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Saqi A, Nishino M, Saieg M, Ly A, Lott Limbach A. Doing more with less: integrating small biopsies in cytology practice. J Am Soc Cytopathol 2024; 13:233-243. [PMID: 38677894 DOI: 10.1016/j.jasc.2024.03.005] [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: 02/15/2024] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/29/2024]
Abstract
Cytopathologists are at the forefront of specimen acquisition during many different procedures while providing rapid on site evaluation (ROSE). This has added pressure to cytopathologists as more and more ancillary testing is being requested on smaller amounts of tissue. By focusing on the most common organ sites: lung, head and neck, and pancreas, there is a discussion of what the cytopathologist needs to know to triage tissue successfully. Finally, there is a discussion of the logistical aspects of integrating small biopsies into everyday practice.
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Affiliation(s)
- Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Mauro Saieg
- Department of Cytology, Fleury Group, Sao Paulo, São Paulo, Brazil
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Abberly Lott Limbach
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio.
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2
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Hamour AF, O'Connell D, Biron VL, Allegretto M, Seemann R, Harris JR, Seikaly H, Côté DWJ. Clinical diagnostic utility of ultrasound-guided fine needle aspiration biopsy in parotid masses. EAR, NOSE & THROAT JOURNAL 2024; 103:NP340-NP344. [PMID: 34818946 DOI: 10.1177/01455613211058922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) is a common diagnostic tool used in the initial evaluation of parotid masses. In the literature, variable diagnostic accuracy of FNA is reported. Therefore, when considering clinical management of these patients, the utility of FNA is unclear. The aim of this study was to determine the capability of ultrasound-guided FNA to differentiate between benign and malignant neoplasms. Further, the way in which FNA results affect clinical decision-making was assessed. METHODS Retrospective data were collected for all patients who underwent parotidectomy at a large Canadian tertiary care center between 2011 and 2016. Patient demographics, preoperative imaging reports, preoperative FNA results, and final pathological diagnosis were analyzed. RESULTS Of the 199 patients who underwent parotidectomy, 184 had preoperative ultrasound-guided FNA. There were a total of 13 non-diagnostic FNAs. In diagnosing malignancy, FNA had a sensitivity and specificity of 71.4% and 98.7%, respectively. The positive predictive value (PPV) was 83.3%. The negative predictive value was 97.5%. Of the non-diagnostic FNAs, 2 out of 13 (15.4%) were deemed malignant neoplasms on final pathology. CONCLUSION FNA is a useful adjunct in the work-up of parotid masses, but it should be used with caution. Due to limited sensitivity, it should not be relied upon as the sole determinant of a surgeon's management plan.
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Affiliation(s)
- Amr F Hamour
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Dan O'Connell
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vincent L Biron
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Michael Allegretto
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Robert Seemann
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey R Harris
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David W J Côté
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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3
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Kazemi MA, Amini F, Kargar B, Lotfi M, Aghazadeh K, Sharifian H, Moradi B, Azadbakht J. The Value of Ultrasound-guided Core Needle Biopsy in Differentiating Benign from Malignant Salivary Gland Lesions. Indian J Otolaryngol Head Neck Surg 2023; 75:266-270. [PMID: 37275055 PMCID: PMC10235295 DOI: 10.1007/s12070-022-03148-4] [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: 12/31/2021] [Accepted: 08/19/2022] [Indexed: 06/07/2023] Open
Abstract
Purpose In recent years, core needle biopsy (CNB) technique has received much attention, being used as alternative method of tissue sampling for surgical biopsy of salivary gland tumors (SGTs). The present study aimed to evaluate the value of CNB in differentiating benign from malignant SGTs. Materials and methods Patients with suspected benign or malignant SGTs in imaging were enrolled in this study. All core needle biopsies were performed under ultrasound guidance, i.e. ultrasound-guided Core Needle Biopsy (USCNB). Histological examination of the specimen after surgical excision was regarded as gold standard test and set as reference standard to assess USCNB accuracy for discriminating between ultrasound-visible benign and malignant SGTs. Results Based on USCNB results, from 36 participants (14 women and 22 men) with SGTs, 44.4% of detected tumors were benign and 55.5% were malignant. Twenty-two patients underwent surgery and postoperative specimen histological examination showed that 59% of excised lesions were benign and 41% were malignant. USCNB and surgical biopsy (SB) findings were completely compatible for 21 patients. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of USCNB were 100% in differentiating malignant from benign lesions. Conclusion USCNB is a valuable and accurate method of diagnosis with high sensitivity and specificity in distinguishing benign from malignant ultrasound-visible SGTs.
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Affiliation(s)
- Mohammad Ali Kazemi
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Amini
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Kargar
- Faculty of medicine, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
| | - Maryam Lotfi
- Department of Pathology, Amiralam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyvan Aghazadeh
- Otorhinolaryngology research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sharifian
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Moradi
- Department of radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Women’ Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Javid Azadbakht
- Department of Radiology, Faculty of Medicine, Kashan University of Medical Sciences, Shahid Beheshti Hospital, Qotb Ravandi Blvd, 8715981151 Kashan, Iran
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4
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Sandhu S, Handa S. Pathology Mimicking Orofacial Pain. Dent Clin North Am 2023; 67:117-127. [PMID: 36404072 DOI: 10.1016/j.cden.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A case of a 64-year-old woman is reported, who developed new-onset pain over a preexisting area of right mandibular fullness. Clinical examination, MRI, and fine-needle aspiration cytology confirmed the diagnosis of a benign parotid gland tumor-pleomorphic adenoma, which was treated by total parotidectomy with complete removal of the tumor. When evaluating a patient with orofacial pain, oral health care providers should be cognizant of all potential differential diagnoses, especially in the setting of red flags such as persistent or enlarging facial swelling/fullness.
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Affiliation(s)
- Shaiba Sandhu
- Division of Orofacial Pain, Oral and Maxillofacial Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard School of Dental Medicine, Boston, MA, USA.
| | - Shruti Handa
- Division of Orofacial Pain, Oral and Maxillofacial Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard School of Dental Medicine, Boston, MA, USA
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5
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Colombo E, Van Lierde C, Zlate A, Jensen A, Gatta G, Didonè F, Licitra LF, Grégoire V, Vander Poorten V, Locati LD. Salivary gland cancers in elderly patients: challenges and therapeutic strategies. Front Oncol 2022; 12:1032471. [PMID: 36505842 PMCID: PMC9733538 DOI: 10.3389/fonc.2022.1032471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/31/2022] [Indexed: 11/26/2022] Open
Abstract
Salivary gland carcinomas (SGCs) are the most heterogeneous subgroup of head and neck malignant tumors, accounting for more than 20 subtypes. The median age of SGC diagnosis is expected to rise in the following decades, leading to crucial clinical challenges in geriatric oncology. Elderly patients, in comparison with patients aged below 65 years, are generally considered less amenable to receiving state-of-the-art curative treatments for localized disease, such as surgery and radiation/particle therapy. In the advanced setting, chemotherapy regimens are often dampened by the consideration of cardiovascular and renal comorbidities. Nevertheless, the elderly population encompasses a broad spectrum of functionalities. In the last decades, some screening tools (e.g. the G8 questionnaire) have been developed to identify those subjects who should receive a multidimensional geriatric assessment, to answer the question about the feasibility of complex treatments. In the present article, we discuss the most frequent SGC histologies diagnosed in the elderly population and the relative 5-years survival outcomes based on the most recent data from the Surveillance, Epidemiology, and End Results (SEER) Program. Moreover, we review the therapeutic strategies currently available for locoregionally advanced and metastatic disease, taking into account the recent advances in precision oncology. The synergy between the Multidisciplinary Tumor Board and the Geriatrician aims to shape the most appropriate treatment pathway for each elderly patient, focusing on global functionality instead of the sole chronological age.
