.8%, and its accuracy for diagnosing malignancy was 97.3%. Institutions that used Romanowsky‐stained preparations had lower nondiagnostic rates and lower risks of neoplasm and malignancy in the non‐neoplastic category. Conclusions The MSRSGC is useful for risk stratification and quality control. Widespread use of the MSRSGC would improve the accuracy of salivary gland cytology and lead to better patient care in Japan. This is the first multi‐institutional study of a large‐scale application of the Milan System for Reporting Salivary Gland Cytopathology in Japan. It demonstrates the usefulness of the Milan system in the diagnosis of salivary gland lesions and for the quality control of salivary gland cytology results.
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Affiliation(s)
- Kayoko Higuchi
- Department of Surgical Pathology, Okinawa Kyodo Hospital, Naha, Japan
| | - Makoto Urano
- Department of Diagnostic Pathology, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Miwako Nogami
- Division of Diagnostic Pathology, Kyushu University Hospital, Fukuoka, Japan
| | - Yukiya Hirata
- Department of Pathology, University of the Ryukyus Hospital, Nishihara, Japan
| | - Yoko Zukeran
- Department of Pathology, University of the Ryukyus Hospital, Nishihara, Japan
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, Kyoto Medical Center, Kyoto, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Mana Fukushima
- Department of Surgical Pathology, Ehime University Hospital, Toon, Japan
| | - Mariko Obayashi
- Department of Diagnostic Pathology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Shinnichi Sakamoto
- Department of Diagnostic Pathology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Kazuya Kuraoka
- Department of Diagnostic Pathology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Kana Kira
- Department of Diagnostic Pathology, Kochi University Hospital, Nangoku, Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Taku Kato
- Department of Pathology, Naritatomisato Tokushukai Hospital, Tomisato, Japan
| | - Maki Tanigawa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hidetaka Yamamoto
- Division of Diagnostic Pathology, Kyushu University Hospital, Fukuoka, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
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Sučić M, Ljubić N, Perković L, Ivanović D, Pažanin L, Sučić Radovanović T, Župnić-Krmek D, Knežević F. Cytopathology and diagnostics of Warthin's tumour. Cytopathology 2021; 31:193-207. [PMID: 32259367 DOI: 10.1111/cyt.12830] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
Warthin's tumour (WT) is a benign epithelial salivary tumour, one type of salivary adenoma. Histologically, WT is structured of two components, epithelial tissue that often lines cystic formations and lymphoid tissue in the tumour stroma. FNA is a reliable diagnostic approach in the diagnosis of salivary gland lesions allowing a highly accurate categorization of benign tumour-like lesions, benign tumours and malignant tumours. In the proposed Milan reporting system of salivary gland lesions, WT is categorized in the IVA group of benign neoplasms. Accurate cytological diagnosis is straightforward when three characteristic components are present: oncocytes, either isolated or associated in clusters, lymphocytes and lymphoid cells and often an inflammatory/necrotic-like substance. Also, specific features of scintigraphy and radiological imaging contribute to the diagnosis of WT. WT is categorized according to Seifert G. et al in 4 types, depending on the proportions of the epithelial component and lymphoid stroma. Differential cytopathological and pathohistological diagnosis include other salivary gland lesions with lymphoid, oncocytic epithelial and cystic components. In some cases, such as the metaplastic WT variant, there are additional cytopathological and histological diagnostic difficulties. Moreover, bilateral, multicentric or multiple and infrequently seen extra-salivary localizations of WT are associated with further cytopathological diagnostic difficulties. Also, a rare possibility of malignant transformation of the epithelial or lymphoid component of WT as well as possible association with other primary tumours remains a challenge in accurate cytopathological and histological diagnosis of WT.
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Affiliation(s)
- Mirna Sučić
- Division of Cytology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia.,Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, Zagreb University, Zagreb, Croatia.,Zagreb Medical School, Zagreb University, Zagreb, Croatia
| | - Nives Ljubić
- Division of Cytology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Leila Perković
- Division of Cytology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Dunja Ivanović
- Division of Cytology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Leo Pažanin
- Ljudevit Jurak Department of Pathology and Cytology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - Dubravka Župnić-Krmek
- Division of Haematology, Clinical Department of Internal Medicine, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Fabijan Knežević
- Division of Pathology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
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Lanišnik B, Levart P, Čizmarevič B, Švagan M. Surgeon-performed ultrasound with fine-needle aspiration biopsy for the diagnosis of parotid gland tumors. Head Neck 2021; 43:1739-1746. [PMID: 33547678 DOI: 10.1002/hed.26630] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ultrasound (US) with or without fine-needle aspiration cytology (FNAC) are readily available and can offer in office and rapid diagnosis of parotid lumps. METHODS We analyzed 398 of patients who underwent blind FNAC or US with FNAC performed by an operating head and neck surgeon. Specificity, sensitivity, as well as accuracy were calculated for US alone, FNAC alone, and US-FNAC combined. RESULTS Nondiagnostic US-guided FNAC rate was 3.1% and 7.2% for blind FNAC. With those cases removed, final accuracy for US alone in diagnosis of malignancy, pleomorphic adenoma (PA), and Warthin tumor (WT) were 90.8%, 81%, and 77.4% respectively. For US-FNAC accuracy for malignancy, PA, and WT were 92.1%, 94 0.8%, and 95.4% respectively. CONCLUSION US with FNAC is cost-effective and rapid diagnostic tool and may help surgeon to deliver more accurate informed consent to a patient.
