Fine-needle aspiration of parotid gland lesions

Cytologic diagnosis of parotid gland Warthin tumor: Systematic review and meta-analysis

It is important to define the accuracy of fine‐needle aspiration cytology (FNAC) in the diagnosis of Warthin tumor (WT). This systematic review and meta‐analysis evaluated the accuracy of FNAC in the diagnosis of WT in the parotid gland and WT growth rate. For determination of FNAC accuracy, 17 studies, encompassing 1710 cases, were included. Pulled random model estimates of sensitivity, specificity, PPV, and NPV were 93.7% (95%CI: 92.1, 95.3), 97.9% (95%CI: 97, 98.9), 93.3% (95%CI: 91.5, 95.1), and 97.4% (95%CI: 96.4, 98.4), respectively. FNAC is highly reliable for the diagnosis of WT of the parotid. The high PPV value suggests that patients with a cytological diagnosis of WT of the parotid may be assigned to active surveillance.

Diagnostic accuracy of ultrasonography-guided core needle biopsy of parotid gland neoplasms: A large, single-institution experience in United Kingdom

Salivary gland tumours present a pleomorphic and complex morphology and, apart from the most common neoplasms with well-established histopathological criteria, may create diagnostic difficulty for histopathologists. The majority of salivary gland tumours occur in the parotid gland and the use of ultrasound guided parotid biopsy (US-PB) has increased. US-PB in contrast with fine needle aspiration (FNA), which is an easy and relatively painless technique, is performed under local anaesthesia, usually by radiologists. US-PB offers some advantages over the FNA such as tumour grading and the possibility of performing immunohistochemistry. We report our experience of the diagnostic value of US-PB in a large, referral centre in the United Kingdom.

Breast Cancer Recurrence Presenting as Solitary Intraparotid Nodal Metastasis Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography: A Very Unusual Occurrence

Primary malignancies of the salivary gland itself are uncommon, while secondary metastatic deposits are further very rare with description of only few case reports in the literature. The most common site of metastatic deposit to parotid gland is from squamous cell malignancies of head and neck, while secondary deposits from primary in infraclavicular location are very rarely described. We herein describe the case of an elderly lady who while on adjuvant endocrine therapy developed metastatic disease with right intraparotid node as the sole site of metastasis detected on FDG PET scan. This type of presentation of recurrence is very uncommon, especially in hormonal receptor-positive cases, with <30 cases described in the literature to the best of our knowledge. This patient underwent metastasectomy followed by palliative the second-line hormonal therapy and achieved long-term survival more than usually seen with other metastatic breast cancers highlighting the importance of metastasectomy in metastatic breast cancer patients on hormonal therapy who develop metachronous oligometastatic disease.

Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration: A Systematic Review and Meta-analysis

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.

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.

Accuracy of fine-needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically

OBJECTIVES/HYPOTHESIS

Fine-needle aspiration (FNA) biopsy and imaging are commonly used in the preoperative assessment of salivary gland mass lesions. The goal of this retrospective study was to clarify the role of FNA and imaging in the workup of salivary gland masses.

STUDY DESIGN

Retrospective cohort study.

METHODS

A computer search identified patients with an FNA of a salivary gland lesion with subsequent excision during a 10-year study period. Chart review of study patients was performed, and information on site of lesion, age, gender, radiologic diagnosis, pain in the tumor area, and facial paralysis was recorded and analyzed.

RESULTS

There were 543 patients who had an FNA and subsequent histopathology. The majority of the tumors were in the parotid gland (n = 492, 90.9%), followed by submandibular gland (n = 45, 8.3%). The incidence of malignancy across all sites was 29.7%. The mean patient age was 54.1 years, and 54.1% were female. The sensitivity and specificity of FNA were 85.7% and 99.5%, respectively. Positive predictive value (PPV) was 98.6%, and negative predictive value (NPV) was 94.3%. A total of 464 patients had available radiologic studies. For the radiological diagnoses, sensitivity was 81.8% and specificity was 67.3%, whereas PPV and NPV were 52.7% and 89.3%, respectively.