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Affiliation(s)
- Elena Colombo
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Charlotte Van Lierde
- Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Alexandra Zlate
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Alexandra Jensen
- Department of Radiation Oncology, University Hospitals Giessen and Marburg (UKGM), Marburg, Germany
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Didonè
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa F. Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Vincent Grégoire
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Vander Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Laura D. Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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6
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Taniuchi M, Terada T, Kawata R. Fine-Needle Aspiration Cytology for Parotid Tumors. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111897. [PMID: 36431032 PMCID: PMC9693155 DOI: 10.3390/life12111897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
Fine-needle aspiration (FNA) cytology is widely used in clinical practice as a simple and minimally invasive test for parotid tumors that allows for preoperative estimation of benignancy and malignancy, histological type, and malignancy grade and can be performed on an outpatient basis. In recent years, cell blocks prepared with core needle biopsy (CNB) and liquid-based cytology (LBC) have increased the reliability of immunostaining and molecular biological testing, leading to improved diagnostic accuracy. In 2018, the Milan System for Reporting Salivary Gland Cytology was introduced, but it does not include malignancy grade or histological type, so we proposed the Osaka Medical College classification as a more clinically based cell classification that includes both types of information, and we have reported on its usefulness. This review gives an overview of the history and use of FNA and describes CNB and LBC and the two classification systems.
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7
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Heidari F, Heidari F, Najafi MS, Ansari R, Aghazadeh K, Sohrabpour S, Karimi E. Core Needle Biopsy in Suspicious Malignant Thyroid Nodules with Repeated Nondiagnostic Fine Needle Aspiration. Indian J Otolaryngol Head Neck Surg 2022; 74:2071-2075. [PMID: 36452564 PMCID: PMC9702104 DOI: 10.1007/s12070-020-02011-8] [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: 06/10/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
Key message The clinician could have CNB in mind for thyroid nodules when FNA results were nondiagnostic. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules. Abstract Usefulness of preoperative tissue sampling and pathology diagnoses in thyroid tumors were accepted worldwide. We investigate the role of Core needle biopsy (CNB) in the thyroid nodules lesions when FNA results are nondiagnostic. We conducted a cross-sectional study to evaluate twenty-six CNBs results of suspicious malignant thyroid nodules with nondiagnostic repeated fine needle aspiration. 25 from 26 CNBs were diagnostic. Twenty-one needle biopsy reports were papillary thyroid carcinoma, three CNB samples diagnosed medullary thyroid carcinoma and one of them had anaplastic results. All diagnostic needle biopsies results were compatible with final pathology. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules while repeated FNA yielded nondiagnostic results.
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Affiliation(s)
- Farrokh Heidari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Firouzeh Heidari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Mohammad Sadeq Najafi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Reza Ansari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Kayvan Aghazadeh
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Saeed Sohrabpour
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Ebrahim Karimi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
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Salim DN, Obinah MPB, Ternov NK, McCullagh MJD, Larsen MS, Hendel HW, Hölmich LR, Chakera AH. Fine needle and core needle ultrasound guided biopsies for assessing suspected melanoma metastasis in lymph nodes and subcutaneous tissue. J Surg Oncol 2022; 126:1058-1066. [DOI: 10.1002/jso.26998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/20/2022]
Affiliation(s)
- David N. Salim
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Magnus P. B. Obinah
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Niels K. Ternov
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Mark J. D. McCullagh
- Department of Radiology Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Mathilde S. Larsen
- Department of Pathology Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Helle W. Hendel
- Department of Clinical Physiology, Nuclear Medicine and PET Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
| | - Lisbet R. Hölmich
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Annette H. Chakera
- Department of Plastic Surgery Copenhagen University Hospital ‐ Herlev and Gentofte Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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9
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Hurry KJ, Karunaratne D, Westley S, Booth A, Ramesar KCRB, Zhang TT, Williams M, Howlett DC. Ultrasound-guided core biopsy in the diagnosis of parotid neoplasia: an overview and update with a review of the literature. Br J Radiol 2022; 95:20210972. [PMID: 34860569 PMCID: PMC8822560 DOI: 10.1259/bjr.20210972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Accurate diagnosis of parotid neoplasia is a key to determine the most appropriate patient management choice, including the need for surgery. This review provides an update of the literature on current practice and outcomes of parotid tissue sampling techniques, with an emphasis on ultrasound-guided core biopsy (USCB) and comparison with fine needle aspiration cytology (FNAC). METHODS A literature review of EMBASE, Medline, PubMed and Google Scholar was conducted. RESULTS USCB has higher sensitivity, specificity and lower non-diagnostic rates than optimized FNAC. It also has a significantly higher sensitivity for the detection of malignancy. Significant complications post-USCB are uncommon, with only one reported case of tumour seeding and no cases of permanent facial nerve dysfunction. The technique is less operator-dependent than FNAC, with less reported variation in results between institutions. CONCLUSIONS USCB can be considered as the optimum tool of choice for the diagnosis of parotid neoplasia. This would particularly be the case in centres utilizing FNAC with high non-diagnostic rates or reduced diagnostic accuracy when compared to USCB published data, or in centres establishing a new service. ADVANCES IN KNOWLEDGE An update of the role and outcomes of USCB in the diagnosis of parotid gland pathologies.Research shows that USCB preforms better than FNAC, in terms of sensitivity and specificity, particularly in the case of malignant neoplasia.Complications following USCB were found to be higher than that of FNAC; however, no long-term major complications following either method have been reported in the literature.
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Affiliation(s)
- Katharine Julia Hurry
- Department of Oral and Maxillofacial Surgery, East Sussex Healthcare NHS Trust, East Sussex, East Sussex
| | | | - Suzanne Westley
- Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, England
| | - Alessandra Booth
- Queen Mary University, London Dental Institute, London, United Kingdom
| | - Keith C R B Ramesar
- Histopathology Department, East Sussex Healthcare NHS Trust, East Sussex, East Sussex
| | | | - Michael Williams
- Department of Oral and Maxillofacial Surgery, East Sussex Healthcare NHS Trust, East Sussex, East Sussex
| | - David C Howlett
- Department of Oral and Maxillofacial Surgery, East Sussex Healthcare NHS Trust, East Sussex, East Sussex
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10
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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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11
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Comparison of Tru-Cut Biopsy and Incisional Biopsy in Achieving Prompt Diagnosis of Maxillofacial Pathology. J Maxillofac Oral Surg 2021; 20:479-485. [PMID: 34408377 DOI: 10.1007/s12663-021-01557-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022] Open
Abstract
Tru-cut (core needle) biopsy has many advantages over open biopsy. It is quick and easy to perform, may be carried out in the outpatient department, avoids incision through previously irradiated skin and has few complications. The purpose of this study is to compare the two available biopsy techniques that are Tru-cut biopsy and incisional biopsy in achieving prompt diagnosis of maxillofacial pathology. A prospective study was conducted in 25 patients reported to our department. The Tru-cut biopsy was performed by using 14 gauge disposable Tru-cut biopsy needles (Baxter, made in the USA) by means of two successive insertions with different angulations of the needle into the core of the lesion followed by incisional biopsy. The diagnostic criteria which were evaluated include: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Tru-cut biopsy had sensitivity of 68.42%; specificity of 83.33%; PPV of 92.86%; NPV of 45.45% with accuracy rate of 72%. The Tru-cut biopsy method was evaluated as a very helpful method for prompt diagnosis of maxillofacial pathology since it is practical to perform, causes minimum trauma to the tissue, decreases the metastatic risk of malignant lesions during the procedure and relatively free from complications.