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Affiliation(s)
- Boštjan Lanišnik
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Primož Levart
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Bogdan Čizmarevič
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Matija Švagan
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center Maribor, Maribor, Slovenia
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Taniuchi M, Kawata R, Omura S, Haginomori SI, Terada T, Higashino M, Kurisu Y, Hirose Y. A novel clinically-oriented classification of fine-needle aspiration cytology for salivary gland tumors: a 20-year retrospective analysis of 1175 patients. Int J Clin Oncol 2020; 26:326-334. [PMID: 33219459 PMCID: PMC7819905 DOI: 10.1007/s10147-020-01816-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/15/2020] [Indexed: 01/23/2023]
Abstract
Background When determining treatment strategy for a salivary gland tumor, assessing histology and malignancy grade before surgery is essential. Several new diagnostic classification systems for salivary gland cytology have recently been proposed. However, none incorporate histology and grade of malignancy. Methods We developed a new cytology classification system that incorporates histology and grade of malignancy of salivary gland tumors (OMC classification), consisting of 11 categories. Our OMC classification was applied to 1175 patients who had preoperative cytology and confirmed final pathological diagnosis available from the past 20 years at our hospital (benign tumor: 981 patients, malignant tumor: 194 patients). Results Based on the cytology, 729 patients (62.0%) had benign histology (Category 4–1), and 87 patients (7.4%) were diagnosed with grade of malignancy (Category 6–3 + 6–4). Based on the final pathological diagnosis, the accuracy rate of Category 4–1 and Category 6–3 + 6–4 of our classification system was 93.4% and 88.5%, respectively. Conclusion Based on the correct diagnosis rate, the inclusion of histology and grade of malignancy in the salivary gland cytology classification was considered feasible. Thus, the OMC classification system is considered a useful tool when determining the treatment strategy for a salivary gland tumor.
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Affiliation(s)
- Masataka Taniuchi
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Shuji Omura
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shin- Ichi Haginomori
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Tetsuya Terada
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masaaki Higashino
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshitaka Kurisu
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
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Rivera Rolon M, Schnadig VJ, Faiz S, Nawgiri R, Clement CG. Salivary gland fine-needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6-year study. Diagn Cytopathol 2020; 48:1067-1074. [PMID: 32452653 DOI: 10.1002/dc.24478] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is based on risk stratification. We presented our experience with fine-needle aspiration cytology (FNAC) for the diagnosis of salivary glands lesions by applying the MSRSGC categorization to the cytological diagnoses, and determined risk of malignancy (ROM) for each category. METHODS Fine-needle aspiration cytology of salivary gland lesions performed over a 6-year period was retrieved. FNAC results were retrospectively categorized according to the MSRSGC criteria, and correlated with corresponding histologic follow-up. ROM for each diagnostic category was calculated. RESULTS A total of 208 FNAC of salivary gland lesions were reviewed and retrospectively categorized as: non-diagnostic (ND) 23 (11%), non-neoplastic (NN) 54 (26%), atypia of undetermined significance (AUS) 10 (4.8%), benign neoplasms (BN) 77 (37%), salivary gland of uncertain malignant potential (SUMP) 13 (6.3%), suspicious for malignancy (SM) 7 (3.4%), and malignant (M) 24 (11.5%). Histopathological follow-up was available for 84 of 208 cases (40.4%). Overall concordance rate between FNAC and histology was 78.8%. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 93.3%, 94.6%, 82.4%, and 98.2%, respectively. Diagnostic accuracy to distinguish benign from malignant disease was 94.4%. ROM for each category was ND 0%, NN 0%, AUS 75%, BN 2.2%, SUMP 28.6%, SM 50%, and M 100%. CONCLUSION Fine-needle aspiration cytology continues to be an accurate diagnostic tool for most salivary gland neoplasms showing classical morphologic features. However, difficult cases with unusual or overlapping features will occur. In these situations, the use of MSRSGC risk-stratification could be helpful to define appropriate management.