CONCLUSIONS

FNA is a reliable method of preoperatively assessing both benign and malignant salivary gland lesions. Preoperative imaging has a lower sensitivity and specificity than FNA in differentiating malignant from benign tumors. Older age, pain, and facial paralysis are clinical features independently associated with malignancy.

Comparison of ultrasonographically guided fine-needle aspiration and core needle biopsy in the diagnosis of parotid masses

BACKGROUND

To retrospectively compare the accuracies of ultrasound-guided fine-needle aspiration (USFNA) and ultrasound-guided core needle biopsy (USCNB) in the diagnosis of parotid masses.

METHODS

A total of 171 patients (aged 17-86 years, mean 54 years) with parotid masses (35 malignant and 136 benign lesions) underwent either USFNA (n = 107) or USCNB (n = 64). The diagnostic accuracies for differentiating benign from malignant lesions of both examinations were compared. Surgical histopathology (n = 104) and clinical diagnosis (n = 67) were used to establish the final diagnoses.

RESULTS

USCNB had a significantly higher sensitivity (94.1%) than USFNA (55.6%) (p < 0.05) in differentiating benign lesions from malignant conditions. The specificity and overall accuracy of USCNB were higher than those of USFNA (100% and 98.4% versus 93.3% and 86.9%, respectively). USCNB provided more specific diagnosis than USFNA (100% versus 93.3%, p < 0.05). All six patients with lymphomas who underwent USCNB were accurately diagnosed, whereas all four patients with lymphomas who underwent USFNA were not.

CONCLUSIONS

USCNB should be preferred to USFNA when a definite diagnosis of a parotid solid mass is needed.

Diagnostic value of ultrasound-guided core needle biopsy in patients with salivary gland masses

The salivary glands are unique in the diversity and complexity of their pathologies. Because fine needle aspiration cytology and frozen section are associated with major diagnostic difficulties, the authors analyzed the use of core needle biopsy (CNB) for the histologic assessment of salivary gland lesions. A systematic observational clinicopathologic quality assessment study was performed over 81 months including 161 CNB procedures in 76 patients with salivary gland pathologies. Adequate samples containing the target tissue were obtained in 73 patients. These samples revealed malignant disease in 45 (62%) patients, benign disease in 26 (36%) patients, and were inconclusive in 2 (3%) patients. Follow-up uncovered no false-positive or false-negative results. On the basis of secondary histologic and clinical follow-up, the statistical parameters were calculated as follows: sensitivity 94%; specificity 100%; accuracy 96%; positive predictive value 100%; negative predictive value 90%. The advantages and potential limitations of CNB in patients with salivary gland masses are discussed. CNB is a reliable biopsy technique for the assessment of salivary gland pathologies, although limitations remain for the subclassification of some neoplastic lesions. The authors recommend CNB as the biopsy technique of choice for a selection of indications.

Fine-needle aspiration cytology of salivary gland tumours: a 10-year retrospective analysis

INTRODUCTION

The aim of this study was to evaluate the sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of fine-needle aspiration cytology (FNAC) of salivary gland tumours performed at a tertiary cancer hospital over a time period of 10 years.

MATERIALS AND METHODS

A retrospective analysis was carried out between 1995 and 2004 to review the cases of patients with salivary gland tumours who had undergone pre-operative FNA and for whom definite histology was either by tru-cut biopsy or by histopathological examination of the operative specimen.

RESULTS

A total of 107 cases of salivary gland tumours were treated during that period, but only 82 cases diagnosed by FNAC could be correlated with histological and clinical data and were considered for this study. The sensitivity, specificity, diagnostic accuracy, PPV and NPV were estimated considering 54 benign and 28 malignant cases. Sensitivity was 90% (28/31), specificity was 98% (54/55), diagnostic accuracy was 95.1% (82/86), PPV was 96% and NPV was 94%.

DISCUSSION

This study confirms that FNA cytology is a technique that offers high sensitivity, specificity and diagnostic accuracy in salivary gland tumour diagnosis.

