Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions

Cytopathological analysis of salivary gland cancer: REFCOR recommendations by the formal consensus method

OBJECTIVE

To determine the indications for fine-needle cytology and the modalities of frozen section pathological analysis in the management of salivary gland cancer.

MATERIAL AND METHODS

The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group according to the formal consensus method.

RESULTS

Fine-needle cytology is recommended as part of the diagnostic work-up for a major salivary gland tumor suspicious for malignancy. Fine-needle cytology should be performed after MRI to avoid artifacts. Frozen section analysis is recommended to confirm the malignant nature of the tumor, to adapt the extent of resection and to indicate neck dissection. Whenever possible, the entire tumor and adjacent salivary or periglandular tissue should be sent for frozen section analysis.

CONCLUSION

Fine-needle cytology and frozen section analysis play an essential role in the management of salivary gland cancers.

Sonographic and Cytological Evaluation of Salivary Gland Tumors

INTRODUCTION

Salivary gland tumours are relatively uncommon, but they have a multifaceted clinical presentation and varied morphological configuration. The investigations required for these tumours remain debatable. We conducted a study to determine the accuracy of various modalities used in salivary gland tumours.

METHODS

We enrolled 72 subjects, consisting of 44 females and 28 males, with a mean age of 40.93 ± 16.51 years (range: 15 to 79 years), suffering from various salivary gland tumours. The tumour distribution included 42 parotid gland tumours (58.33%), followed by 21 submandibular gland tumours (29.16%), three sublingual gland tumours (4.16%), and six minor salivary gland tumours (8.33%). These individuals were subjected to clinical examination, sonography, and fine needle aspiration cytology as per indications. The results of each modality were compared to surgical pathology to find sensitivity and accuracy.

RESULTS

The clinical examination was found to be least sensitive (83.8%) as compared to FNAC (97.6%), and ultrasound (100%). Ultrasound had the highest diagnostic accuracy (86.2%) as compared to clinical examination (80.6%) and FNAC (82.6%).

CONCLUSION

Although sonography was found to have the highest sensitivity and accuracy as compared to fine needle aspiration cytology and clinical examination, the difference was subtle, as both sonography and fine needle aspiration cytology had a statistically significant correlation with histopathology.

Application of ultrasound in distinguishing the incipient microtumor from inherent lymph nodes of the parotid glands

BACKGROUND

Parotid microtumors (size ≤ 1 cm) pose a significant clinical challenge due to their malignant potential and risks associated with surgery. It is imperative to explore the diagnostic workflow that incorporates ultrasound (US) in order to make appropriate clinical decisions with minimal invasiveness.

METHODS

The patients receiving both US and ultrasound-guided fine needle aspiration (USFNA) for the parotid microtumors in a medical center were retrospectively recruited. The ultrasonic features, cytology of USFNA, and final surgical pathology were analyzed to differentiate the tumor origins and their malignant potential.

RESULTS

From August 2009 to March 2016, a total of 92 patients were enrolled in the study. The short axis, long-to-short axis ratio, and presence of an echogenic hilum were found to be significantly useful in distinguishing lymphoid tissue origin from salivary gland origin, which was confirmed by USFNA. An irregular border was predictive for malignant parotid microtumors from both origins. Intra-tumoral heterogeneity was also identified as a significant feature associated with malignant lymph nodes. USFNA was able to confirm all malignant lymph nodes, but it had a false negative rate of 8.5% in parotid microtumors of salivary gland origin. Based on the analysis of US and USFNA results, a diagnostic workflow for parotid microtumors was proposed.

CONCLUSION

US and USFNA can be helpful in classifying the origins of parotid microtumors. US-FNA carries the risk of producing false negative results specifically for microtumors originating from salivary glands, but not lymphoid tissue. The diagnostic workflow, which incorporates both US and USFNA, assists in determining the clinical decision for diagnosing and managing parotid microtumors.

Is the combined use of ultrasonography (USG) and fine needle aspiration biopsy (FNAB) safe in parotis masses? Retrospective comprehensive comparison of 123 cases

OBJECTIVES

The purpose of the study was to compare final pathology results with ultrasonography (USI) and fine needle aspiration biopsy (FNAB) results in parotis masses.

METHODS

A total of 123 patients with primary parotis mass who applied to our center between 2010 and 2020 were selected for the study. Among these, 100 patients with preoperative USI, preoperative FNAB, and postoperative final pathology were included in the study. USI, FNAB, pathology results, surgery types, and demographic characteristics of the patients were analyzed.