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Affiliation(s)
- Maria Rivera Rolon
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Vicki J Schnadig
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sara Faiz
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ranjana Nawgiri
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Cecilia G Clement
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
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10
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Borsetto D, Fussey JM, Cazzador D, Smith J, Ciorba A, Pelucchi S, Donà S, Boscolo-Rizzo P, Tomasoni M, Lombardi D, Nicolai P, Zanoletti E, Colangeli R, Emanuelli E, Osborne MS, Ahsan SF, Tofanelli M, Tirelli G, McNamara K, Liew L, Harrison K, Fassina A, Sarcognato S, Sharma N, Rao K, Pracy P, Nankivell P. The diagnostic value of cytology in parotid Warthin's tumors: international multicenter series. Head Neck 2019; 42:522-529. [PMID: 31762130 DOI: 10.1002/hed.26032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Warthin's tumor (WT) is a common benign salivary gland neoplasm with a negligible risk of malignant transformation. However, there is a risk of malignant tumors being misdiagnosed as WT on cytology and inappropriately managed conservatively. METHODS Patients from nine centers in Italy and the United Kingdom undergoing parotid surgery for cytologically diagnosed WT were included in this multicenter retrospective series. Definitive histology was compared with preoperative cytological diagnoses. Surgical complications were recorded. RESULTS A total of 496 tumors were identified. In 88.9%, the final histological diagnosis was WT. In 21 cases (4.2%) a malignant neoplasm was diagnosed, which had been incorrectly labeled as WT on cytology. CONCLUSIONS The risk of undiagnosed malignancy should be balanced against surgical risks when considering the management of WT. Although nonsurgical management remains an appropriate option, there may be a rationale for serial clinical or radiological evaluation if surgical excision is not performed.
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Affiliation(s)
- Daniele Borsetto
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Jonathan M Fussey
- Department of Otolaryngology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Diego Cazzador
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy.,Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Joel Smith
- Department of Otolaryngology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrea Ciorba
- ENT Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Sara Donà
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
| | - Roberta Colangeli
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
| | - Enzo Emanuelli
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
| | - Max S Osborne
- Head and Neck Department, Princess Royal Hospital, Telford, UK
| | - Syed F Ahsan
- Head and Neck Department, Princess Royal Hospital, Telford, UK
| | - Margherita Tofanelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | - Leonard Liew
- Department of ENT, New Cross Hospital, Wolverhampton, UK
| | - Katherine Harrison
- Department of Histopathology, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Ambrogio Fassina
- Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Samantha Sarcognato
- Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Neil Sharma
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Kanishka Rao
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Paul Pracy
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Paul Nankivell
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Kaushik R, Bhatia K, Sarin H, Gautam D, Sarin D. Incorporation of the Milan system in reporting salivary gland fine needle aspiration cytology—An insight into its value addition to the conventional system. Diagn Cytopathol 2019; 48:17-29. [DOI: 10.1002/dc.24321] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/21/2019] [Accepted: 09/04/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Richa Kaushik
- Department of Pathology and Laboratory MedicineMedanta, The Medicity Gurgaon India
| | - Khyati Bhatia
- Department of ENT & Head and Neck surgeryMedanta, The Medicity Gurgaon India
| | - Haimanti Sarin
- Cytopathology, Department of Pathology and Laboratory MedicineMedanta, The Medicity Gurgaon India
| | - Dheeraj Gautam
- Department of Pathology and Laboratory MedicineMedanta, The Medicity Gurgaon India
| | - Deepak Sarin
- Department of Head & Neck OncosurgeryMedanta, The Medicity Gurgaon India
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So T, Sahovaler A, Nichols A, Fung K, Yoo J, Weir MM, MacNeil SD. Utility of clinical features with fine needle aspiration biopsy for diagnosis of Warthin tumor. J Otolaryngol Head Neck Surg 2019; 48:41. [PMID: 31464652 PMCID: PMC6716907 DOI: 10.1186/s40463-019-0366-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
Abstract
Background Conservative management of Warthin tumor (WT) may be a viable alternative to surgery, but there are concerns of missed malignancies on fine needle aspiration biopsy (FNAB). The purpose of this study is to measure the sensitivity and positive predictive value of FNAB for WT, and to identify clinical features associated with WT that can aid in this diagnosis. Methods Retrospective analysis of patients from January 1, 2006 to April 30, 2017 at a tertiary care center in London, Ontario, Canada. All patients with a diagnosis of WT on FNAB or resection were included. Electronic medical records were identified for 177 patients that fit the criteria. Study outcomes included the sensitivity and positive predictive value of FNAB alone for WT, and, when including clinical features associated with WT. Results The mean age of patients in this study was 63.2 years (SD 10.4); 115 (65%) were male, and 157 (89%) were past or present smokers. The measured sensitivity and positive predictive value of FNAB for WT were 95.8 and 97.2% respectively. Two cases were classified as WT on FNAB but confirmed at resection as mucoepidermoid carcinoma and acinic cell carcinoma. When only patients with multifocal, bilateral or incidental tumors were assessed, sensitivities and positive predictive values for each were 100%. Isolating for inferior pole location also resulted in a positive predictive value of 100%. Conclusions The sensitivity and positive predictive value of FNAB for WT in this study are high, with two false negatives on FNAB. Multifocal, bilateral, incidentaloma and inferior pole location were identified as potential clinical features that may increase the diagnostic confidence for WT, strengthening the argument for conservative management in these patients. Overall, this study serves as an initial exploration into whether clinical features may be included with FNAB results to improve the sensitivity and positive predictive value of diagnosing WT. Further research is necessary before these findings can be translated into clinical practice.
