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Mao Y, Lee B, Sun Z, Tang Z, Hu L, Zhang W, Yu Y, Peng X. The efficacy of clinicopathological and imaging features in differentiating benign from malignant parotid micro- and minitumors: a retrospective analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:440-452. [PMID: 38744548 DOI: 10.1016/j.oooo.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/06/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To compare clinicopathological and imaging features of micro- and minitumors of the parotid gland and provide a reference for preoperative prediction of benign vs malignant status. STUDY DESIGN Patients with parotid gland tumors treated surgically were selected. Relevant clinicopathological and imaging data were collected for patients with maximum tumor diameters ≤20 mm on preoperative computed tomography (CT). The lesions were divided into 2 groups, microtumors and minitumors, based on maximum tumor diameter. CT imaging features of benign and malignant tumors were compared through binary logistic regression analysis. RESULTS Microtumors and minitumors were categorized by maximum diameters <10 mm (n = 74) and 10-20 mm (n = 611), respectively. Benign and malignant minitumors exhibited significant differences in boundary, tumor density, margin morphology, spiculation margin, and CT values in the plain and arterial phase (P ≤ .027), resembling those found in typical malignant parotid gland tumors. However, no significant differences were observed between benign and malignant microtumors. Logistic regression analysis identified boundary, margin morphology, and spiculation margin as independent predictors of malignancy. The prediction model excelled in identifying benign lesions but was less successful in identifying malignancies. CONCLUSION Parotid gland minitumors had imaging features similar to typical larger malignant tumors. Active exclusion of the malignant risk and early surgical treatment is recommended for these tumors.
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Affiliation(s)
- Yaqing Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China
| | - Byeongwoo Lee
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China
| | - Zhipeng Sun
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China
| | - Zunan Tang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China
| | - Leihao Hu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China
| | - Wenbo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China.
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Ali HM, Sankar GB, Stickney EA, Johns HL, Whaley RD, Rivera M, Lohse CM, Tasche KK, Price DL, Van Abel KM, Yin LX, Moore EJ. Ability for fine needle aspiration and frozen section to predict extent of parotidectomy. Head Neck 2023; 45:3006-3014. [PMID: 37752736 DOI: 10.1002/hed.27527] [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: 04/16/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Several diagnostic modalities with various sensitivity and specificities can be used to evaluate a parotid mass. The aims of this project were to compare the diagnostic actionability, accuracy, and ability to accurately predict extent of surgery for FNA and frozen section during the evaluation of a parotid mass. METHODS A retrospective chart review of patients who underwent parotidectomy for a parotid mass from January 1, 2015 to January 30, 2022 was conducted. Actionability was defined as a pathology diagnosis or the histologic grade of a lesion, as this provided clear and useful information for the surgeon to act upon. Diagnostic accuracy was determined by comparing FNA and frozen section results to final pathology. Accuracy of extent of surgery was determined by comparing predicted extent of surgery from the FNA or frozen section result to the extent of surgery predicted by the final pathology. RESULTS A total of 626 patients were included in this study. FNA was obtained in 396 (63%) patients, while all neoplasms were evaluated by frozen section analysis. FNA diagnosis was actionable in 318 (80%), while frozen section diagnosis was actionable in 616 (98%) patients. Exactly 294 (92.5%) FNA diagnoses were accurate compared with 600 (98%) frozen section diagnoses. The FNA diagnosis predicted appropriate extent of surgery in 294 (74%) while the frozen section diagnosis predicted appropriate extent of surgery in 600 (96%). Among the 396 patients with FNA, frozen section was significantly more likely to accurately predict appropriate extent of surgery compared with FNA (p < 0.001). CONCLUSION Frozen section is more likely to yield actionable and accurate results compared with FNA. Additionally, frozen section is better than FNA in predicting the appropriate extent of surgery.
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Affiliation(s)
- Hawa M Ali
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - George B Sankar
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Heather L Johns
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rivera
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Sah SK, Sah NK, Khan ZA. Triple Assessment of a Palpable Parotid Lump in "One-Stop" Clinics. J Maxillofac Oral Surg 2022; 21:972-978. [PMID: 36274879 PMCID: PMC9474984 DOI: 10.1007/s12663-021-01590-5] [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: 05/22/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction The National Institute of Clinical Excellence in the UK (NICE) recommended the use of "one-stop" clinics for the assessment and management of head and neck lumps like those established for breast lumps. "One-stop" clinics should follow a triple assessment protocol involving physical examination, radiological imaging and fine-needle aspiration cytology (FNAC). Methods A retrospective analysis of 144 patients with suspected parotid tumours from 2005 to 2011 was done. Patients were assessed for individual modalities and compared against the final histological diagnosis. Statistical analysis was used for sensitivity and specificity, as well as positive and negative predictive values. All calculations were performed using SPSS version 16 (Statistical Packages for the Social Sciences, Chicago, IL). A p value of < 0.05 was considered to indicate statistical significance. Results A total of 105 patients underwent all the three modalities. Out of them, 93 had imaging that was considered radiologically benign and 12 were reported to have a malignant lesion. Cytologically, 75 were found to have a benign tumour, 13 were malignant, and 17 were considered to be indeterminate. The most common benign neoplasm was pleomorphic adenoma followed by Warthin's tumour. The sensitivity and specificity of triple assessment were 96% (p value 0.878-0.984) and 73% (p value 0.42-0.904), respectively. The positive predictive value was 96% (p value 0.878-0.984) and negative predictive value came out to be 93% (p value 0.42-0.904). Conclusions The overall accuracy of triple assessment was found to be 92%. This study concludes that triple assessment is a useful assessment tool to evaluate a patient with parotid lump. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-021-01590-5.