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12
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You Y, Wang P, Wan X, Xu L, Gong Y, Zhang W. Androgen Deprivation Therapy for Patients with Androgen-Receptor-Positive Metastatic Salivary Duct Carcinoma: A Case Report and Review of the Literature. Onco Targets Ther 2021; 14:3481-3486. [PMID: 34093024 PMCID: PMC8169051 DOI: 10.2147/ott.s304900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 12/19/2022] Open
Abstract
Salivary duct carcinoma (SDC) is a rare and aggressive malignancy with high rates of recurrence and metastasis. There are no standard treatment options available for patients with recurrence and metastases. The case of a 61-year-old male with SDC of the left parotid gland is presented in this study. The results revealed that the patient’s tumour had strong positive staining for androgen receptor (AR) expression, mutations in HRAS and PIK3CA but not in other related genes, and no gene amplification of HER-2. After the primary therapy of parotidectomy with neck dissection and postoperative radiation, bone metastases were found in the ribs, pelvis and spine. Androgen deprivation therapy (ADT) involving combined androgen blockade (CAB) was effective as the first-line therapy for the patient’s metastases and resulted in a progression-free survival (PFS) of over 7 months to date. In conclusion, androgen deprivation therapy is recommended for patients with recurrent or metastatic SDC positive for androgen receptor expression.
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Affiliation(s)
- Yongfei You
- Department of Oncology, The First Hospital of Nanchang, Nanchang, Jiangxi, 330008, People's Republic of China
| | - Panpan Wang
- Department of Oncology, The First Hospital of Nanchang, Nanchang, Jiangxi, 330008, People's Republic of China
| | - Xi Wan
- Operating Room, The First Hospital of Nanchang, Nanchang, Jiangxi, 330008, People's Republic of China
| | - Liping Xu
- Department of Pathology, The First Hospital of Nanchang, Nanchang, Jiangxi, 330008, People's Republic of China
| | - Yi Gong
- Department of Imaging, The First Hospital of Nanchang, Nanchang, Jiangxi, 330008, People's Republic of China
| | - Weihua Zhang
- Department of Oncology, The First Hospital of Nanchang, Nanchang, Jiangxi, 330008, People's Republic of China
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13
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Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, Glastonbury C, Kaufman M, Lamarre E, Lau HY, Licitra L, Moore MG, Rodriguez C, Roshal A, Seethala R, Swiecicki P, Ha P. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39:1909-1941. [PMID: 33900808 DOI: 10.1200/jco.21.00449] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lisa Licitra
- Istituto Nazionale Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | | | | | | | - Patrick Ha
- University of California San Francisco, San Francisco, CA
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Johnson DN, Antic T, Reeves W, Mueller J, Lastra RR, Cipriani NA, Biernacka A. Histopathologic and clinical outcomes of Milan System categories "non-diagnostic" and "non-neoplastic" of salivary gland fine needle aspirations. J Am Soc Cytopathol 2021; 10:349-356. [PMID: 33867311 DOI: 10.1016/j.jasc.2021.03.001] [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] [Received: 01/07/2021] [Revised: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) specifies six categories with estimated risks of malignancy (ROM) and suggested management. The estimated ROM is 25% for Non-Diagnostic (ND) category, and 10% for Non-Neoplastic (NN). This study aimed to investigate histopathologic and clinical outcomes of MSRSGC categories ND and NN at the authors' institution. MATERIALS AND METHODS Cytopathology fine needle aspiration reports from 2008-2020 were searched for the word "salivary", "parotid", and "submandibular". Cases fitting Non-Diagnostic (ND) and Non-Neoplastic (NN) categories were identified. Follow-up cyto-/histopathologic and clinical data were extracted. RESULTS There were 43 ND and 46 NN cases. The average age was 58.3 years. Neoplastic lesions were found in 13 of 43 (30%) ND and 3 of 46 (6.5%) NN. The rate of malignancy in ND category was 14.0% (6/43) and 0% (0/46) in NN category. Four cases in ND (9.3%) and 6 (13.0%) in NN had no neoplasm and instead had an underlying reactive condition (e.g., chronic sialadenitis) or inflammatory lesion (e.g., lymphoepithelial cyst) on histologic follow-up. There was no follow-up pathology in 46.5% NDs (20/43) and 82.6% NNs (38/46); however, no lesions were apparent clinically with a mean follow-up of 3 years and 1.5 years, respectively. CONCLUSIONS MSRSGC categories ND and NN are helpful for reporting salivary gland FNA results. With proper clinical and radiologic correlation, ROM of NN is low; however, ROM of ND remains significant. Repeat FNA after correlation for ND cases seems prudent as neoplasms and malignancies may have gone undetected.
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Affiliation(s)
- Daniel N Johnson
- Department of Pathology, Northwestern University, Chicago, Illinois.
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ward Reeves
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Anna Biernacka
- Department of Pathology, The University of Chicago, Chicago, Illinois
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Wei PY, Shao C, Huan T, Wang HB, Ding ZX, Han ZJ. Diagnostic value of maximum signal intensity on T1-weighted MRI images for differentiating parotid gland tumours along with pathological correlation. Clin Radiol 2021; 76:472.e19-472.e25. [PMID: 33731262 DOI: 10.1016/j.crad.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/05/2021] [Indexed: 12/27/2022]
Abstract
AIM To investigate the efficacy of the maximum signal intensity of tumour on T1-weighted magnetic resonance imaging (MRI) images for differentiating Warthin's tumours (WTs) from pleomorphic adenomas (PAs) and malignant tumours (MTs). MATERIALS AND METHODS One hundred and fifty-four histopathologically confirmed parotid tumours, including 76 PAs, 45 WTs, and 33 MTs, were analysed. MRI results were compared with pathological findings. The maximum signal intensity of tumour and the average signal intensity of spinal cord were measured on T1-weighted images, then the tumour-to-spinal cord signal intensity ratio (T1-max-SIR) was calculated. The distribution of T1-max-SIRs among the three groups of tumours was analysed using the Mann-Whitney U-test. Receiver operating characteristic curves were generated to assess the ability of T1-max-SIRs to differentiate parotid tumours. In addition, the interobserver agreement between readers was assessed using interclass correlation coefficient (ICC). RESULTS T1-max-SIRs were higher in WTs than in PAs (p<0.001) and MTs (p<0.001), and no significant difference was found between PAs and MTs (p=0.151). The area under the curve (AUC) of T1-max-SIRs for differentiating WTs from PAs was 0.901, with a sensitivity of 91.1% and a specificity of 82.9%. The AUC of T1-max-SIRs for differentiating WTs from MTs was 0.851, with a sensitivity of 88.9% and a specificity of 78.8%. Readers had excellent interobserver agreement on T1-max-SIRs (ICC = 0.989; 95% confidence interval, 0.985-0.992). CONCLUSIONS T1-max-SIRs can be useful for differentiating WTs from PAs and MTs with high diagnostic efficiency.