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Affiliation(s)
- Thomas So
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada
| | - Michele M Weir
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada. .,Victoria Hospital, Suite B3-429, 800 Commissioners Rd E, 31, London, ON, N6A 5W9, Canada.
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13
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Ogawa T, Kojima I, Ishii R, Sakamoto M, Murata T, Suzuki T, Kato K, Nakanome A, Ohkoshi A, Ishida E, Kakehata S, Shiga K, Katori Y. Clinical utility of dynamic-enhanced MRI in salivary gland tumors: retrospective study and literature review. Eur Arch Otorhinolaryngol 2018; 275:1613-1621. [PMID: 29623392 DOI: 10.1007/s00405-018-4965-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/31/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE To improve the diagnoses of the salivary gland tumors, a dynamic-enhanced MRI (dMRI) was investigated. METHODS We conducted a retrospective chart review of 93 cases of salivary gland tumors. The histological diagnoses were obtained from all patients using a surgical specimen and/or an open biopsy specimen. The dMRI as well as fine-needle aspiration cytology (FNAC) and intraoperative frozen section (IFS) were analyzed. This study focused on the time-intensity curve (TIC) after injection, peak time (Tpeak), washout ratio (WR) as well as the gradient of enhancement and washout profile. RESULTS The histological diagnoses included pleomorphic adenoma (PMA) in 53 cases, the Warthin tumors (WT) in 14 cases and malignant tumors (MT) in 26 cases. Incorrect diagnosis rate of FNAC and IFS were 5.2 and 8.3%, respectively. The TIC revealed differences among the three types of tumors. Tpeak as well as WR also revealed significant differences (p < 0.001). Tpeak were lower in order of WT, MT, PMA, respectively. WR of TICs at 30, 45 and 105 s after Tpeak were higher in order of WT, MT, PMA, respectively (p < 0.001). The gradient of increment and washout in the TIC curve was also an important parameter to distinguish the three types of tumors. In MT, the rapid enhancement pattern was found in high or intermediate histological grade tumors, whereas the slow enhancement pattern was exhibited in low grade tumors. CONCLUSIONS Our findings indicate that using Tpeak and WR, it is possible to distinguish between WT, PMA and MT. Additionally, a rapid enhancement pattern may be a potential marker for these tumors.
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Affiliation(s)
- Takenori Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Ikuho Kojima
- Department of Oral Diagnosis, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ryo Ishii
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Maya Sakamoto
- Department of Oral Diagnosis, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takaki Murata
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takahiro Suzuki
- Department of Otorhinolaryngology, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aobaku, Sendai, Miyagi, 981-8558, Japan
| | - Kengo Kato
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ayako Nakanome
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Eiichi Ishida
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Seiji Kakehata
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University School of Medicine, Yamagata, 990-9585, Japan
| | - Kiyoto Shiga
- Department of Head and Neck Surgery, Iwate Medical University, Morioka, 090-8505, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Sood N, Borah P. Warthins tumor: Cyto histological spectrum with emphasis on diagnostic difficulties. Diagn Cytopathol 2018; 46:613-619. [PMID: 29399982 DOI: 10.1002/dc.23896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/15/2018] [Accepted: 01/23/2018] [Indexed: 11/12/2022]
Abstract
Warthins tumour is characterized by the presence of epithelial proliferation in a lymphoid stroma. It has been categorized as Sieferts types: 1-4, depending on the proportions of the 2 components. Although FNA is fairly accurate in establishing the diagnosis, the cytologic diagnosis of this tumor has potential sources of error. This retrospective study was conducted in the Department of Pathology and Lab Medicine, of a tertiary care hospital. Cytology and surgical pathology records of past 15 years were screened. A total of 1200 FNAC cases of salivary gland lesions in the past 15 years were retrieved. 36 cases with presumptive cytodiagnosis of WT were identified and histopathological correlation was done. Histopathological correlation could be done in 24 cases. 19 out of 24 cases, were confirmed as WT. The 5 cases with discordance were analyzed for potential diagnostic pitfalls. The most common discordance was in the category of papillary proliferation with minimal lymphoid infiltrate. One case proved as oncocytoma and the other was papillary oncocyticcystadenoma. The other major pitfalls, were the interpretation of atypical squamoid cells. Their presence in a lymphoid background needs consideration of cytologic diagnosis of WT, mucoepidermoid carcinoma and metastatic squamous carcinoma. FNA showed an accuracy of 79% for WT. Cytological misinterpretation can thus occur in presence of morphology other than classical Siefert type1. An awareness of these potential pitfalls should push the need for avoiding single cytologic interpretation.