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Affiliation(s)
- S. K. Sah
- Craniofacial Center, Janakpurdham, Nepal
- Pinderfields Hospital, Wakefield, UK
| | - N. K. Sah
- Craniofacial Center, Janakpurdham, Nepal
| | - Z. A. Khan
- Craniofacial Center, Janakpurdham, Nepal
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Rameeza A, Hemalata M. Fine-needle aspiration cytology of salivary gland lesions. J Oral Maxillofac Pathol 2022; 26:52-56. [PMID: 35571296 PMCID: PMC9106261 DOI: 10.4103/jomfp.jomfp_496_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Fine-needle aspiration cytology (FNAC) is a sensitive, specific, cost-effective tool and has been widely used as a diagnostic tool for the management of various head-and-neck lesions. Salivary gland lesions constitute the most common head-and-neck lesions. These lesions can range from inflammatory to neoplastic, which can be either benign or malignant. Materials and Methods: The study was performed on 104 patients who presented with salivary gland swelling to the department of pathology at a tertiary care center from January 2016 to June 2020. FNAC was performed using a 22–24G needle, and smears were stained with Giemsa, hematoxylin and eosin and Papanicolaou stain. Histopathology was assessed on routine hematoxylin- and eosin-stained paraffin sections. The cytological and histopathological slides were studied, analyzed and correlated. Sensitivity, specificity, positive predictive value and negative predictive were calculated. Results: The study included 104 cases in the age range of 10–70 years and a mean of 45 years (±16 standard deviation). There was a male preponderance with a male-to-female ratio of 1.6:1. The parotid gland was the most common site 91 (87%). On cytology, 71 (68%) were neoplastic, of which 58 (81%) were benign and 13 (19%) were malignant. Histopathological correlation was available in 36 cases (50%), 24 (67%) of which were benign and the remaining 12 (33%) were malignant. The sensitivity, specificity, positive predictive value and negative predictive value of the present study are 95%, 85%, 91% and 92%, respectively. Conclusion: FNAC of the salivary gland is a safe, reliable and cost-effective technique which can be used as the first line of investigation in evaluating salivary gland lesions.
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Affiliation(s)
- A Rameeza
- Department of Pathology, Kempegowda Institute of Medical Science, Bengaluru, Karnataka, India
| | - M Hemalata
- Department of Pathology, Kempegowda Institute of Medical Science, Bengaluru, Karnataka, India
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Walsh E, Allan K, Brennan PA, Tullett M, Gomez RS, Rahimi S. Diagnostic accuracy of ultrasonography-guided core needle biopsy of parotid gland neoplasms: A large, single-institution experience in United Kingdom. J Oral Pathol Med 2021; 51:1-4. [PMID: 34784059 DOI: 10.1111/jop.13260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Elizabeth Walsh
- Department of Pathology, Brighton and Sussex University Hospitals NHS Trust, Eastern Road Brighton, UK
| | - Kimberly Allan
- Department of Pathology, Brighton and Sussex University Hospitals NHS Trust, Eastern Road Brighton, UK
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Southwick Hill Road, UK
| | - Mark Tullett
- Department of Pathology, St. Richard's Hospital Spitalfield Lane, Chichester, UK
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, Universidade Federal de Minas Gerais, Pampulha, Brasil
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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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Akinmoladun VI, Gbolahan OO, Aladelusi TO, Ogun GO, Ajani MA. Diagnostic Accuracy of Fine-Needle Aspiration Cytology in Head and Neck Lesions from a Tertiary Health Facility in Southwestern Nigeria. Niger Med J 2020; 61:303-306. [PMID: 33888925 PMCID: PMC8040946 DOI: 10.4103/nmj.nmj_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/29/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background Fine-needle aspiration cytology (FNAC) is widely employed as an initial investigative tool in the diagnosis of various lesions in the body, however, it is limited in the provision of precise architectural detail of lesions. This is said to be responsible for the wide variation in the documented usefulness and accuracy relative to histopathology. This study aimed to correlate cytopathological and histopathological examination (HPE) of head and neck lesions, and assess the usefulness and accuracy of FNAC in our center. Materials and Methods This was a retrospective study that utilized historical data obtained from case notes and histopathology records of 91 patients that had both FNAC and HPE done for head and neck lesions in our center during the study. The FNAC results were correlated with that of the histopathological diagnosis to obtain the accuracy of the FNAC diagnosis. Diagnostic validity of FNAC in terms of sensitivity, specificity, and predictive value were also evaluated. Results A total of 91 FNAC-HPE sample pairs were included. The Sensitivity and specificity for benign lesion was 95.4% and 42.3%, respectively, while for sensitivity and specificity for malignant lesion was 31.8% and 96.9%, respectively. The overall Sensitivity and specificity for cytology was 96.8% and 30.4%, respectively. Conclusion FNAC appears to be a useful tool in the initial assessment of head and neck lesions in our center, however, the high rate of missed diagnosis especially as concerned malignancies has dire negative treatment implications. There is need to develop capacity for improved skill in making cytopathologic diagnoses among anatomical pathologists involved in the use of FNAC as diagnostic and screening tool.
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Affiliation(s)
- Victor I Akinmoladun
- Department of Oral and Maxillofacial Surgery, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Olalere Omoyosola Gbolahan
- Department of Oral and Maxillofacial Surgery, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Timothy O Aladelusi
- Department of Oral and Maxillofacial Surgery, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Gabriel O Ogun
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Mustapha A Ajani
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Horáková M, Porre S, Tommola S, Baněčková M, Skálová A, Kholová I. FNA diagnostics of secondary malignancies in the salivary gland: Bi-institutional experience of 36 cases. Diagn Cytopathol 2020; 49:241-251. [PMID: 33017519 DOI: 10.1002/dc.24629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/27/2020] [Accepted: 09/22/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Fine-needle aspiration (FNA) is a key diagnostic method in the evaluation of salivary gland lesions. Secondary tumors of salivary glands represent only 5% of all malignancies of major salivary glands. The goal of our study was to examine the cytological and clinical features of secondary tumors sampled by FNA. MATERIALS AND METHODS A series of 36 secondary tumors from the pathology departments of two university hospitals are presented. Clinical referrals to FNA, cytological features, immunohistochemical results, and histopathological diagnoses were reviewed in all cases. RESULTS The study population consisted of 36 cases (19 males and 17 females) with mean age 70.9 ± 13.0 years (range 41-96 years). The most common site of the metastasis was parotid gland (n = 26). The primary malignancy was known in 17 cases at the time of FNA diagnosis. The most common primary site was skin of head and neck area (11 cases) followed by lungs (n = 5) and tonsils (n = 5), kidney (n = 2) and breast (n = 2) and thyroid gland, gastrointestinal tract and soft tissue, 1 case of each. In 8 cases, the primary site remained unknown. The diagnostic or confirmatory immunocytochemistry was performed on cell blocks in 21 cases. CONCLUSIONS FNA is a reliable technique in the diagnosis of salivary gland secondary malignancies. The knowledge of the personal history of malignancy is essential for the successful immunocytochemical targeted diagnosis without any delay.