A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology for parotid gland lesions

The clinical usefulness of fine-needle aspiration cytology (FNAC) for the diagnosis of parotid gland lesions is controversial. Many accuracy studies have been published, but the literature has not been adequately summarized. We identified 64 studies on the diagnosis of malignancy (6,169 cases) and 7 studies on the diagnosis of neoplasia (795 cases). The diagnosis of neoplasia (area under the summary receiver operating characteristic [AUSROC] curve, 0.99; 95% confidence interval [CI], 0.97-1.00) had higher accuracy than the diagnosis of malignancy (AUSROC, 0.96; 95% CI, 0.94-0.97). Several sources of bias were identified that could affect study estimates. Studies on the diagnosis of malignancy showed significant heterogeneity (P < .001). The subgroups of American, French, and Turkish studies showed greater homogeneity, but the accuracy of these subgroups was not significantly different from that of the remaining subgroup. It is not possible to provide a general guideline on the clinical usefulness of FNAC for parotid gland lesions owing to the variability in study results. There is a need to improve the quality of reporting and to improve study designs to remove or assess the impact of bias.

Role of fine-needle aspiration cytology in swellings of the parotid region

To report the role of preoperative fine-needle aspiration cytology (FNAC) in patients with swellings in the parotid region at a tertiary care center. Prospective study of FNAC results compared with final histologic diagnosis as the standard criterion. An academic tertiary care center. A consecutive series of 51 patients who underwent FNAC of swellings in the parotid region between 2007 and 2009, of whom 41 had surgical resection. Predictive value, sensitivity, specificity, and accuracy. FNAC was performed in all the 51 patients who presented with a swelling in the parotid region in the out patient department in our hospital. Sixteen patients (31.4 %) were diagnosed to have malignancy, thirty patients (58.8 %) were diagnosed as benign condition. The FNAC was not satisfactory in 5 patients (9.8%) even after repeated aspiration. The FNAC diagnosis of malignant or suspicious lesion of the parotid region had positive and negative predictive values of 90 % and 96.66%, respectively. The diagnostic accuracy of FNAC is 95 %. We strongly recommend FNAC as a safe and accurate and less expensive method for preoperative diagnosis of the swellings in the parotid region.

Metastatic involvement of parotid from carcinoma of the breast--a case report

INTRODUCTION

Involvement of parotid gland by metastases from distant primary malignant tumors is rare.

CASE REPORT

A 42-year-old female having right breast cancer had reported to the Department of Oral Diagnosis and Medicine with a chief complaint of a swelling in the left parotid gland region for 2 months. On the basis of clinical findings, the primary malignancy of parotid gland was provisionally suspected.

DISCUSSION

Microscopic examination of parotid and breast revealed that parotid gland was involved as a distant metastases from a breast carcinoma, indicating that a swelling in the parotid needs to be assessed and investigated very carefully.

Primary and non-primary parotid malignancies: comparison of treatment modalities and outcomes

Our aim was to report our experience in the management of malignant primary and non-primary parotid neoplasms and to compare the clinical presentations, the treatment modalities and the outcomes in these two groups. We performed a retrospective review of the clinical and surgical data contained in patient files. Between January 1995 and December 2004, 60 patients with malignant parotid tumors were admitted to our department. Two groups were isolated: a group of 42 patients with primary parotid malignancies (group 1) and a group of 18 patients with non-primary parotid malignancies (intra-parotid metastasis and parotid lymphoma), (group 2). We compared the preoperative data, the surgical procedures performed total parotidectomy (TP) versus superficial parotidectomy (SP), the need for sacrificing the facial nerve and postoperative facial nerve function in the two groups. Actuarial survival rates were calculated using the Kaplan-Meier method in combination with the Log Rank test for comparison of the results in the two groups. Preoperative clinical facial nerve impairment was significantly more frequent in group 1 (33%) as compared to group 2 (6%) (P = 0.023). A SP was performed in 15 patients in group 2 while a TP was performed in 37 patients in group 1. The facial nerve was completely or partially sacrificed in 17 cases in group 1 and in only one case in group 2 (P = 0.03). One month after surgery, 18 patients in group 1 had persistent facial nerve dysfunction compared to only one patient in group 2 (P = 0.004). In group 1, the overall 1, 3 and 5-year survival rates were, respectively, 94, 76 and 69%. In group 2, the respective survival rates were 84, 62 and 40% (P = 0.4). This study outlines the differences in clinical presentation, surgical management and outcomes in the two main groups of malignant parotid tumors. The prognosis of facial nerve function was better in non-primary parotid malignancies. SP was the standard surgical option in group 2 patients while a TP was performed in the majority of the patients in group 1. Except when melanoma or lymphoma were present (which require specific treatment), adjuvant radiotherapy had the same indications in both groups when the tumors were high-grade, AJCC stages III and IV or when they had positive margins or lymph node and facial nerve involvement.