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Affiliation(s)
- Neelam Sood
- Department of Pathology and Lab Medicine, DeenDayalupadhay Hospital, Govt of NCT, Delhi, Harinagar, New Delhi, India
| | - Parismrita Borah
- Department of Pathology and Lab Medicine, DeenDayalupadhay Hospital, Govt of NCT, Delhi, Harinagar, New Delhi, India
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15
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Vasudevan G, Bishnu A, Singh BMK, Singh VK. Mucoepidermoid Carcinoma of Salivary Gland: Limitations and Pitfalls on FNA. J Clin Diagn Res 2017; 11:ER04-ER06. [PMID: 28658793 DOI: 10.7860/jcdr/2017/25341.9941] [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: 11/12/2016] [Accepted: 02/05/2017] [Indexed: 11/24/2022]
Abstract
Mucoepidermoid Carcinoma (MEC) is the most common malignant neoplasm of salivary gland origin. However, its morphologic heterogeneity poses difficulty in interpretation. In the present series we discuss the morphologic features of MEC, limitations and pitfalls in its diagnosis on Fine Needle Aspiration Cytology (FNAC). Fourteen cases of suspected MEC were evaluated cytologically followed by histopathological examination for confirmation. A definite cytological diagnosis was rendered in nine cases; three of the remaining five were underdiagnosed as abscess, pleomorphic adenoma and mucus cyst. Of the remaining two cases, one case each of sebaceous carcinoma and sialadenitis was mislabeled as MEC on cytology. A satisfactory aspirate composed of intermediate cells, mucin secreting cells and squamous cells in a mucinous background may not be obtained in all cases of low grade MEC. High grade MEC can be classified as squamous cell carcinoma. Hence, awareness of confounding factors with clinicopathologic correlation and judicious use of frozen section can help in minimizing errors.
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Affiliation(s)
- Geetha Vasudevan
- Additional Professor, Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Arijit Bishnu
- Assistant Professor, Department of Pathology, Melaka Manipal Medical College, Manipal University, Manipal, Karnataka, India
| | - Brij Mohan Kumar Singh
- Assistant Professor, Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Varun Kumar Singh
- Junior Resident, Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Kawata R, Terada T, Lee K, Higashino M, Ichihara S. [Surgical Management for Benign Parotid Tumors: Review of a 16-year Experience with 633 Patients]. ACTA ACUST UNITED AC 2016; 119:196-203. [PMID: 27244905 DOI: 10.3950/jibiinkoka.119.196] [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: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the diagnosis and postoperative complications of benign parotid tumors for a series of 633 patients who underwent the same diagnostic methods and operation procedure in a single institute. MATERIALS & METHODS A series of 633 patients who underwent parotidectomy for benign parotid tumors over a 16-year period was reviewed. RESULTS There were 345 female and 288 male patients. The site of the tumors was divided among three groups, superficial, deep, and lower pole tumors. The numbers of each type of above tumors were 342, 122, and 169 cases, respectively. The most common pathology of the parotid tumor was a pleomorphic adenoma (372 cases) followed by a Warthin tumor (166 cases). Pleomorphic adenomas and Warthin tumors accounted for 85% of all benign tumors. The accuracy rate of fine needle aspiration cytology (FNAC) for all benign tumors was 71%, 84% for pleomorphic adenomas and 72% for Warthin tumors. Transient facial nerve dysfunction was observed in 130 patients (21%) in 612 cases of primary benign parotid tumors, and only one patient developed a permanent weakness. The incidence of transient facial nerve dysfunction was 18% in superficial tumors, 39% in deep tumors, and 15% in lower pole tumors. Significant risk factors for development of a transient facial palsy were the site of the tumors, the size of the tumors, operation time, and bleeding volume. Among these risk factors, for the site of the tumors, the deep lobe was the most important factor associated with transient facial nerve dysfunction. Transient facial nerve dysfunction recovered within 6 months in 90% of all cases. CONCLUSIONS The accuracy rate of FNAC for benign parotid tumors was 72%. The incidence of transient facial nerve dysfunction in deep tumors was significantly higher compared to that in superficial and lower pole tumors. According to the rate of facial palsy, operation time, and bleeding volume, benign parotid tumor should be divided among three groups, namely superficial, deep, and lower pole tumors.