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Affiliation(s)
- P Y Wei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - C Shao
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - T Huan
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - H B Wang
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Z X Ding
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Z J Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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16
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Huh G, Ahn JC, Cha W, Jeong WJ. Can the height of the parotid tumor be a predictor of malignancy? Gland Surg 2021; 10:721-728. [PMID: 33708554 DOI: 10.21037/gs-20-741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Accurate diagnosis of malignancy in the parotid gland before surgery is often challenging. Various clues should be used to increase the index of suspicion for malignancy. We hypothesized that malignant lesions of the parotid gland are located at the superior part of the gland compared to benign ones. Methods A total of 169 consecutive patients were included in this study whose medical records were retrospectively reviewed. Benign and malignant tumors were compared in size, height difference from five anatomical landmarks: hard palate, mastoid tip, earlobe, condylar head, and mandibular notch. The cutoff heights from significant landmarks (hard palate, condylar head) were estimated with ROC analysis and chi-square test. Results Twenty-nine patients (17.2%) were diagnosed with malignant and 140 patients (82.8%) as benign. The height differed significantly between benign and malignant tumors when the reference point was set for the hard palate (P=0.024) and the condylar head (P=0.049), with the cutoff height from reference points to be 22.5, 51.5 mm, respectively. Diagnostic values of parotid level difference presented higher sensitivity (75.9% for hard palate, 72.4% for condylar head vs. 47.8% for fine needle aspiration cytology) and lower false negative rate (24.1% for hard palate, 27.6% for condylar head vs. 52.2% for fine needle aspiration cytology) compared to fine needle aspiration cytology. Conclusions Malignant tumors of the parotid gland tend to locate at the superior part of the gland compared to benign tumors. Parotid tumors lying cephalad should raise an index of suspicion for malignancy. Height of the tumor in the parotid gland should be deliberately considered during the first encounter of the patient, which in turn could curate the next step in the diagnostic approach and treatment planning.
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Affiliation(s)
- Gene Huh
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae-Cheul Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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17
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Heidari F, Heidari F, Rahmaty B, Jafari N, Aghazadeh K, Sohrabpour S, Karimi E. The role of core needle biopsy in parotid glands lesions with inconclusive fine needle aspiration. Am J Otolaryngol 2020; 41:102718. [PMID: 32977065 DOI: 10.1016/j.amjoto.2020.102718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Usefulness of preoperative tissue sampling and pathology diagnoses in parotid gland tumors were accepted worldwide. We investigate the role of CNB in the parotid gland lesions when FNA results are inconclusive. METHODS We conducted a cross sectional study to evaluate CNB results from fifty-two patients with history of parotid gland lesion and inconclusive previous fine needle aspiration. RESULTS In this study, 45 out of 52 CNB results determined definite histological subtype diagnosis. Four CNB reports were inconclusive and three CNB results were compatible with malignancies, but did not define definite diagnosis. Calculated sensitivity for diagnosis of malignancy was 96% and specificity was 85%. Negative predictive value, positive predictive value, and accuracy for CNB in detecting malignancy, were calculated 94%, 90%, and 92%, respectively. CONCLUSIONS When FNA is not conclusive, CNB may be used as a precise method to evaluate the parotid gland lesions.
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Affiliation(s)
- Farrokh Heidari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Firouzeh Heidari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Rahmaty
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Neda Jafari
- Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kayvan Aghazadeh
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Sohrabpour
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Karimi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Jaber OI, Shawash SI. Retrospective implementation of the Milan system for reporting salivary gland cytopathology; a review of 5 years in a specialized cancer center. Diagn Cytopathol 2020; 49:187-194. [PMID: 33002325 DOI: 10.1002/dc.24621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/13/2020] [Accepted: 09/11/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Milan system for reporting salivary gland cytopathology (MSRSGC) aims to standardize terminology, facilitate communication, and optimize management by providing risk of malignancy (ROM) for each category. Our retrospective cohort aims to study the reproducibility of reporting using the MSRSGC and to calculate the ROM for each category. METHODS Cases of fine needle aspiration (FNA) of salivary glands and related cervical lymph nodes were retrieved from our files between 2015 to 2019. From a total of 63 cytology cases, 57 cases had available material for cytological reexamination of which 45 cases had follow up data. All cases were reviewed independently by two pathologists and reclassified based on the MSRSGC. The reclassification of cases for both pathologists was compared and the ROM for each diagnostic category was calculated. RESULTS The 57 cases were studied. Both pathologists had initial concordance in classification of 52 of 57 cases. The remainder five cases were concurred upon after combined review. The cases were classified as: Non Diagnostic (ND); (n = 8), Non Neoplastic (NN); (n = 7), Atypia of Undetermined Significance (AUS); (n = 8), Neoplasm Benign (NB) (n = 10), Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) (n = 5), Suspicious for Malignancy (SM) (n = 1) and Malignant (M) (n = 18). The ROM was: ND: (33.3%); NN: (0%); AUS (33.3%); NB (0%); SUMP (25%); SM (100%) and M (100%). CONCLUSION Applying the MSRSGC is reproducible which facilitates standardization of reports and stratifying cases preoperatively. In general, the ROM for our cases was close to that reported in the literature.
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Affiliation(s)
- Omar I Jaber
- Department of Pathology and Laboratory medicine, King Hussein Cancer Center, Amman, Jordan
| | - Sarah I Shawash
- Department of Pathology and Laboratory Medicine, Eastbourne Disrtrict General Hospital - East Sussex, Healthcare NHS Trust, Kings Drive, Eastbourne, England
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19
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Soumya, Whitehorn A, Ooi EH, Lockwood C. Accuracy of core needle biopsy compared to fine needle biopsy for the diagnosis of neoplasm in patients with suspected head and neck cancers: a systematic review protocol of diagnostic test accuracy. JBI Evid Synth 2020; 18:1602-1608. [PMID: 32813401 DOI: 10.11124/jbisrir-d-19-00225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of this review is to determine the difference in diagnostic accuracy of core needle biopsy and fine needle aspiration for patients with a head and neck mass using surgical histopathology as a reference test. The risks and adverse events associated with each technique will also be compared. INTRODUCTION Tissue diagnosis is critical in evaluation of head and neck lesions to guide management. Options for tissue biopsy include surgical biopsy, fine needle aspiration and core needle biopsy. INCLUSION CRITERIA Studies that compare ultrasound-guided core needle biopsy and/or fine needle aspiration to investigate lumps in the thyroid, cervical lymph nodes, or salivary glands for malignancy in adult patients will be included. The comparator test will be definitive histology in form of surgical biopsy/excision. METHODS MEDLINE, Emcare, Embase, Web of Science and Cochrane Register of Diagnostic Accuracy Studies will be searched. Studies will be critically appraised by two independent reviewers for methodological quality, using the modified critical appraisal instrument QUADAS-2 and JBI SUMARI software. Two independent reviewers will extract data from papers included in the review using the standardized data extraction tool available in the JBI Reviewer's Manual. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020140005.
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Affiliation(s)
- Soumya
- 1Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Australia 2JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 3Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia 4Department of Surgery, Flinders University, Bedford Park, Australia
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20
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Cho J, Kim J, Lee JS, Chee CG, Kim Y, Choi SI. Comparison of core needle biopsy and fine‐needle aspiration in diagnosis of ma lignant salivary gland neoplasm: Systematic review and meta‐analysis. Head Neck 2020; 42:3041-3050. [DOI: 10.1002/hed.26377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jungheum Cho
- Department of Radiology Seoul National University Bundang Hospital Seongnam South Korea
| | - Junghoon Kim
- Department of Radiology Seoul National University Bundang Hospital Seongnam South Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center Seoul South Korea
| | | | - Youngjune Kim
- Aerospace Medical Group Air Force Education and Training Command Jinju Korea
| | - Sang Il Choi
- Department of Radiology Seoul National University Bundang Hospital Seongnam South Korea
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21
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Whelan A, Al-Sayed AA, Bullock M, Taylor SM. Primary parotid lymphoepithelial carcinoma: A case report and literature review of a rare pathological entity. Int J Surg Case Rep 2020; 72:610-614. [PMID: 32698300 PMCID: PMC7332494 DOI: 10.1016/j.ijscr.2020.06.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/29/2022] Open
Abstract
A high index of suspicion is required for primary parotid lymphoepithelial cancer in Caucasians with a pre-auricular mass. LEC can afflict patients of any ethnicity in Epstein-Barr Virus non-endemic areas. LEC of the parotid gland is a rare entity that requires complete surgical resection and post-operative radiation therapy.