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Affiliation(s)
- Markéta Horáková
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd, Pilsen, Czech Republic
| | | | - Satu Tommola
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - Martina Baněčková
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd, Pilsen, Czech Republic
| | - Alena Skálová
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd, Pilsen, Czech Republic
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Tampere, Finland.,Pathology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Martin H, Jayasinghe J, Lowe T. Superficial parotidectomy versus extracapsular dissection: literature review and search for a gold standard technique. Int J Oral Maxillofac Surg 2019; 49:192-199. [PMID: 31301925 DOI: 10.1016/j.ijom.2019.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/24/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022]
Abstract
Benign parotid tumours usually present as a slow-growing, asymptomatic mass in the pre-auricular region. Although they are uncommon, surgical excision is the mainstay of treatment due to the risk of malignant transformation in some benign tumours. Surgical techniques have evolved over the years, with superficial parotidectomy and extracapsular dissection being the current procedures of choice. There is currently no gold standard, and it remains unclear which surgical modality is the superior option. A literature review was performed in relation to the relative merits of each technique and to evaluate the reasons underpinning the ongoing debate. A total of 16 papers comparing the main clinical outcomes of the procedures were critically reviewed using the PRISMA protocol. Overall, extracapsular dissection indicated a reduced recurrence rate, facial nerve paralysis, Frey syndrome, and operation time. The superior outcomes following extracapsular dissection could be attributed to the less radical nature of the procedure. However, there were various limitations identified within the review that may have affected the results. Selection bias was the most significant, with patients assigned to the different procedures depending on the tumour size and location. Consequently, the debate continues as to what constitutes the gold standard of care for benign parotid tumours.
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Affiliation(s)
- H Martin
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK.
| | - J Jayasinghe
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - T Lowe
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK
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Diagnostic accuracy and utility of fine-needle aspiration cytology in therapeutic management of parotid gland tumours. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:74-79. [DOI: 10.1016/j.otorri.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/11/2018] [Accepted: 03/15/2018] [Indexed: 11/23/2022]
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Lameiras AR, Estibeiro H, Montalvão P, Magalhães M. Diagnostic accuracy and utility of fine-needle aspiration cytology in therapeutic management of parotid gland tumours. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Farahani SJ, Baloch Z. Retrospective assessment of the effectiveness of the Milan system for reporting salivary gland cytology: A systematic review and meta-analysis of published literature. Diagn Cytopathol 2018; 47:67-87. [DOI: 10.1002/dc.24097] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Sahar J Farahani
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania; University of Pennsylvania; Philadelphia Pennsylvania
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania; University of Pennsylvania; Philadelphia Pennsylvania
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Accuracy and effectiveness of ultrasound-guided core-needle biopsy in the diagnosis of focal lesions in the salivary glands. Eur Radiol 2018; 28:2934-2941. [DOI: 10.1007/s00330-017-5295-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/25/2017] [Accepted: 12/27/2017] [Indexed: 01/07/2023]
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Ramírez-Pérez F, González-García R, Hernández-Vila C, Monje-Gil F, Ruiz-Laza L. Is fine-needle aspiration a reliable tool in the diagnosis of malignant salivary gland tumors? J Craniomaxillofac Surg 2017; 45:1074-1077. [DOI: 10.1016/j.jcms.2017.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 02/16/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022] Open
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Wang H, Hoda RS, Faquin W, Rossi ED, Hotchandani N, Sun T, Pusztaszeri M, Bizzarro T, Bongiovanni M, Patel V, Jhala N, Fadda G, Gong Y. FNA biopsy of secondary nonlymphomatous malignancies in salivary glands: A multi-institutional study of 184 cases. Cancer Cytopathol 2016; 125:91-103. [DOI: 10.1002/cncy.21798] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022]
Affiliation(s)
- He Wang
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Raza S. Hoda
- Department of Pathology; Massachusetts General Hospital, Harvard University; Boston Massachusetts
| | - William Faquin
- Department of Pathology; Massachusetts General Hospital, Harvard University; Boston Massachusetts
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | - Nihar Hotchandani
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Tianlin Sun
- Department of Pathology; Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Marc Pusztaszeri
- Department of Pathology; Geneva University Hospital; Geneva Switzerland
| | - Tommaso Bizzarro
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | | | - Viren Patel
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Nirag Jhala
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Guido Fadda
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | - Yun Gong
- Department of Pathology; Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center; Houston Texas
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Haldar S, Sinnott JD, Tekeli KM, Turner SS, Howlett DC. Biopsy of parotid masses: Review of current techniques. World J Radiol 2016; 8:501-505. [PMID: 27247715 PMCID: PMC4882406 DOI: 10.4329/wjr.v8.i5.501] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/31/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology (FNAC) or ultrasound guided core biopsy (USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section (IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.
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Lin AC, Bhattacharyya N. The Utility of Fine Needle Aspiration in Parotid Malignancy. Otolaryngol Head Neck Surg 2016; 136:793-8. [PMID: 17478218 DOI: 10.1016/j.otohns.2006.12.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 12/21/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To determine clinical utility of fine needle aspiration (FNA) in parotid neoplasia. STUDY DESIGN AND SETTING: Retrospective cohort study. METHODS: FNA and final pathology data were reviewed for patients who underwent parotidectomy for malignancy. Surgical outcomes were compared between patients with malignant cytology versus nonmalignant/nondiagnostic cytology. RESULTS: Twenty-seven of 33 primary malignant parotid lesions underwent FNA. Seventeen (63.0%) patients were diagnosed with cancer on FNA. The remaining 16 patients did not undergo FNA (n = 6), had a nondiagnostic FNA specimen (n = 5), or were incorrectly diagnosed with a benign lesion (n = 5). Patients who went on to parotidectomy with intent to treat malignancy based on FNA had significantly higher rates of upfront neck dissections (47.1% vs 12.5%, P = 0.036) as well as clear pathological margins (70.6% vs 31.3%, P = 0.027) vs those with nonmalignant FNA diagnoses. CONCLUSIONS: Preoperative FNA diagnosis of malignancy improves surgical treatment of parotid cancer. SIGNIFICANCE: FNA in the evaluation of parotid masses should strongly be considered.