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17
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Warthin's tumor of parotid gland: Surgery or follow-up? Diagnostic value of a decisional algorithm with functional MRI. Diagn Interv Imaging 2016; 97:37-43. [DOI: 10.1016/j.diii.2014.11.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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18
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Liu CC, Jethwa AR, Khariwala SS, Johnson J, Shin JJ. Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2016; 154:9-23. [PMID: 26428476 PMCID: PMC4896151 DOI: 10.1177/0194599815607841] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/02/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES (1) To analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease. (2) To determine the anticipated posttest probability of malignancy and probability of nondiagnostic and indeterminate cytology with parotid FNA. DATA SOURCES Independently corroborated computerized searches of PubMed, Embase, and Cochrane Central Register were performed. These were supplemented with manual searches and input from content experts. REVIEW METHODS Inclusion/exclusion criteria specified diagnosis of parotid mass, intervention with both FNA and surgical excision, and enumeration of both cytologic and surgical histopathologic results. The primary outcomes were sensitivity, specificity, and posttest probability of malignancy. Heterogeneity was evaluated with the I(2) statistic. Meta-analysis was performed via a 2-level mixed logistic regression model. Bayesian nomograms were plotted via pooled likelihood ratios. RESULTS The systematic review yielded 70 criterion-meeting studies, 63 of which contained data that allowed for computation of numerical outcomes (n = 5647 patients; level 2a) and consideration of meta-analysis. Subgroup analyses were performed in studies that were prospective, involved consecutive patients, described the FNA technique utilized, and used ultrasound guidance. The I(2) point estimate was >70% for all analyses, except within prospectively obtained and ultrasound-guided results. Among the prospective subgroup, the pooled analysis demonstrated a sensitivity of 0.882 (95% confidence interval [95% CI], 0.509-0.982) and a specificity of 0.995 (95% CI, 0.960-0.999). The probabilities of nondiagnostic and indeterminate cytology were 0.053 (95% CI, 0.030-0.075) and 0.147 (95% CI, 0.106-0.188), respectively. CONCLUSION FNA has moderate sensitivity and high specificity in differentiating malignant from benign parotid lesions. Considerable heterogeneity is present among studies.
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Affiliation(s)
- C Carrie Liu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonas Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Synchronous Ipsilateral Parotid Tumors with Cytologic-Histologic Correlation. Head Neck Pathol 2015; 10:265-8. [PMID: 26440804 PMCID: PMC4838957 DOI: 10.1007/s12105-015-0658-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/01/2015] [Indexed: 10/23/2022]
Abstract
Synchronous ipsilateral tumor formation within a major salivary gland is a very rare event. In this case, a 54-year-old female tobacco smoker presented with a slowly enlarging left parotid gland. Computed tomography of the neck demonstrated a solid mass superficial to a cystic mass in the deep lobe of the gland. Ultrasound-guided fine needle aspiration yielded oncocytic cells, lymphoid cells, and granular debris along with rare cohesive groups of basaloid cells. Parotidectomy was performed, and the resected gland was found to contain two adjacent but distinct masses. One mass, a predominantly solid, well-circumscribed lesion composed of ribbons of double-layered oncocytic cells and a lymphoid stroma with germinal center formation, was a Warthin tumor. The other mass, a predominantly cystic lesion composed of cords and nests of basaloid cells with associated deposits of basement membrane-like material, was a basal cell adenoma of the membranous type. To our knowledge, this is the first reported case of synchronous Warthin tumor and basal cell adenoma of the parotid gland with cytologic-histologic correlation attributable to each tumor.
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Schwalje AT, Uzelac A, Ryan WR. Growth rate characteristics of Warthin's tumours of the parotid gland. Int J Oral Maxillofac Surg 2015; 44:1474-9. [PMID: 26314235 DOI: 10.1016/j.ijom.2015.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to evaluate growth characteristics of parotid gland Warthin's tumours. The medical records of 134 patients who had a cytological or histopathological diagnosis of Warthin's tumour between 1997 and 2013, at a single tertiary care centre, were reviewed retrospectively. Thirteen of these patients underwent observation with 30 serial computed tomography or magnetic resonance imaging scans of the head and neck, with 24 Warthin's lesions identified. The mean length of time between scans was 882 days, and mean initial and final sizes per lesion were 3.9 cm(3) and 5.6 cm(3), respectively. Average growth of these lesions was 8% per year (95% confidence interval -27% to 43%; range -148% to 460%; median -8%), and was highly variable (standard deviation 96%). Age over 75 years was associated with slower growth (P=0.03), but gender, smoking status, multifocality, bilaterality versus unilaterality, and initial size did not correlate with the growth rate. Warthin's tumours appear to have an approximate average doubling time of 9 years, but can have a wide range of growth rates, with many cases showing a reduction in size. Either conservative management or surgical resection could be supported by these data, depending on the current size of the tumour, appearance, symptoms, and the age, health, and wishes of the patient.
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Affiliation(s)
- A T Schwalje
- School of Medicine, University of California - San Francisco, San Francisco, CA, USA
| | - A Uzelac
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA
| | - W R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, CA, USA.
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21
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Routine non-thyroid head and neck cytology in a large UK centre: clinical utility and pitfalls. The Journal of Laryngology & Otology 2015; 129:682-7. [DOI: 10.1017/s0022215115000092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:This study aimed to examine the performance of head and neck cytology at Nottingham University Hospitals between 2009 and 2010.Methods:Cases were extracted from the Winpath pathology reporting system and correlations were investigated between results and the histological and clinical outcomes. Specimen adequacy and the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the cytology tests were calculated.Results:In all, 19.7 per cent of aspirates were judged to be inadequate. The absolute and relative sensitivities of head and neck cytology were 87.0 per cent and 89.0 per cent, respectively, and the absolute and relative specificities were 99.0 per cent and 97.0 per cent, respectively. The positive predictive values were 99.0 per cent and 96.0 per cent and the negative predictive values were 92.0 per cent and 92.0 per cent for a diagnostic accuracy of 94.5 per cent and 93.0 per cent. The performance was consistent with previous reports and superior to that of a recent UK series. The high rate of inadequate samples is, however, a concern.Conclusion:Head and neck cytology is a robust technique at our institution, although there are certain problem areas. There is room for improvement in the technical quality of fine needle aspiration.