Background Lymphoepithelial carcinoma (LEC) of the salivary glands is a rare, but distinct, poorly-differentiated neoplasm that resembles undifferentiated nasopharyngeal carcinomas (NPC). Among primary salivary gland LECs, they most commonly arise in the parotid gland. These lesions have a noticeable racial predilection, mostly occurring in Asians and Arctic region native populations. They are strongly associated with Epstein-Barr virus (EBV), and are more common in EBV-endemic areas. The most common presenting symptoms of primary parotid LEC are parotid mass development and cervical lymphadenopathy. We report an unusual case of EBV-negative LEC in a Canadian Caucasian woman. Case presentation A 40-year-old female from Atlantic Canada presented with a rapidly enlarging preauricular mass and cervical lymphadenopathy. Preoperative diagnostics via radiology and fine needle aspiration alluded to an ambiguous primary parotid malignancy. She underwent a total parotidectomy with facial nerve sacrifice and ipsilateral selective neck dissection. The facial nerve was reconstructed with a lateral antecubital nerve graft. Pathology came back positive for LEC, and she began adjuvant radiotherapy. At her 1-year follow up, she was disease-free and obtained a House-Brackmann facial nerve function grade of 3. Conclusions The case report highlights the importance of having a high index of suspicion and the need for interdisciplinary collaboration in reaching the diagnosis of primary parotid LEC. LEC can afflict patients of any ethnicity in non-EBV endemic areas and should therefore be considered in all patients with a painless parotid mass regardless of ethnicity. Further studies are required to elucidate the oncogenic role of EBV in these cancers.
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Affiliation(s)
- Ashley Whelan
- Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS B3H 4R2, Canada; Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS B3K 6R8, Canada.
| | - Ahmed A Al-Sayed
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS B3K 6R8, Canada; Department of Otolaryngology Head and Neck Surgery, King Saud University, King Abdul Aziz Rd, Al Malaz, Riyadh 12629, Saudi Arabia
| | - Martin Bullock
- Department of Pathology, Dalhousie University, Sir Charles Tupper Medical Building, Room 11B, 5850 College Street, Halifax, NS B3H 4R2, Canada
| | - S Mark Taylor
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS B3K 6R8, Canada
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22
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Ray HM, Kuban JD, Tam AL, Huynh TT, Pisimisis GT. Percutaneous retrograde left external carotid artery coil embolization for management of hemorrhage from a persistent proatlantal intersegmental artery type 2. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:250-253. [PMID: 32490297 PMCID: PMC7261950 DOI: 10.1016/j.jvscit.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/29/2020] [Indexed: 12/17/2022]
Abstract
Persistent fetal communications between the carotid and vertebrobasilar systems are rare and most often discovered incidentally. We present the case of a patient with oropharyngeal cancer status post chemotherapy, radiation therapy, and surgical resection who developed acute oropharyngeal hemorrhage on postoperative day 36, originating from branches of the ligated external carotid artery stump by retrograde flow through a proatlantal intersegmental artery type 2. This hemorrhage was successfully controlled with coil embolization through percutaneous access of the external carotid artery without recurrence at 1-year follow-up.
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Affiliation(s)
- Hunter M Ray
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Joshua D Kuban
- The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Alda L Tam
- The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Tam T Huynh
- The University of Texas MD Anderson Cancer Center, Houston, Tex
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23
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Mallon D, Dixon L, Campion T, Dawe G, Bhatia K, Kachramanoglou C, Kirmi O. Beyond the brain: Extra-axial pathology on diffusion weighted imaging in neuroimaging. J Neurol Sci 2020; 415:116900. [PMID: 32464349 DOI: 10.1016/j.jns.2020.116900] [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: 02/17/2020] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 01/10/2023]
Abstract
Diffusion-weighted imaging (DWI) has a central role in the assessment of the brain parenchyma, particularly in the context of acute stroke. However, the applications of DWI extend far beyond the brain parenchyma and include the assessment of the extra-axial structures of the head and neck that are included in routine brain imaging. In this pictorial review, the added-value of DWI over other conventional sequences is illustrated through discussion of a broad range of disorders affecting the vasculature, skull, orbits, nasal cavity and salivary glands. This article highlights the requirement for all structures, both intra- and extra-axial, to be carefully reviewed on DWI.
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Affiliation(s)
- Dermot Mallon
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - Luke Dixon
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Tom Campion
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Gemma Dawe
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Kunwar Bhatia
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Carolina Kachramanoglou
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Olga Kirmi
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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Johnson DN, Onenerk M, Krane JF, Rossi ED, Baloch Z, Barkan G, Bongiovanni M, Callegari F, Canberk S, Dixon G, Field A, Griffith CC, Jhala N, Jiang S, Kurtycz D, Layfield L, Lin O, Maleki Z, Perez-Machado M, Pusztaszeri M, Vielh P, Wang H, Zarka MA, Faquin WC. Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel. Cancer Cytopathol 2020; 128:392-402. [PMID: 32267606 DOI: 10.1002/cncy.22271] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Fine needle aspiration (FNA) is commonly used for the preoperative evaluation of salivary gland tumors. Tumor grade is a key factor influencing clinical management of salivary gland carcinomas (SGCs). To assess the ability to grade nonbasaloid SGCs in FNA specimens, an international panel of cytopathologists convened to review and score SGC cases. METHODS The study cohort included 61 cases of primary SGC from the pathology archives of 3 tertiary medical centers. Cases from 2005 to 2016 were selected, scanned, and digitized. Nineteen cytopathologists blinded to the histologic diagnosis reviewed the digitized cytology slides and graded them as low, high, or indeterminate. The panelists' results were then compared to the tumor grades based on histopathologic examination of the corresponding resection specimens. RESULTS All but 2 of the 19 (89.5%) expert panelists review more than 20 salivary gland FNAs per year; 16 (84.2%) of the panelists work at academic medical centers, and 13 (68.4%) have more than 10 years' experience. Participants had an overall accuracy of 89.4% in the grading of SGC cases, with 90.2% and 88.3% for low- and high-grade SGC, respectively. Acinic cell carcinoma and mucoepidermoid carcinoma had the highest degree of accuracy, while epithelial-myoepithelial carcinoma and salivary duct carcinoma had the lowest degree of accuracy. As expected, the intermediate-grade SGC cases showed the greatest variability (high-grade, 42.1%; low-grade, 37.5%, indeterminate, 20.4%). CONCLUSION This study confirms the high accuracy of cytomorphologic grading of primary SGC by FNA as low- or high-grade. However, caution should be exercised when a grade cannot be confidently assigned.