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Affiliation(s)
- Aaron C Lin
- Department of Otolaryngology--Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02115, USA
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Ghantous Y, Naddaf R, Barak M, Abd-Elraziq M, Abu Eln-Naaj I. The Role of Fine Needle Aspiration in the Diagnosis of Parotid Gland Tumors. J Craniofac Surg 2016; 27:e192-6. [DOI: 10.1097/scs.0000000000002446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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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Howlett DC, Skelton E, Moody AB. Establishing an accurate diagnosis of a parotid lump: evaluation of the current biopsy methods - fine needle aspiration cytology, ultrasound-guided core biopsy, and intraoperative frozen section. Br J Oral Maxillofac Surg 2015; 53:580-3. [PMID: 25886878 DOI: 10.1016/j.bjoms.2015.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 03/25/2015] [Indexed: 11/18/2022]
Abstract
The optimum technique for histological confirmation of the nature of a parotid mass remains controversial. Fine needle aspiration cytology (FNAC), which has traditionally been used, is associated with high non-diagnostic and false negative rates, and ultrasound (US)-guided core biopsy and frozen section have been explored as alternatives. US-guided core biopsy is more invasive than FNAC, but is safe, well-tolerated, and associated with improved diagnostic performance. Although frozen section offers better specificity than FNAC, it has a number of important drawbacks and cannot be considered as a primary diagnostic tool. US-guided core biopsy should be considered as the initial diagnostic technique of choice, and in units where the accuracy of FNAC is good it can be used when FNAC is equivocal or non-diagnostic.
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Affiliation(s)
- D C Howlett
- Eastbourne District General Hospital, United Kingdom
| | - E Skelton
- Eastbourne District General Hospital, United Kingdom.
| | - A B Moody
- Eastbourne District General Hospital, United Kingdom
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Eom HJ, Lee JH, Ko MS, Choi YJ, Yoon RG, Cho KJ, Nam SY, Baek JH. Comparison of fine-needle aspiration and core needle biopsy under ultrasonographic guidance for detecting malignancy and for the tissue-specific diagnosis of salivary gland tumors. AJNR Am J Neuroradiol 2015; 36:1188-93. [PMID: 25678480 DOI: 10.3174/ajnr.a4247] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Diagnostic test accuracy studies for ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy have shown inconclusive results due to their heterogenous study designs. Our aim was to compare the diagnostic accuracy of ultrasonography-guided fine-needle aspiration versus ultrasonography-guided core needle biopsy for detecting malignant tumors of the salivary gland and for the tissue-specific diagnosis of salivary gland tumors in a single tertiary hospital. MATERIALS AND METHODS This retrospective study was approved by our institutional review board and informed consent was waived. Four hundred twelve patients who underwent ultrasonography-guided fine-needle aspiration (n = 155) or ultrasonography-guided core needle biopsy (n = 257) with subsequent surgical confirmation or clinical follow-up were enrolled. We compared the diagnostic accuracy of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy regarding malignant salivary gland tumors and the correct tissue-specific diagnosis of benign and malignant tumors. We also tested the difference between these procedures according to the operator's experience and lesion characteristics. RESULTS The inconclusive rates of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy were 19% and 4%, respectively (P < .001). The overall accuracy of ultrasonography-guided core needle biopsy for diagnosing malignant tumors was significantly higher than that of ultrasonography-guided fine-needle aspiration (P = .024). The correct tissue-specific diagnosis rates of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy were 95% versus 97% for benign tumors (P = .648) and 67% versus 80% for malignant tumors (P = .310). Trainees showed significantly lower accuracy with ultrasonography-guided fine-needle aspiration than with ultrasonography-guided core needle biopsy for diagnosing malignant tumors (P = .021). There was no difference between the diagnostic accuracy of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy according to the internal composition of the lesions. There were no complications requiring intervention or hospitalization in our patients. CONCLUSIONS Ultrasonography-guided core needle biopsy is superior to ultrasonography-guided fine-needle aspiration in detecting and characterizing malignant tumors of the salivary gland and could emerge as the diagnostic method of choice for patients presenting with a salivary gland mass.
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Affiliation(s)
- H-J Eom
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
| | - J H Lee
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
| | - M-S Ko
- Departments of Health Medicine (M.-S.K.)
| | - Y J Choi
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
| | - R G Yoon
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
| | | | - S Y Nam
- Otolaryngology (S.Y.N.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J H Baek
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
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Liu Y, Li J, Tan YR, Xiong P, Zhong LP. Accuracy of diagnosis of salivary gland tumors with the use of ultrasonography, computed tomography, and magnetic resonance imaging: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:238-245.e2. [PMID: 25577417 DOI: 10.1016/j.oooo.2014.10.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 07/02/2014] [Accepted: 10/29/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) for clinical differential diagnosis in patients with salivary gland tumor (SGT). STUDY DESIGN Six databases were used to search the literature published between 1982 and 2013. Histologic diagnosis was required as standard diagnosis. Pooled estimate for sensitivity, specificity, summary receiver-operating characteristic curve (SROC) and area under curve (AUC) were calculated and compared using STATA and Meta-Disc statistical software. RESULTS Nineteen articles were included. Pooled sensitivity for US, CT, and MRI was 0.629 (95% confidence interval [CI] 0.52-0.73), 0.830 (95% CI 0.74-0.90), and 0.807 (95% CI 0.73-0.87), respectively; pooled specificity for US, CT, and MRI was 0.920 (95% CI 0.89-0.94), 0.851 (95% CI 0.79-0.90), and 0.886 (95% CI 0.85-0.92), respectively. The AUC under SROC for US, CT, and MRI was 0.934 ± 0.058, 0.912 ± 0.889, and 0.903 ± 0.045, respectively. CONCLUSIONS CT is recommended, as it is an effective imaging tool for differential diagnosis in patients with primary SGT, and MRI is suggested for differential diagnosis between benign and malignant GSTs because of its highest sensitivity and specificity.
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Affiliation(s)
- Ying Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai, China
| | - Jia Li
- Department of Ultrasound, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-ran Tan
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai, China
| | - Ping Xiong
- Department of Ultrasound, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lai-ping Zhong
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai, China.