Diagnostic accuracy of fine-needle aspiration cytology and frozen section in primary parotid carcinoma

BACKGROUND

The low incidence and histologic heterogeneity of primary parotid carcinomas makes it difficult to evaluate the value of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen section (FS) analysis. In the current study, the authors reviewed a single institution's experience regarding the preoperative and intraoperative diagnostic value of FNAC and FS in primary salivary gland carcinomas.

METHODS

Between January 1990 and December 2002, 108 primary parotid carcinomas were resected at the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Berne, Inselspital (Berne, Switzerland). Included in the study were a total of 101 carcinomas with preoperative FNAC results in 88 tumors and/or intraoperative FS results in 45 tumors. In a retrospective study, the results of FNAC and FS were analyzed and compared with the corresponding histopathologic diagnoses.

RESULTS

The cytologic findings were true-positive for malignancy in 63 tumors (72%), false-negative in 22 tumors (25%), and nondiagnostic in 3 tumors (3%). The tumor grading was correct in 29 of 63 tumors (46%), and the exact tumor typing was correct in 27 of 63 (43%) true-positive tumors. The FS findings were true-positive for malignancy in 43 of 45 tumors (96%), the tumor grading was correct in 35 of 45 tumors (78%), and the tumor typing was correct in 32 of 45 tumors (71%). Overall, at the time of surgery, of the 101 parotid carcinomas, the tumor was known to be malignant in 83 tumors (82%), and the correct grade and the exact tumor type were known in 55 tumors (54%) and 48 tumors (48%), respectively.

CONCLUSIONS

FNAC recognized malignancy in 72% of tumors, but it could not be relied upon to provide an accurate tumor grading or typing. Therefore, FNAC alone is not prone to determine the surgical management of primary parotid carcinomas. The current analysis showed the statistically significant superiority of FS compared with FNAC regarding the diagnosis of malignancy, tumor grading, and tumor typing in primary parotid carcinomas.

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

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Preoperative computed tomography scans for parotid tumor evaluation

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Validade da punção biópsia por agulha fina nas doenças da glândula parótida

OBJETIVO: Avaliar o método de punção biópsia aspirativa por agulha fina (PBAAF), técnica relativamente simples, de conhecida importância em cirurgia de cabeça e pescoço. Sua indicação em doenças das glândulas salivares, no entanto, especialmente na parótida, ainda é muito controversa na literatura. O diagnóstico pela PBAAF permite o adequado planejamento terapêutico e preparo do paciente. Muitos, porém, alegam que seu emprego acrescenta muito pouco à conduta terapêutica, além de ser procedimento doloroso e elevar o custo do tratamento. MÉTODO: Os autores analisaram os prontuários de 247 pacientes submetidos a parotidectomias, realizadas entre 1986 e 1998, comparando a punção aspirativa por agulha fina com o anatomopatológico definitivo. Isso foi possível em 211 casos. Houve predomínio do sexo feminino, com idade variando de dez a 84 anos. RESULTADOS: Os tumores benignos foram os mais prevalentes, correspondendo a 85,3% dos casos, com predomínio do adenoma pleomórfico. A punção por agulha fina permitiu diferenciar tumores benignos de malignos em 165 casos (78,1%) e acertou o diagnóstico histológico em 77,6 %. CONCLUSÕES: Concluímos que a PBAAF é um método eficiente e simples que fornece ao cirurgião diagnóstico das neoplasias na grande maioria das vezes e deve fazer parte, sempre que possível, da documentação pré-operatória.