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Affiliation(s)
- Daniel N Johnson
- Department of Pathology, Cytopathology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mine Onenerk
- Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Jeffrey F Krane
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Esther Diana Rossi
- Department of Pathology, Fondazione Policlinico Universitario "Agostino Gemelli," IRCCS, Universita' Cattolica, Rome, Italy
| | - Zubair Baloch
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Güliz Barkan
- Loyola University Healthcare System, Maywood, Illinois
| | | | | | - Sule Canberk
- Cancer Signaling and Metabolism, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Division of Cytopathology, Department of Pathology, Acibadem University, Istanbul, Turkey
| | - Glen Dixon
- HCA Laboratories, HCA Healthcare UK, London, United Kingdom
| | - Andrew Field
- Department of Pathology, St. Vincent Hospital, Sydney, Australia
| | | | - Nirag Jhala
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Sara Jiang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Daniel Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, State Laboratory of Hygiene, Madison, Wisconsin
| | - Lester Layfield
- Department of Pathology and Anatomical Services, University of Missouri, Columbia, Missouri
| | - Oscar Lin
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Marc Pusztaszeri
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Philippe Vielh
- Department of Pathology, Laboratoire National de Santé, Dudelange, Luxembourg
| | - He Wang
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew A Zarka
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Scottsdale, Arizona
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts
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25
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Dostalova L, Kalfert D, Jechova A, Koucky V, Novak S, Kuchar M, Zabrodsky M, Novakova Kodetova D, Ludvikova M, Kholova I, Plzak J. The role of fine-needle aspiration biopsy (FNAB) in the diagnostic management of parotid gland masses with emphasis on potential pitfalls. Eur Arch Otorhinolaryngol 2020; 277:1763-1769. [PMID: 32107613 DOI: 10.1007/s00405-020-05868-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The treatment strategy of parotid gland tumours depends mainly on the histopathological type of the lesion. Fine-needle aspiration biopsy (FNAB) is recommended in preoperative diagnostics. The aim of the study was to evaluate the FNAB standing in the diagnostic algorithm of parotid gland lesions and to correlate FNAB results in relation to the definitive histopathological diagnosis. MATERIAL AND METHODS The retrospective analyses of 651 examined and consequently surgically treated parotid gland lesions at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague between 2006 and 2016 were used. Preoperative cytological results were consequently evaluated in relation to the definitive histopathological diagnosis. RESULTS The cohort consisted of 367 women and 284 men (average age 58 years). FNAB was diagnostic in 604 (92.8%) patients and non-diagnostic in 47 (7.2%) patients. The result of FNAB was positive (suspicious for malignant tumour) in 89 (14.7%) patients and negative (benign) in 515 (85.3%) patients. Sensitivity of the examination was 80.00%, specificity was 93.82%, PPV 62.92%, NPV 97.28%, and LR + and LR- were 12.95 and 0.21, respectively, with an accuracy of 92.22%. CONCLUSION Our results confirm the significant role of FNAB in the diagnostic algorithm of parotid gland lesions.
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Affiliation(s)
- Lucie Dostalova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic.
| | - Alzbeta Jechova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Vladimir Koucky
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Stepan Novak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Martin Kuchar
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Michal Zabrodsky
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Daniela Novakova Kodetova
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, University Hospital Motol, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Marie Ludvikova
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Ivana Kholova
- Department of Pathology, Faculty of Medicine and Health Technology, Fimlab Laboratories and Tampere University, Tampere, Finland
| | - Jan Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
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Benchetrit L, Torabi SJ, Morse E, Mehra S, Rahmati R, Osborn HA, Judson BL. Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins. Laryngoscope 2019; 130:1450-1458. [PMID: 31411749 DOI: 10.1002/lary.28224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 07/19/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Determine rate of preoperative biopsy in parotid malignancies, identify factors associated with its use, and its association with surgical margins. STUDY DESIGN Retrospective cohort. SETTING Commission on Cancer-Accredited Institutions. SUBJECTS AND METHODS We included 5533 patients treated surgically for a parotid malignancy 2004-2014 in the National Cancer Database. Chi-squared tests, univariable, and multivariable logistic regressions were used to evaluate predictors of preoperative biopsy (defined as needle, aspiration, or incisional), and associate biopsy with surgical margins. RESULTS Preoperative biopsy was utilized in 26.0% of patients. Biopsy was more likely in patients >60 years (odds ratio [OR]: 1.19, P = .035), advanced clinical T stage (vs. T1,T2 OR: 1.23, P = .009; T3 OR: 1.26, P = .026; T4A OR: 2.05, P < .001), advanced clinical N stage (vs. N0, N1: OR: 1.39, P = .013; N2/3: OR: 1.63, P < .001), in academic centers (OR: 1.18, P < .024), and in higher volume centers (vs. low, medium OR: 1.28, P = .002; high OR: 2.16, P < .001). Biopsy use increased over time (vs. 2004-2006, 2007-2010 OR: 1.20, P = .047; 2011-2014 OR: 1.39, P < .001). Biopsy was associated with a reduced risk of positive margins in patients with clinical T1 stage (OR: 0.70, P = .012), and younger than 61 (OR: 0.79, P = .036). CONCLUSION The national rate of preoperative biopsy in parotid malignancy is low at 26.0%, but has increased over time. Preoperative biopsy is associated with a reduced risk of positive margins in younger patients and those with early clinical stage, suggesting its increased use may improve surgical outcomes and decrease reoperation or adjuvant therapy in these subgroups of patients. LEVEL OF EVIDENCE 3 Laryngoscope, 130:1450-1458, 2020.
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Affiliation(s)
- Liliya Benchetrit
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Sina J Torabi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Elliot Morse
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Saral Mehra
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
| | - Rahmatullah Rahmati
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
| | - Heather A Osborn
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
| | - Benjamin L Judson
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
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Benchetrit L, Morse E, Judson BL, Mehra S. Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation. Otolaryngol Head Neck Surg 2019; 161:620-628. [PMID: 31159649 DOI: 10.1177/0194599819852094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Identify positive margin rate in a national cohort of patients with submandibular carcinoma, identify predictors of positive margins, and associate margins with overall survival. STUDY DESIGN Retrospective cohort. SETTING Commission on Cancer-accredited hospitals. SUBJECTS AND METHODS We included patients in the National Cancer Database from 2004 to 2014 who were diagnosed with submandibular carcinoma and underwent primary surgical resection. We determined the rate of positive surgical margins and associated patient, tumor, and treatment factors with positive margins via univariable and multivariable logistic regression analysis. We associated margin status with overall survival by Kaplan-Meier curve and Cox proportional hazards regression. RESULTS We identified 1150 patients with submandibular malignancy undergoing surgical resection. Positive margin rate was 41.0%. Increased odds of positive margins were seen in patients with advanced T stage (vs T1, T3: odds ratio [OR] = 3.04, P < .001; T4a: OR = 2.89, P < .001), adenoid cystic carcinoma histology (OR = 1.54, P = .020), and those treated at nonacademic facilities (OR = 1.41, P = .008). Patients who underwent a preoperative diagnostic biopsy had decreased odds of positive margins (OR = 0.72, P = .014). Positive margins were associated with reduced overall survival (58% vs 69% 5-year overall survival, P < .001; hazard ratio = 1.49, P = .001) when controlling for patient, tumor, and management factors. CONCLUSIONS The national positive margin rate of submandibular carcinoma is 41.0%. Preoperative biopsy and treatment at academic institutions independently decreased the risk of positive margins, and positive margins were independently associated with diminished overall survival. Positive margin rate for submandibular carcinoma may be considered a benchmark for quality of care.
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Affiliation(s)
- Liliya Benchetrit
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elliot Morse
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
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Renshaw AA, Gould EW. Improving the diagnostic accuracy of biliary cytology. Diagn Cytopathol 2019; 47:639-640. [PMID: 31041845 DOI: 10.1002/dc.24199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida
| | - Edwin W Gould
- Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida
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Abstract
Salivary gland tumors are rare pathologic entities that are derived from major and minor salivary gland tissue located throughout the head and neck region. These tumors are distinctly heterogenous, comprising numerous cell types, especially those deemed malignant. The incidence of malignant salivary gland tumors is widely distributed in both adult and pediatric patient populations. Accurate diagnosis and optimal treatment of these tumors pose challenges to both interpreting pathologists and ablative surgeons. This article examines the epidemiology and pathology of malignant tumors of the major and minor salivary glands and provides recommendations for the most successful treatment approaches.