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Haldar S, Mandalia U, Skelton E, Chow V, Turner SS, Ramesar K, Tighe D, Williams M, Howlett D. Diagnostic investigation of parotid neoplasms: a 16-year experience of freehand fine needle aspiration cytology and ultrasound-guided core needle biopsy. Int J Oral Maxillofac Surg 2014; 44:151-7. [PMID: 25457828 DOI: 10.1016/j.ijom.2014.09.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/25/2014] [Accepted: 09/30/2014] [Indexed: 01/12/2023]
Abstract
This study aimed to examine the diagnostic yield of fine needle aspiration cytology (FNAC) and ultrasound-guided core needle biopsy (USCB) in the diagnosis of parotid neoplasia. A 16-year retrospective analysis was performed of patients entered into our pathology database with a final diagnosis of parotid neoplasia. FNAC and USCB data were compared to surgical excision where available. One hundred and twenty FNAC, 313 USCB, and 259 surgical specimens were analyzed from 397 patients. Fifty-six percent of FNAC and 4% of USCB were non-diagnostic. One hundred and thirty-two (33%) patients had a final diagnosis made by USCB and did not undergo surgery. Surgery was performed in 257 (65%) patients, 226 (88%) of whom had a preoperative biopsy. Most lesions were benign, but there were 62 parotid and 13 haematological malignancies diagnosed; false-negative results were obtained in three FNAC and two USCB samples. The sensitivity and specificity of FNAC were 70% and 89%, respectively, and for USCB were 93% and 100%, respectively. This study represents the largest series of patients with a parotid neoplasm undergoing USCB for diagnosis. USCB is highly accurate with a low non-diagnostic rate and should be considered an integral part of parotid assessment.
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Affiliation(s)
- S Haldar
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK.
| | - U Mandalia
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - E Skelton
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - V Chow
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - S S Turner
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - K Ramesar
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - D Tighe
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - M Williams
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - D Howlett
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
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Bates AS, Craig P, Knepil GJ. Myopericytoma of the parotid region treated by extracapsular dissection. BMJ Case Rep 2014; 2014:bcr-2013-201924. [PMID: 24717593 DOI: 10.1136/bcr-2013-201924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Myopericytoma (MPC) is a vascular neoplasm exhibiting differentiation towards perivascular cells. Variable cytoarchitechtural features are visible within MPC, and there is much overlap between MPC, myofibroma and glomus tumours. MPC have a local recurrence rate of 10-20% and malignancy has been described in a few published cases. Previously, superficial parotidectomy has been recommended for MPC but, in this case, the surgical approach was via extracapsular dissection (ECD). A 66-year-old Caucasian man presented with a palpable mass arising from the superficial lobe of the right parotid gland. Following removal by ECD, the histopathological diagnosis of MPC was made. This is the first published report describing ECD of MPC associated with the parotid gland. ECD is preferable to superficial parotidectomy for small superficial lesions such as MPC, with similar oncological outcomes and fewer functional and aesthetic complications.
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Poorey VK, Tyagi A. Accuracy of fine needle aspiration cytology in head and neck masses. Indian J Otolaryngol Head Neck Surg 2014; 66:182-6. [PMID: 24822159 DOI: 10.1007/s12070-014-0709-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 02/01/2014] [Indexed: 10/25/2022] Open
Abstract
In ENT clinical practice patients with neck swelling is a common presentation. To know their exact nature a simple, sensitive and diagnostic tool is required to prevent unnecessary costlier investigation and corresponding treatment. Fine needle aspiration cytology (FNAC) is a very safe, sensitive and diagnostic tool. This study was done to know the diagnostic accuracy, sensitivity and specificity of the FNAC in head and neck masses. Present prospective study was done in 179 patients of head and neck masses which were subjected to FNAC and their results were later correlated with histopathological examination report (HPR) wherever available. Out of 179 FNAC, HPR available only in 152 cases. In present study 104 cases (58.10 %) of lymph node, 35 cases (19.55 %) of thyroid gland, 17 cases (9.49 %) of salivary gland, 12 cases (6.70 %) of soft tissue and 11 cases (6.14 %) of miscellaneous swellings were present. The sensitivity, specificity, positive predictive value and negative predictive value of present study were 81.8, 95.0, 81.8 and 95.0 % respectively. The accuracy was 92.10 %.
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Affiliation(s)
- V K Poorey
- Department of ENT and Head and Neck Surgery, Gandhi Medical College and Hamidia Hospital, Bhopal, 462001 MP India
| | - Amit Tyagi
- Department of ENT and Head and Neck Surgery, Gandhi Medical College and Hamidia Hospital, Bhopal, 462001 MP India
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FINE NEEDLE ASPIRATION CYTOLOGY OF SALIVARY GLAND LESIONS AND ITS DIAGNOSTIC PITFALLS – A TERTIARY CARE CENTRE EXPERIENCE FROM NORTH EAST INDIA. ACTA ACUST UNITED AC 2013. [DOI: 10.14260/jemds/920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Huang YC, Wu CT, Lin G, Chuang WY, Yeow KM, Wan YL. Comparison of ultrasonographically guided fine-needle aspiration and core needle biopsy in the diagnosis of parotid masses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:189-194. [PMID: 21953076 DOI: 10.1002/jcu.20873] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 08/12/2011] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Yu-Chieh Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, 5 Fushing Road, Taoyuan, Taiwan
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Diagnostic value of ultrasound-guided core needle biopsy in patients with salivary gland masses. Int J Oral Maxillofac Surg 2011; 41:437-43. [PMID: 22204925 DOI: 10.1016/j.ijom.2011.12.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 08/25/2011] [Accepted: 12/01/2011] [Indexed: 12/23/2022]
Abstract
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.
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Dyckhoff G, Warta R, Gonnermann A, Plinkert PK, Flechtenmacher C, Volkmann M. Carbohydrate antigen 19-9 in saliva: possible preoperative marker of malignancy in parotid tumors. Otolaryngol Head Neck Surg 2011; 145:772-7. [PMID: 21746840 DOI: 10.1177/0194599811414512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Facial nerve preservation and oncological safety are crucial in surgery of parotid tumors. An unexpected histopathologic diagnosis of a malignant parotid tumor, however, may unfavorably require a second, more radical surgery. The aim of this study was to find out whether the assessment of serological tumor markers in parotid saliva might have some diagnostic significance in the preoperative differentiation between benign and malignant parotid lesions. STUDY DESIGN, SETTING, PATIENTS, AND METHODS: In a prospective pilot study performed at a university medical center in 28 patients with a unilateral parotid tumor, 7 serological tumor markers established in the clinical routine were quantitatively assessed in parotid saliva collected simultaneously on both sides after stimulation. The results were correlated with the histopathological diagnosis. RESULTS Of the 4 investigated tumors that were malignant neoplasms, 3 had a sufficient quantity of saliva available for tumor marker measurements. Carbohydrate antigen 19-9 (CA 19-9) consistently revealed high levels compared with the unaffected side in all malignant tumors, thus allowing malignant tumors to be differentiated from benign lesions. CONCLUSION The results of this pilot study are encouraging, showing that preoperative tumor marker investigation in saliva from parotid glands is feasible and merits further investigation. CA 19-9 might be a valuable new diagnostic tool in the preoperative differentiation between malignant and benign parotid tumors and should be investigated in a larger number of patients.