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23
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Zerpa Zerpa V, Cuesta Gonzáles MT, Agostini Porras G, Marcano Acuña M, Estellés Ferriol E, Dalmau Galofre J. [Diagnostic accuracy of fine needle aspiration cytology in parotid tumours]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 65:157-61. [PMID: 24598025 DOI: 10.1016/j.otorri.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Fine needle aspiration cytology (FNAC) is a globally accepted technique in the preoperative evaluations of head and neck tumours; however, the effectiveness in the interpretation of salivary glands neoplastic lesions is still controversial. The objective of this study consisted of assessing the efficacy of FNAC in preoperative diagnosis of parotid tumours. METHODS This retrospective study was conducted using 93 patient samples with parotid gland tumoral pathology, treated at the Otorhinolaryngology Department in our institution during the 2007-2011 period. Preoperative FNAC was employed and the patients subsequently submitted to surgical excision with histopathological diagnosis of the specimen. Cytology results were classified as negative for malignancy, positive for malignancy or insufficient sample, and later compared with the definitive histological diagnosis. RESULTS The mean age of the studied sample was 52.9 years (range: 11 to 88 years); 55.9% were men. The FNAC showed significant sensitivity of 57.1%, with a specificity of 95.1%, for detecting malignancy in parotid gland tumours. The positive and negative predictive values for malignancy were 50 and 96.3%, respectively. CONCLUSIONS FNAC is considered a simple test but of limited use for diagnostic guidance in tumour pathology of the parotid gland in our environment, mainly because of its low sensitivity. However, the high specificity and high negative predictive value of FNAC makes it a more accurate test in benign or negative result cases.
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Affiliation(s)
- Vanessa Zerpa Zerpa
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Valencia, España.
| | | | | | - Martin Marcano Acuña
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Valencia, España
| | | | - José Dalmau Galofre
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Valencia, España
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Lee DH, Yoon TM, Lee JK, Lim SC. Clinical utility of fine needle aspiration cytology in pediatric parotid tumors. Int J Pediatr Otorhinolaryngol 2013; 77:1272-5. [PMID: 23726957 DOI: 10.1016/j.ijporl.2013.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/06/2013] [Accepted: 05/07/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of pediatric parotid tumors. METHODS From June 2002 to June 2012, 22 patients ≤18-years-of-age with parotid mass were treated at Chonnam National University Hospital. Included in the study were 21 cases with preoperative FNAC. A retrospective chart review analyzed the results of FNAC and compared them with the corresponding histopathological diagnosis. RESULTS Twenty-one of the 22 patients had undergone preoperative FNAC, which diagnosed pleomorphic adenoma in 13 patients. The remaining eight patients were diagnosed with benign tumor (n = 6), malignant tumor (n = 1) or Kimura disease (n = 1). All 21 patients underwent parotid tumor removal. FNAC had a diagnostic sensitivity of 92.3%, positive-predictive value of 92.3% and accuracy of 90.5% for diagnosing pleomorphic adenoma of pediatric parotid tumor. FNAC had a diagnostic sensitivity of 100%, a positive-predictive value of 85% and accuracy of 85.7% for diagnosing benign parotid tumor. CONCLUSIONS Preoperative FNAC is a useful and accurate adjunct for preoperative evaluation of pediatric parotid tumors. We recommend that preoperative FNAC should be part of the initial evaluation of pediatric patients with parotid masses.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea.
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Jeong WJ, Park SJ, Cha W, Sung MW, Kim KH, Ahn SH. Fine needle aspiration of parotid tumors: diagnostic utility from a clinical perspective. J Oral Maxillofac Surg 2013; 71:1278-82. [PMID: 23540432 DOI: 10.1016/j.joms.2013.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/12/2013] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The utility of fine needle aspiration (FNA) for parotid tumors is limited owing to its low diagnostic accuracy. In this study, the authors sought to analyze and interpret FNA results for parotid tumors from a clinical perspective. MATERIALS AND METHODS Parotid tumors subjected to preoperative FNA and subsequent complete excision were the subject of this study. Patient demographics, medical records, FNA findings, and final pathology of 158 consecutive cases were analyzed. RESULTS The accuracy of FNA was 77.8%. The positive predictive value and likelihood ratio for malignancy were 90.0% and 52.8% (95% confidence interval, 7.02-397), respectively. The positive predictive value and likelihood ratio for benign pathology of Warthin tumor plus pleomorphic adenoma were 97.8% and 7.67% (2.03-29.0), respectively. CONCLUSIONS The FNA diagnosis of Warthin tumor or pleomorphic adenoma is reliable and can be safely regarded as a benign tumor. Based on the high positive predictive value and likelihood ratio, FNA of the parotid gland can offer valuable information in surgical planning and patient counseling in many centers.