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Affiliation(s)
- Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Cancer Institute, 1930 Alcoa Highway, Suite 335, Knoxville, TN 37920, USA.
| | - Thomas Schlieve
- Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical School, Parkland Memorial Hospital, 5323 Harry Hines Boulevard, Mail Code 9109, Dallas, TX 75390, USA
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30
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Rossi ED, Faquin WC. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): An international effort toward improved patient care-when the roots might be inspired by Leonardo da Vinci. Cancer Cytopathol 2018; 126:756-766. [DOI: 10.1002/cncy.22040] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Agostino Gemelli” School of Medicine; Rome Italy
| | - William C. Faquin
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
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Zbären P, Triantafyllou A, Devaney KO, Poorten VV, Hellquist H, Rinaldo A, Ferlito A. Preoperative diagnostic of parotid gland neoplasms: fine-needle aspiration cytology or core needle biopsy? Eur Arch Otorhinolaryngol 2018; 275:2609-2613. [DOI: 10.1007/s00405-018-5131-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022]
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32
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Gupta N, Gupta P, Rajwanshi A. Trucut/Core Biopsy versus FNAC: Who Wins the Match? Thyroid Lesions and Salivary Gland Lesions: An Overview. J Cytol 2018; 35:173-175. [PMID: 30089948 PMCID: PMC6060581 DOI: 10.4103/joc.joc_18_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Thyroid and salivary gland are amongst the most common sites subjected to fine needle aspiration cytology (FNAC) due to easy accessibility of these sites along with high diagnostic accuracy of FNAC. The performance of FNAC can be increased with the use of ultrasonographic guidance and rapid on-site evaluation. Cell block along with immunochemistry and other ancillary techniques further helps in clinching the correct diagnosis in certain diagnostically challenging cases. Core needle biopsy (CNB) is proposed to have a better diagnostic accuracy in certain situations. However, CNB has no definite role as an upfront first-line diagnostic technique for thyroid or salivary gland lesions. We describe role of FNAC and CNB in thyroid and salivary gland lesions with detailed discussion of advantages and disadvantages of both these techniques.
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Affiliation(s)
- Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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33
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Rossi E, Baloch Z, Pusztaszeri M, Faquin W. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): An ASC-IAC-Sponsored System for Reporting Salivary Gland Fine-Needle Aspiration. Acta Cytol 2018. [DOI: 10.1159/000488969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The diagnostic role of salivary gland fine-needle aspiration (SG-FNA) is well established in the preoperative evaluation of patients with salivary gland lesions. At present, most salivary SG-FNA specimens are diagnosed based on conventional diagnostic criteria. However, there exists a lack of uniform reporting for these specimens to guide the clinical management of patients. This void motivated a group of experienced cytopathologists to spearhead the development of a uniform reporting system. This international panel, under the sponsorship of the American Society of Cytopathology (ASC) and the International Academy of Cytology (IAC), gathered in September 2015 at the European Congress of Cytology, held in Milan, Italy, to propose the “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC). This effort sparked the interest of many and brought forth an agreement to develop an evidence-based tiered classification consisting of 6 diagnostic categories. It is hoped that this standard reporting system will enhance the overall effectiveness of SG-FNA reporting across institutions, with the ultimate result being better communication and improved patient care.
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34
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Rossi ED, Baloch Z, Pusztaszeri M, Faquin WC. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): an ASC-IAC-sponsored system for reporting salivary gland fine-needle aspiration. J Am Soc Cytopathol 2018; 7:111-118. [PMID: 31043307 DOI: 10.1016/j.jasc.2018.02.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/30/2018] [Accepted: 02/07/2018] [Indexed: 06/09/2023]
Abstract
The diagnostic role of salivary gland fine-needle aspiration (SG-FNA) is well established in the preoperative evaluation of patients with salivary gland lesions. At present, most salivary SG-FNA specimens are diagnosed based on conventional diagnostic criteria. Nevertheless, there exists a lack of uniform reporting for these specimens to guide the clinical management of patients. This void motivated a group of experienced cytopathologists to spearhead the development of a uniform reporting system. This international panel, under the sponsorship of the American Society of Cytopathology (ASC) and the International Academy of Cytology (IAC), gathered in September 2015 at the European Congress of Cytology, held in Milan, Italy, to propose "The Milan System for Reporting Salivary Gland Cytopathology. This effort sparked the interest of many and brought forth an agreement to develop an evidence-based tiered classification consisting of 6 diagnostic categories. We hope that this standard reporting system will enhance the overall effectiveness of SG-FNA reporting across institutions, with the ultimate result being better communication and improved patient care.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy.
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marc Pusztaszeri
- Division of Pathology, Jewish General Hospital and McGill University, Montréal, Canada
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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35
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Lie G, Chia J, Quiroga J, Howlett D, Topple J. Metastatic adenocarcinoma of the oesophagus to the submandibular gland—the imaging and pathological features of a rare phenomenon. BJR Case Rep 2017; 3:20160127. [PMID: 30363254 PMCID: PMC6159206 DOI: 10.1259/bjrcr.20160127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 11/05/2022] Open
Abstract
Metastatic disease affecting the submandibular gland is a rare entity, with just over a 100 cases documented. We present the case of a 55-year-old female with an apparently operable oesophageal primary adenocarcinoma, who was identified on staging PET scan and confirmed on ultrasound-guided biopsy to have metastatic disease in her left submandibular gland. The imaging and pathological findings are presented and compared with the current body of literature. Previously recognized primary sites of metastasis include the breast, thyroid, lung and genitourinary organs. We believe this to be the first documented case of oesophageal adenocarcinoma metastasising to the submandibular gland.
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Affiliation(s)
- Geoffrey Lie
- Department of Clinical Radiology, Eastbourne District General Hospital, Eastbourne, UK
| | - Jonathan Chia
- Department of Clinical Radiology, Eastbourne District General Hospital, Eastbourne, UK
| | - Jose Quiroga
- Department of Histopathology, Eastbourne District General Hospital, Eastbourne, UK
| | - David Howlett
- Department of Clinical Radiology, Eastbourne District General Hospital, Eastbourne, UK
| | - Jane Topple
- Department of Clinical Radiology, Conquest District General Hospital, Saint Leonards-On-Sea, UK
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36
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Kim HJ, Kim JS. Ultrasound-guided core needle biopsy in salivary glands: A meta-analysis. Laryngoscope 2017; 128:118-125. [DOI: 10.1002/lary.26764] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/23/2017] [Accepted: 06/01/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Hee Joon Kim
- Department of Radiology; Presbyterian Medical Center; Jeonju Republic of Korea
| | - Jong Seung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; College of Medicine, Chonbuk National University; Jeonju Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University; Biomedical Research Institute of Chonbuk National University Hospital; Jeonju Republic of Korea
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37
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Ahn D, Roh JH, Kim JK. Ultrasound-Guided Core Needle Biopsy for Head and Neck Mass Lesions in Patients Undergoing Antiplatelet or Anticoagulation Therapy: A Preliminary Report. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1339-1346. [PMID: 28370160 DOI: 10.7863/ultra.16.05045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/23/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We compared the complications and diagnostic adequacy of ultrasound (US)-guided core needle biopsy (CNB) for head and neck mass lesions between patients who did and did not receive antiplatelet/anticoagulation therapy. METHODS This study was designed as a prospective case study including 146 consecutive patients who underwent US-guided CNB for head and neck mass lesions. Of these, 32 patients were undergoing antiplatelet/anticoagulation therapy involving aspirin, clopidogrel, cilostazol, and warfarin. RESULTS None of the patients had clinical bleeding/hematoma in either group. Subclinical bleeding/hematoma recognized only by a US examination was not significantly different between the groups (P = .229). No other complications were noticed. The rate of unsatisfactory sampling was also not different between the groups (P > .999). Furthermore, when patients receiving aspirin (n = 18) were reclassified into the no-antiplatelet/anticoagulation therapy group, there was still no significant difference in the incidences of complications compared with the patients receiving clopidogrel, cilostazol, or warfarin (n = 14). CONCLUSIONS Our study suggests that US-guided CNB is safe and provides good diagnostic results without necessitating the discontinuation of antiplatelet/anticoagulation therapy in patients with head and neck mass lesions. However, as this was a preliminary study, the cohort was relatively small. Larger studies are needed to confirm our findings.