Fine needle aspiration biopsy (FNAB) for lesions of the salivary glands

We examined 112 fine needle aspiration biopsy (FNAB) specimens of salivary glands (80 parotid and 32 submaxillary) taken between January 1989 and December 1995. Cytologic diagnoses were compared with the final histological diagnoses of the surgical specimens. The sensitivity and specificity were 84.8% and 93.7% respectively, and the accuracy was 91.1%. We conclude that FNAB by itself does not provide total security because of the high percentage of false-negatives. It is nevertheless useful when combined with an adequate clinical history, examination and radiological tests.

The role of fine-needle aspiration cytology in the management of parotid tumors: a critical clinical appraisal

BACKGROUND

Fine-needle aspiration cytology (FNA) is a well-established tool for investigating many head and neck conditions. It application in parotid tumors is, however, very controversial. This article is aimed at defining the exact role of FNA in the diagnostic workup of patients.

METHODS

A retrospective review of a 12-years' experience in a university surgical unit of 186 consecutive patients. Clinical opinion, FNA results, and final pathologic findings were examined.

RESULTS

FNA obtained the correct final pathologic condition in 54.3% of cases. It increased the identification of malignancy to 64.5% compared with 26% based solely on clinical signs. Malignant FNA diagnoses (85.7%) and repeatedly inconclusive reports (25.7%) were associated with a higher incidence of malignancy.

CONCLUSIONS

Methodological interpretation of FNA results provides useful preoperative information and enables more reliable patient counseling and reduces pathologic surprises. Its enhancement of the preoperative recognition of malignant parotid tumors may alert more stringent attention to the operative margin and hence better tumor clearance.

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

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

Fine-needle sample of salivary gland lesions. V: Cytology of 22 cases of acinic cell carcinoma with histologic correlation

Fine-needle sampling (FNS) of 22 acinic cell carcinomas, including 17 primary tumors, 4 local recurrences, and 1 lymph node metastasis was performed preoperatively in 17 patients. Cytologic diagnoses were concordant with histology in 3 (13.7%) cases, whereas 15 (68.2%) cases were cytologically classified as malignant, 2 (9.1%) as suspicious, and 1 (4.5%) as benign (pleomorphic adenoma). The material was unsatisfactory for cytologic evaluation in 1 (4.5%) case. Preoperative FNS technique is, therefore, useful in acinic cell carcinoma with a concordant malignant/suspicious rate of 91%.

Parotid fine-needle aspiration: a cytologic study of pediatric lesions

Fine-needle aspiration (FNA) of parotid lesions in the pediatric age group presents interesting diagnostic problems. There is limited cytologic literature available on the subject. We studied the cytologic findings on FNA of parotid masses in seven such cases. Patients ranged in age from 1 to 17 years (mean = 10.4). Diagnoses included lymphoepithelial cyst (n = 1), mucoepidermoid carcinoma (n = 2), pilomatrixoma (n = 1), acinic-cell carcinoma (n = 1), rhabdomyosarcoma (n = 1), and Ewing's sarcoma (n = 1). Six cases were confirmed by subsequent histologic examination. The study elaborates on the cytologic features of each lesion and discusses the differential diagnosis of closely related entities peculiar to this age group. It highlights the role of FNA as the diagnostic modality of choice in dealing with pediatric parotid masses.

Fine-needle aspiration biopsy of parotid lesions: comparison with frozen section

BACKGROUND

Opinions vary as to the necessity for fine-needle aspiration biopsy (FNAB) in parotid tumours. The present study reflects the experience gained over a 12-year period and shows the accuracy of a diagnostic FNAB, and improved results with experience.

METHODS

Between 1983 and 1995, 201 parotid lesions were excised by one surgeon(AGP) and a prospective database was established. Fine-needle aspiration biopsy was performed prior to surgery in 195 lesions and frozen section was performed in 159 lesions.