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Affiliation(s)
- Gerhard Dyckhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
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Ultrasound-Guided Fine Needle Aspiration of Major Salivary Gland Masses and Adjacent Lymph Nodes. Ultrasound Q 2011; 27:105-13. [DOI: 10.1097/ruq.0b013e31821c1177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lechner Goyault J, Riehm S, Neuville A, Gentine A, Veillon F. Interest of diffusion-weighted and gadolinium-enhanced dynamic MR sequences for the diagnosis of parotid gland tumors. J Neuroradiol 2011; 38:77-89. [DOI: 10.1016/j.neurad.2009.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 10/13/2009] [Indexed: 01/05/2023]
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Sharma G, Jung AS, Maceri DR, Rice DH, Martin SE, Grant EG. US-guided fine-needle aspiration of major salivary gland masses and adjacent lymph nodes: accuracy and impact on clinical decision making. Radiology 2011; 259:471-8. [PMID: 21364082 DOI: 10.1148/radiol.11101087] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine whether ultrasonography (US)-guided fine-needle aspiration (FNA) is an effective technique for diagnosing masses in the salivary gland and adjacent lymph nodes. MATERIALS AND METHODS The institutional review board waived the requirement to obtain informed consent and approved this HIPAA-compliant retrospective study. Radiology records of 50 patients (28 female patients aged 25-85 years [median age, 58 years], 22 male patients aged 11-82 years [median age, 62 years]) who underwent 52 consecutive US-guided FNA procedures from 2004 to 2009 were reviewed. In 46 cases, lesions were sampled for biopsy under real-time US guidance by means of three passes with a 25-gauge needle. In six cases, two subsequent passes were performed with a 22-gauge needle after the first pass showed minimal or no aspirate. Findings from cytopathologic analysis, clinical follow-up, and surgery were evaluated and compared. RESULTS A diagnostically adequate biopsy specimen was obtained in 48 of the 52 cases (92%). Among the 20 patients who underwent surgical intervention after diagnostic US-guided FNA findings, results of surgical-pathologic analysis helped confirm the cytologic diagnosis in 19 (95%). Twenty of the 50 patients (40%) were spared surgical intervention on the basis of findings from US-guided FNA. US-guided FNA did not result in any intra- or postprocedural complications. CONCLUSION The diagnostic accuracy of US-guided FNA is similar to that of core needle biopsy, and there were no complications in this study. Information yielded with FNA cytology plays an integral role in clinical decision making in the management of masses in the major salivary glands and adjacent structures.
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Affiliation(s)
- Gaurav Sharma
- Department of Radiology, Keck School of Medicine of USC, 1500 San Pablo St, Second Floor Imaging, Los Angeles, CA 90033, USA.
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Saha S, Woodhouse NR, Gok G, Ramesar K, Moody A, Howlett DC. Ultrasound guided Core Biopsy, Fine Needle Aspiration Cytology and Surgical Excision Biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: an eleven year experience. Eur J Radiol 2010; 80:792-5. [PMID: 21093189 DOI: 10.1016/j.ejrad.2010.10.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 10/12/2010] [Accepted: 10/20/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study aims to review our 11 year experience of diagnosing metastatic squamous cell carcinoma presenting as head and neck lumps. The techniques of Ultrasound guided Core Biopsy (USCB), Fine Needle Aspiration Cytology (FNAC) and Surgical Excision Biopsy (SEB) are compared. MATERIALS AND METHODS All patients with metastatic squamous cell carcinoma (SCC) involving the lymph nodes of the head and neck or parotid gland, diagnosed at Eastbourne District General Hospital between January 1998 and November 2009 were identified. The following data items were collated: biopsy location (e.g. cervical lymph node or parotid), any history of likely primary SCC and site, type of biopsy used to establish a conclusive diagnosis (index diagnostic technique), previous biopsies, the technique and their results, subsequent histology results. RESULTS A total of 90 patients were diagnosed with metastatic squamous cell carcinoma. The index diagnostic technique was USCB in 48 patients, FNAC in 29 and SEB in 13. In 72 (80%) patients the index biopsy was the sole tissue sample taken prior to surgery or other treatment. The remaining 18 patients underwent a total of 22 previous biopsies prior to the index biopsy. 95% (21/22) of these previous biopsies were non-definitive FNAC and 5% (1/22) was a non-definitive USCB. FNACs also demonstrated the highest non-diagnostic rate (42%). The accuracy of USCB and FNAC in correlating with final histopathology was 97% and 85% respectively. CONCLUSIONS USCB demonstrates excellent results in the diagnosis of metastatic SCC in the head and neck with higher accuracy and greater reliability than FNAC.
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Affiliation(s)
- Shouvik Saha
- Department of Radiology, Eastbourne District General Hospital, United Kingdom.
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Selective fine needle aspiration of parotid masses. FNA should be performed in all patients older than 60 years. The Journal of Laryngology & Otology 2010; 124:975-9. [PMID: 20497621 DOI: 10.1017/s0022215110001088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The exact role of fine needle aspiration in the pre-operative assessment of patients presenting with parotid masses is controversial. Some surgeons propose that fine needle aspiration be performed only selectively in those patients with likely malignant disease, whilst others recommend it for all patients presenting with such a mass. Intuitively, one would expect older patients to be more likely to suffer from primary malignant parotid tumours and secondary deposits of malignant skin tumours. Therefore, we hypothesised that older patients with a parotid mass should undergo fine needle aspiration regardless of their medical history. DESIGN We retrospectively reviewed 197 consecutive parotidectomies to test this hypothesis. RESULTS One hundred and twenty-one patients (61.4 per cent) were diagnosed with benign disease, whilst 76 (38.6 per cent) were diagnosed with malignant disease. Eighty-three per cent of patients aged 60 years or younger had benign disease, as opposed to 35.6 per cent of patients aged more than 60 years. Malignant disease occurred more commonly in patients older than 60 years (odds ratio 8.962, 95 per cent confidence interval 4.607-17.434). CONCLUSION In patients with a parotid mass, fine needle aspiration should be performed on all those aged 60 years or older.