RESULTS

According to the postoperative final pathology, preoperative USI sensitivity was found to be 100%, specificity was 55, positive predictive value was 84.31%, negative predictive value was 100%, and accuracy was 86.89%. Preoperative FNAB had a sensitivity of 85.7%, a specificity of 92.1%, a positive predictive value of 82.1%, a negative predictive value of 90.2%, and a diagnostic accuracy of 89.3%, according to the postoperative final pathology.

CONCLUSION

Preoperative USI and preoperative FNAB are very valuable diagnostic tools in the evaluation of parotis lesions. When used together, they provide highly accurate and important data for the surgeon.

The Diagnostic Value of Fine Needle Aspiration Biopsy in Parotid Tumors

The aim of this study was to investigate the diagnostic accuracy rates of the patients who underwent an operation for parotid mass, by comparing their fine needle aspiration biopsy (FNAB) cytology results with the final pathology. A total of 136 patient files of those who applied to Otorhinolaryngology clinic due to parotid mass and underwent parotidectomy procedure between 2010 and 2020 at a tertiary center were scanned retrospectively. Database on patient age, gender, preoperative FNAB results, and final surgical histopathology results was created. The mean age of the patients was 48.26 ± 17.37 Superficial parotidectomy was performed to 108 (79.4%) and total parotidectomy to 28 (20.6%) of the patients. The sensitivity of FNAB was found as 85.2%, specificity as 96.2%, positive predictive value as 85.2%, negative predictive value as 96.2% and accuracy as 94.0%. It is found that FNAB has the high specificity and high negative predictive value with high diagnostic accuracy on detecting preoperative malignancy in parotid gland. We think that FNAB is a significant, necessary and safe method in the diagnosis of parotid lesions in preoperative sense.

[Ultrasound-guided minimally invasive diagnostics and treatment in the head and neck area]

Tumoral lesions in the head and neck region represent a diagnostic and therapeutic challenge in otorhinolaryngologic routine. High-resolution ultrasound is usually able to guide diagnosis. Nevertheless, a definite differentiation between benign and malignant lesions can only be achieved by tissue biopsy. The various options for obtaining samples for histopathological or cytological examination-from minimally invasive ultrasound-guided fine-needle biopsy to punch biopsy and open surgical biopsy-will be discussed in the first part along with the associated advantages and disadvantages. In the second part of this CME article, minimally invasive ultrasound-guided therapeutic options in the head and neck region which can be performed on an outpatient basis are depicted.

The Role of FNAC in the Diagnosis and Management of Warthin Tumour: Analysis of 74 Cases

Introduction  After pleomorphic adenoma, Warthin tumor gets its popularity as the second most common benign neoplasm of the parotid gland. Fine-needle aspiration cytology (FNAC) is the most cost-effective and minimally-invasive way to determine the histological character of a parotid gland tumor. Objective  To determine the accuracy of FNAC in the diagnosis of Warthin Tumour. Methods  A retrospective study conducted between 2014 and 2018. Out of 243 FNACs performed for parotid lesions, a histopathological correlation was established in 74 cases to reveal the accuracy of FNAC in the diagnosis of Warthin tumor. Results  A total of 243 FNACs of parotid lesions were performed, and a histopathological correlation was established in 74 (30.4%) cases. Later on, we confirmed that 16 (21.6%) out of these 74 patients had cases of Warthin tumor. In total, 15 (20.3%) out of those 74 cases were confirmed as Warthin tumors on the initial cytology, which revealed a true positive concordance between the cytology and the final histological diagnosis; 55/74 (74%) were true negative results; on the other hand, 1/74 (1.4%) was a false negative, and 3/74 (4.1%) were false positive results. The sensitivity of the FNAC in the diagnosis of Warthin tumor was of 93%, while the specificity was of 94.8%, and the accuracy, of 94.6%. Conclusion  In the present study, FNAC had a high diagnostic accuracy, reaching 94%.

Salivary gland disease in the era of COVID-19 pandemic

Coronavirus disease 2019 (COVID‐19) pandemic forced significant changes in current approach to outpatient evaluation of common otolaryngology complaints as hospitals around the world are trying to limit the spread of the virus and to preserve health care resources. These changes raise a lot of questions regarding patient triage and treatment decisions in clinical situations when it is unclear if the workup and management can be postponed. In this communication, we present our approach to evaluation and triage of new patients with complaints concerning for salivary gland disease.