RESULTS

The FNAB was diagnostic in 129 (66%) specimens and its sensitivity for malignancy was 90% and specificity was 100% (excluding non-diagnostic FNAB, where there was insufficient cellular material for reliable diagnosis or where specific tissue diagnosis could not be given). The positive predictive value was 100% and the negative predictive value was 98%. Of interest, the positive predictive value of diagnostic FNAB for pleomorphic adenomas was 99%. A specific tumour diagnosis could not be made on the FNAB sample in 37 specimens; 11 of these lesions were histologically confirmed as malignant after excision. Frozen section was diagnostic in 144 specimens (91%). Its sensitivity for malignancy was 96% and specificity was 99%. The positive predictive value was 96% and negative predictive value 99%. A specific tumour diagnosis could not be made on frozen section in 15 specimens including six cases in which malignancy was finally reported. The positive predictive value of diagnostic frozen section for pleomorphic adenomas was 99%.

CONCLUSIONS

A diagnostic FNAB is an accurate and useful tool in the management of parotid lesions. An FNAB diagnosis of pleomorphic adenoma obviates the need for frozen section. The performance of FNAB in parotid tumours does not in any way preclude the necessity of surgical removal of such lesions except in exceptional circumstances.

Fine-needle aspiration biopsy in the diagnosis of parotid gland lesions: evaluation of 438 biopsies

The usefulness of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of salivary gland lesions is still controversial. The 438 FNABs taken at the Turku University Central Hospital between 1984-1991 were reviewed. Of these FNABs, 218 had been confirmed histologically. Within this subset, 136 FNABs were taken from benign neoplasms, and of these, 103 were correct (sensitivity 76%, specificity 83%). Only 26 of the 47 FNABs from malignant lesions were cytologically considered to be malignant (sensitivity 55%) and 11 samples raised a false suspicion of malignancy (specificity 92%). Out of 35 FNABs from non-neoplastic lesions, 27 were correct (sensitivity 77%, specificity 80%). There were 175 patients (217 FNABs), who had not been operated on: the follow-up of these patients showed that false malignant and false benign findings were rare. FNAB was safe and no serious complications occurred. However, there was a delay in the treatment of six patients probably because of the physicians' limited understanding of the diagnostic role of FNAB. FNAB offers valuable information about the type of parotid lesion, but the clinician must know how to interpret the cytologic statement, and the decision to use operative and other treatment should not be based solely on the result of FNAB. Diagn Cytopathol 1996; 15:185-190.

Fine-needle aspiration cytology of submandibular gland lesions

The usefulness of fine-needle aspiration cytology (FNAC) in the diagnosis and treatment of submandibular gland lesions is not well known. The 210 FNACs taken from submandibular gland lesions at Turku University Central Hospital between 1984 and 1991 were reviewed. Of these FNACs, 78 samples from primary lesions were confirmed histologically. Within this subset 10 FNACs were taken from benign neoplasms, all of which were correctly classified (sensitivity 100 per cent; specificity 88 per cent). Only four of the 14 FNACs from malignant lesions were cytologically considered malignant (sensitivity 29 per cent). On the other hand, four FNACs raised a false suspicion of malignancy (specificity 6 per cent). Out of 54 FNACs from non-neoplastic lesions 43 were correct (sensitivity 80 per cent; specificity 63 per cent). There were 104 patients (123 FNACs), who had not been operated on: the follow-up of these patients shows that in this subset of FNACs there were no false malignant but probably one false benign finding (1 per cent). We conclude that FNAC can offer valuable information about the type of the submandibular gland lesion, but the decision of operative and other treatment should not be based solely on the result of FNAC.

Undifferentiated nasopharyngeal carcinoma presenting as a parotid mass

BACKGROUND

Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of cases it may present with serous otitis or cervical metastases. Although the metastases usually occur in the neck, the lymphatic network of the parotid may also serve as a site for the metastatic deposits. We present a case in which the initial manifestation of nasopharyngeal carcinoma of the lymphoepithelioma type was a parotid mass.

METHODS

Case study.

RESULTS

A patient who was initially seen with an isolated parotid mass was found to have an undifferentiated carcinoma of the lymphoepithelial type. Further evaluation identified an occult nasopharyngeal carcinoma, and the patient underwent radiotherapy.

CONCLUSIONS

A diagnosis of a malignant lymphoepithelial lesion of the parotid gland or undifferentiated carcinoma of the lymphoepithelial type mandates a search for an occult primary nasopharyngeal tumor.