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Salgarelli AC, Capparè P, Bellini P, Collini M. Usefulness of fine-needle aspiration in parotid diagnostics. Oral Maxillofac Surg 2009; 13:185-190. [PMID: 19821124 DOI: 10.1007/s10006-009-0182-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Fine needle aspiration (FNA) is a safe diagnostic technique that is widely employed for lesions of the head and neck. Among head and neck sites, the parotid gland is unique in the number, diversity, and peculiarity of its pathological processes. This complexity has prompted a great deal of discussion regarding the application of FNA to parotid masses, primarily focusing on the reliability of FNA as a diagnostic tool in guiding patient management. METHODS This review presents an analysis of the usefulness of FNA in differential diagnosis of parotid pathologies. RESULTS Recent studies have confirmed a wide range of accuracy rates for FNA evaluation of parotid masses, varying from 79% to 97%. These data cannot be uniformly anticipated across all diagnostic scenarios. FNA is notoriously unreliable in recognising the malignant nature of parotid carcinoma providing its precise classification and establishing its grade. A few malignant neoplasms are particularly prone to diagnostic error: acinic cell carcinoma is frequently interpreted as benign, and low-grade lymphomas are often discounted as inflammatory processes. CONCLUSIONS FNA cytology is useful in avoiding surgery (inflammatory lesions) or limiting surgical procedures (benign tumours). For planning the extent of surgery of malignant parotid tumours, the histological subtype and/or grade should be determined; therefore, a histological diagnosis by frozen section analysis is required. Moreover, reliance on FNA findings at the expense of clinical, radiographic, and intraoperative findings is unwarranted. Regardless of whether FNA is used routinely or selectively in patients with parotid masses, the findings should contribute to, and not replace, the overall diagnostic impression.
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Affiliation(s)
- Attilio Carlo Salgarelli
- Maxillofacial Surgery Unit, Head and Neck Department, Modena and Reggio Emilia University, Via del Pozzo 71, 41100 Modena, Italy.
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Hernando M, Martín-Fragueiro L, Eisenberg G, Echarri R, García-Peces V, Urbasos M, Plaza G. Tratamiento quirúrgico de los tumores de glándulas salivales. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 60:340-5. [DOI: 10.1016/j.otorri.2009.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 04/13/2009] [Indexed: 11/25/2022]
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Surgical management of salivary gland tumours. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009. [DOI: 10.1016/s2173-5735(09)70154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Prades JM, Oletski A, Faye MB, Dumollard JM, Timoshenko AP, Veyret C, Peoc'h M, Martin C. [Parotid gland masses: diagnostic value of MR imaging with histopathologic correlations]. Morphologie 2008; 91:44-51. [PMID: 17652005 DOI: 10.1016/j.morpho.2007.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of our study has been to describe the pre-operatively MR Imaging appearance of masses in the parotid gland which may be sources of clinical and radiological confusion. METHODS Sixty-eight adults patients with a parotid mass (39 female, 29 male) has been prospectively investigated. T1-weighted, T2-weighted, diffusion-weighted and contrast-enhanced dynamic MR images were performed by using a 1.5 or 1 T MR Imaging unit (Philips Gyroscan Intera 1.5 T. Siemens Expert 1 T). All patients underwent a parotidectomy with histopathologic analysis. RESULTS-CONCLUSIONS In case of pleomorphic adenoma (N=30) MR imaging sensibility, specificity and accuracy were respectively 87.5, 80.5 and 83%. In case of Warthin tumors (N=13) the same values were respectively 45.5, 93 and 85%. In case of malignant tumors (N=13) theses values were respectively 71, 89 and 87%. Our routine MR Imaging study appears excellent not only for assessing the type and extent of benign salivary gland tumors and the relationship to adjacent structures, but also for determining whether the tumor is benign or malignant.
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Affiliation(s)
- J-M Prades
- Laboratoire d'anatomie, faculté de médecine, Saint-Etienne, France.
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Herrera Hernández ÁA, Díaz Pérez JA, Andrés García C, Paola Herrera L, Aranda Valderrama P, Orozco Vargas LC. Evaluación de la citología por punción-aspiración con aguja fina en el diagnóstico de cáncer de la glándula parótida. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73297-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Evaluation of Fine Needle Aspiration Cytology in the Diagnosis of Cancer of the Parotid Gland. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s2173-5735(08)70225-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nakahara T, Suzuki T, Hashimoto J, Shigematsu N, Tomita T, Ogawa K, Kubo A. Role of salivary gland scintigraphy with Tc-99m pertechnetate in determining treatment of solitary parotid gland tumors: a retrospective study. Clin Nucl Med 2007; 32:363-6. [PMID: 17452863 DOI: 10.1097/01.rlu.0000259323.04488.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REPORT Although salivary gland scintigraphy has been useful for the diagnosis of Warthin's tumor (WT), there are no reports concerning the clinical impact of this scintigraphy. MATERIALS AND METHODS We retrospectively investigated 127 patients with solitary parotid tumors who had undergone salivary gland scintigraphy. RESULTS For patients who had surgery, the sensitivity, specificity, and accuracy of differentiating WT from non-WTs were 95%, 91%, and 92%, respectively. There was a significant correlation between scintigraphic results and the treatment decisions made for the 127 patients (chi2=16.5, P=0.00026). The proportion of WT patients among those who underwent surgery was 19%, whereas 42% of those who were suspected to have WT from scintigraphy were followed without surgical intervention. The main reasons for clinical observation in these patients were comorbidity, refusal of surgery, and age. CONCLUSIONS The high percentage of nonsurgical patients suspected to have WT can be explained by the high diagnostic accuracy of salivary gland scintigraphy, which is useful for determining further management when surgery is contraindicated or is refused by the patient.