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Affiliation(s)
- Woo-Jin Jeong
- Seoul National University Bundang Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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Jo HJ, Ahn HJ, Jung S, Yoon HK. Diagnostic difficulties in fine needle aspiration of benign salivary glandular lesions. KOREAN JOURNAL OF PATHOLOGY 2013; 46:569-75. [PMID: 23323108 PMCID: PMC3540335 DOI: 10.4132/koreanjpathol.2012.46.6.569] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/24/2012] [Accepted: 10/15/2012] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Hye Jung Jo
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Kawata R, Lee K, Yoshimura K, Nishimawa S, Araki M. [Review of 300 cases of parotidectomy for benign parotid tumors]. ACTA ACUST UNITED AC 2012; 115:618-24. [PMID: 22844822 DOI: 10.3950/jibiinkoka.115.618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the diagnosis and postoperative complications of benign parotid tumors for a series of 300 patients who underwent the same diagnostic methods and operation procedure in a single institute. MATERIALS & METHODS A series of 300 patients who underwent primary parotidectomy for benign parotid tumors over a 12-year period was reviewed. RESULTS There were 145 female and 155 male paitents. The site of the tumors was divided into three groups, superficial, deep, and lower pole tumor. The number of each type of the tumor was 152, 45, 103 cases, respectively. The most common pathology of the parotid tumor was a pleomorphic adenoma (147 cases) followed by a Warthin tumor (111 cases). Pleomorphic adenomas and Warthin tumors accounted for 86% of all benign tumors. The accuracy rate of fine needle aspiration cytology (FNAC) for all benign tumors was 66%, 80% for pleomorphic adenoma and 67% for Warthin tumor. Transient facial nerve dysfunction was observed in 63 patients (20.3%) in all benign parotid tumors, and no patients developed a permanent weakness. The incidence of transient facial nerve dysfunction was 16.4% in superficial tumors, 55.3% in deep tumors, and 10.7% in lower pole tumors. Significant risk factors for development of a transient facial palsy were the site of tumors, operation time, and bleeding volume. Transient facial nerve dysfunction recovered with 1.7 months and 2.8 months in superficial and deep tumors, respectively. CONCLUSIONS The accuracy rate of FNAC for benign parotid benign tumors was 66%. The incidence of transient facial nerve dysfunction in deep tumors was significantly higher compared to that in superficial and lower pole tumors. According to the rate of facial palsy, operation time, and bleeding volume, benign parotid tumor should be divided into three groups, superficial, deep, and lower pole tumors.
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Affiliation(s)
- Ryo Kawata
- Department of Otolaryngology, Osaka Medical College, Takatsuki
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Naujoks C, Sproll C, Singh DD, Heikaus S, Depprich R, Kübler NR, Handschel J. Bilateral multifocal Warthin's tumors in upper neck lymph nodes. Report of a case and brief review of the literature. Head Face Med 2012; 8:11. [PMID: 22472434 PMCID: PMC3342104 DOI: 10.1186/1746-160x-8-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 04/03/2012] [Indexed: 12/13/2022] Open
Abstract
Cystadenolymphomas (Warthin's tumors) are the second most frequent lesions of the parotid gland. Due to their benign clinical behavior, the low rates of recurrence and malignant transformation they were classified as tumor-like lesions. In addition, a polyclonal growth of the epithelial components of the tumor could be detected. Warthin's tumors occur bilateral in 7-10%, whereas a multifocal appearance is extremely rare. Even if the pathogenesis is still unclear a heterotopia of salivary tissue during embryogenesis is the most likely explanation for the origin of these tumors in the upper neck and periparotideal region. Here we present a rare case of bilateral, multifocal, extraglandular Warthin's tumors in lymph nodes of the upper neck and give a brief review of the literature. If a primary malignancy can be excluded by a careful staging procedure prior to the operation an isolated excision of the lesions of the neck is the adequate treatment.
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Affiliation(s)
- Christian Naujoks
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-Universität, Moorenstr, 5, D-40225 Düsseldorf, Germany
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Ogawa T, Suzuki T, Sakamoto M, Watanabe M, Tateda Y, Oshima T, Kato K, Sagai S, Kobayashi T, Shiga K. Correct Diagnosis of Warthin Tumor in the Parotid Gland with Dynamic MRI. TOHOKU J EXP MED 2012; 227:53-7. [DOI: 10.1620/tjem.227.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takenori Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine
| | - Takahiro Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine
| | - Maya Sakamoto
- Department of Oral Diagnosis, Tohoku University School of Dentistry
| | - Mika Watanabe
- Department of Pathology, Tohoku University School of Medicine
| | - Yutaka Tateda
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine
| | - Takeshi Oshima
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine
| | - Kengo Kato
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine
| | - Shun Sagai
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine
| | - Toshimitsu Kobayashi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine
| | - Kiyoto Shiga
- Department of Otolaryngology-Head and Neck Surgery, Iwate Medical University
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