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Affiliation(s)
- Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
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Howlett DC, Menezes LJ, Lewis K, Moody AB, Violaris N, Williams MD. Sonographically Guided Core Biopsy of A Parotid Mass. AJR Am J Roentgenol 2007; 188:223-7. [PMID: 17179369 DOI: 10.2214/ajr.05.1549] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the accuracy of sonographically guided core biopsy in the evaluation of parotid masses. SUBJECTS AND METHODS Between 1998 and 2004, 135 patients consecutively presenting with a parotid mass were prospectively enrolled into this study. A single operator performed initial diagnostic sonography and then sonographically guided core biopsy using local anesthesia. Biopsy was performed with an 18- or 20-gauge needle and a spring-loaded biopsy gun with a mean of two passes per patient. Outcome measures were accuracy, sensitivity, specificity, and predictive values of sonographically guided core biopsy compared with the final pathologic diagnosis in the surgical group. In the nonsurgical group, final diagnosis was established on the basis of histologic findings after adequate core biopsy and clinical follow-up. RESULTS All sonographically guided core biopsy specimens were considered satisfactory for histologic evaluation. Overall there were 71 benign tumors, 35 malignant tumors, and 29 miscellaneous, nonneoplastic lesions. In 76 (56%) of the 135 patients who underwent surgery, sonographically guided core biopsy and surgical histologic findings were correlated for 74 patients. In two cases sonographically guided core biopsy and surgical histologic findings did not correlate. In one case, the sonographically guided core biopsy finding was mucoepidermoid carcinoma, but the final diagnosis was squamous cell carcinoma. In the other case, the finding at sonographically guided core biopsy was squamous cell carcinoma, but the final diagnosis was mucoepidermoid carcinoma. The treatment of these patients was not affected. Fifty-nine (44%) of the 135 patients avoided surgery. In differentiation of benign from malignant disease, sonographically guided core biopsy had a sensitivity, specificity, and diagnostic accuracy of 100%. Sonographically guided core biopsy also had positive and negative predictive values of 100% in the diagnosis of malignancy. There were no significant complications of sonographically guided core biopsy. CONCLUSION Sonographically guided core biopsy is a highly accurate technique for evaluation of parotid lesions and can be safely performed as an outpatient procedure. Sonographically guided core biopsy has potential advantages over fine-needle aspiration cytologic examination, particularly in the typing and grading of lymphoma and carcinoma and in improved differentiation of reactive nodal hyperplasia from lymphoma. The use of sonographically guided core biopsy may help reduce the need for surgical biopsy and facilitates prompt referral to the appropriate clinical team.
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Affiliation(s)
- David C Howlett
- Department of Radiology, Eastbourne District General Hospital, East Sussex BN21 2UD, United Kingdom.
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Ahn SH, Park SY. Sebaceous lymphadenocarcinoma of parotid gland. Eur Arch Otorhinolaryngol 2006; 263:940-2. [PMID: 16786364 DOI: 10.1007/s00405-006-0087-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 04/06/2006] [Indexed: 02/07/2023]
Abstract
The sebaceous lymphadenocarcinoma of the salivary glands is extremely rare and represents carcinomatous transformation of sebaceous lymphadenoma. There are only four reported patients in the medical literature. A patient who presented with a recent increase of a left infraauricular mass, of more than 10 years duration, underwent surgery. The microscopic examination revealed a typical sebaceous lymphadenoma with transition to a sebaceous adenocarcinoma. After postoperative adjuvant radiotherapy, the patient remains disease-free at 24 months postoperatively. We here report a fifth case of this tumor and the youngest age at diagnosis among reported cases.
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Affiliation(s)
- Soon-Hyun Ahn
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 463-707, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of South Korea.
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Howlett D, Moody A, Williams M. Surgeon 2006; 4:185. [DOI: 10.1016/s1479-666x(06)80094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Witcher TP, Williams MD, Howlett DC. "One-stop" clinics in the investigation and diagnosis of head and neck lumps. Br J Oral Maxillofac Surg 2006; 45:19-22. [PMID: 16678313 DOI: 10.1016/j.bjoms.2006.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2006] [Indexed: 12/01/2022]
Abstract
This article considers the issues raised by the NICE guidelines "Improving outcomes in head and neck cancers" (2004) with particular emphasis on the guidelines regarding the creation of "one-stop" neck lump assessment clinics. Tissue sampling is an essential function of the clinics and the relative merits of fine needle aspiration cytology (FNAC) and ultrasound-guided core biopsy (US-CB) in the context of a one-stop model are discussed. All cancer service providers in the UK have a duty to implement the NICE guidelines, with the intention of improving cancer services to our patients. The measures against which head and neck cancer teams are to be accredited through the process of peer review will specify such a clinic to be in place. Teams should implement the guidance in such a way that there is a genuine benefit to patients. In many centres this may require clinicians to learn new skills and adopt different ways of working.
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Affiliation(s)
- T P Witcher
- Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex, UK.
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Alphs HH, Eisele DW, Westra WH. The role of fine needle aspiration in the evaluation of parotid masses. Curr Opin Otolaryngol Head Neck Surg 2006; 14:62-6. [PMID: 16552260 DOI: 10.1097/01.moo.0000193184.38310.0a] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Fine needle aspiration is a safe diagnostic technique that is widely employed for lesions of the head and neck. Among head and neck sites, the parotid gland stands apart for the number, diversity and peculiarity of pathologic processes to target this structure. This matchless complexity has prompted a thoughtful discussion regarding the application of the fine needle aspiration to parotid masses--a discussion that has primarily focused on the reliability of the fine needle aspiration as a diagnostic tool, and on its utility in guiding patient management. RECENT FINDINGS Recent studies have confirmed a high overall accuracy rate for fine needle aspiration evaluation of parotid masses, ranging from 90 to 95%. At the same time, these soaring accuracy rates cannot be uniformly anticipated across all diagnostic scenarios. Fine needle aspiration is notoriously unreliable in recognizing the malignant nature of the parotid carcinoma, providing its precise classification, and establishing its grade. A few malignant neoplasms are particularly prone to diagnostic error. Acinic cell carcinoma is frequently interpreted as benign or even nonneoplastic; and low-grade lymphomas are often discounted as inflammatory processes. SUMMARY Parotid gland masses are not particularly conducive to diagnostic accuracy and precision by fine needle aspiration. Accordingly, indiscriminant reliance on the fine needle aspiration findings at the expense of the clinical, radiographic, and intraoperative findings is unwarranted. Whether one uses the fine needle aspiration routinely or selectively in patients with parotid masses, the fine needle aspiration findings should contribute to, not displace, the overall diagnostic impression.
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Affiliation(s)
- H H Alphs
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21231, USA
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Abstract
Fine needle aspiration cytology (FNAC) has been widely adopted for the cytological diagnosis of parotid lumps. FNAC does have drawbacks, even under optimum conditions and may be associated with poor levels of diagnostic accuracy, particularly outside the specialized clinic environment. Ultrasound-guided core biopsy (USCB) is a relatively recently described technique in the parotid gland which has been well tolerated and has demonstrated a high degree of diagnostic accuracy in several studies. This article discusses the merits and pitfalls of FNAC, together with the technique of USCB and also highlights the potential advantages benefit provided by USCB in parotid diagnosis.
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Affiliation(s)
- D C Howlett
- Department of Radiology, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK
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