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Affiliation(s)
- Dongbin Ahn
- Departments of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Hyung Roh
- Department of Cardiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong Kyu Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea
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38
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Romano EB, Wagner JM, Alleman AM, Zhao L, Conrad RD, Krempl GA. Fine-needle aspiration with selective use of core needle biopsy of major salivary gland tumors. Laryngoscope 2017; 127:2522-2527. [DOI: 10.1002/lary.26643] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/05/2017] [Accepted: 03/28/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Erica B. Romano
- University of Oklahoma College of Medicine; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
| | - Jason M. Wagner
- Department of Radiological Sciences; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
| | - Anthony M. Alleman
- Department of Radiological Sciences; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
| | - Lichao Zhao
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
| | - Rachel D. Conrad
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
| | - Greg A. Krempl
- Department of Otorhinolaryngology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma U.S.A
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39
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Atula T, Panigrahi J, Tarkkanen J, Mäkitie A, Aro K. Preoperative evaluation and surgical planning of submandibular gland tumors. Head Neck 2017; 39:1071-1077. [PMID: 28370782 DOI: 10.1002/hed.24691] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/29/2016] [Accepted: 11/29/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Roughly half of submandibular gland neoplasms are malignant. Because preoperative information on the nature of these tumors remains limited, both preoperative evaluation and assessment of the extent of primary surgery warrant guidelines that are more accurate. METHODS We evaluated the preoperative examinations and management of all submandibular gland neoplasms treated surgically at the Helsinki University Hospital between 2000 and 2010. RESULTS Of the 83 tumors, 58 (70%) were benign and 25 (30%) were malignant. Of the benign tumors, 54 (93%) were pleomorphic adenomas. The cytology in 8 patients (10%) was class IV or V, and in 12 patients was class III; the tumors in 9 of these 12 patients turned out to be malignant. Of all malignancies, 10 (40%) required additional more extensive surgery. CONCLUSION Ultrasound-guided fine-needle aspiration cytology (FNAC) proved useful, with limitations, in preoperative examination. Surgeons should always obtain wide margins whenever possible, even when clinical means or cytology indicates no malignancy. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1071-1077, 2017.
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Affiliation(s)
- Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Panigrahi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,School of Dentistry, University of California, Los Angeles, California
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40
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Lewis AG, Tong T, Maghami E. Diagnosis and Management of Malignant Salivary Gland Tumors of the Parotid Gland. Otolaryngol Clin North Am 2017; 49:343-80. [PMID: 27040585 DOI: 10.1016/j.otc.2015.11.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Malignant parotid tumors are heterogeneous and diverse. Accurate diagnosis requires a pathologist familiar with the various histologic subtypes, immunohistochemistry stains, and common translocations. Clinical course varies according to tumor subtype, ranging from indolent, slow-growing adenoid cystic carcinoma to rapidly progressive, possibly fatal, salivary ductal carcinoma. Histologic grade is important in prognosis and therapy. Surgery remains the mainstay of treatment when negative margins can be achieved. Radiation improves locoregional control of tumors with high-risk features. Chemotherapy for parotid tumors can be disappointing. Studies of new targeted therapies have not offered significant benefits.
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Affiliation(s)
- Aaron G Lewis
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Tommy Tong
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Ellie Maghami
- Division of Head and Neck Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Staging and follow-up of high-grade malignant salivary gland tumours: The role of traditional versus functional imaging approaches – A review. Oral Oncol 2016; 60:157-66. [DOI: 10.1016/j.oraloncology.2016.04.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/19/2016] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
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42
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Kuan EC, Mallen-St. Clair J, St. John MA. Evaluation of Parotid Lesions. Otolaryngol Clin North Am 2016; 49:313-25. [DOI: 10.1016/j.otc.2015.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Schmidt RL, Factor R, Witt B, Hall BJ, Wilson AR, Layfield LJ. Fine-needle aspiration cytology versus core-needle biopsy for major salivary gland lesions. Hippokratia 2016. [DOI: 10.1002/14651858.cd009610.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Robert L Schmidt
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
| | - Rachel Factor
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
| | - Benjamin Witt
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
| | - Brian J Hall
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
| | - Andrew R Wilson
- ARUP Laboratories; Reasearch and Development; 500 Chipeta Way Salt Lake City Utah USA 84108
| | - Lester J Layfield
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
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Mucoepidermoid Carcinoma Associated with Osteosarcoma in a True Malignant Mixed Tumor of the Submandibular Region. Case Rep Otolaryngol 2015; 2015:694684. [PMID: 26600963 PMCID: PMC4639669 DOI: 10.1155/2015/694684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. True malignant mixed tumor, also known as carcinosarcoma, is a rare tumor of the salivary gland composed of both malignant epithelial and malignant mesenchymal elements. Frequently carcinosarcoma arises in the background of a preexisting pleomorphic adenoma; however, if no evidence of benign mixed tumor is present, the lesion is known as carcinosarcoma “de novo.” We reported the first case of true malignant mixed tumor of the submandibular gland composed of high grade mucoepidermoid carcinoma associated with osteosarcoma. Case Presentation. A 69-year-old Caucasian male came to our department complaining of the appearance of an asymptomatic left submandibular neoformation progressively increasing in size over 3 months. We opted for surgical treatment. Histological examination confirmed the diagnosis of carcinosarcoma with the coexistence of high grade mucoepidermoid carcinoma and osteosarcoma. Conclusion. To the best of our knowledge, in the true malignant mixed tumor of the submandibular gland, mucoepidermoid carcinoma associated with osteosarcoma has never been previously reported.
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Malzone MG, Campanile AC, Losito NS, Longo F, Perri F, Caponigro F, Schiavone C, Ionna F, Maiello F, Martinuzzi C, Nasti S, Botti G, Fulciniti F. Brooke-Spiegler syndrome presenting multiple concurrent cutaneous and parotid gland neoplasms: Cytologic findings on fine-needle sample and description of a novel mutation of the CYLD gene. Diagn Cytopathol 2015; 43:654-8. [DOI: 10.1002/dc.23275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/09/2015] [Accepted: 03/30/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Gabriella Malzone
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
| | - Anna Cipolletta Campanile
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
| | - Nunzia Simona Losito
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
| | - Francesco Longo
- S.C Di Chirurgia Maxillo-Facciale ORL, Istituto Nazionale Tumori “Fondazione G. Pascale,”; Napoli Italy
| | - Francesco Perri
- Medical Oncology Unit, Presidio Ospedaliero Centrale “SS Annunziata,”; Taranto Italy
| | - Francesco Caponigro
- S.C. Di Oncologia Medica Testa Collo E Sarcomi, Istituto Nazionale Tumori “Fondazione G. Pascale,”; Napoli Italy
| | - Concetta Schiavone
- S.C. Di Radioterapia, Istituto Nazionale Tumori “Fondazione G. Pascale,”; Napoli Italy
| | - Franco Ionna
- S.C Di Chirurgia Maxillo-Facciale ORL, Istituto Nazionale Tumori “Fondazione G. Pascale,”; Napoli Italy
| | - Francesco Maiello
- Servizio Di Anatomia, Istologia Patologica E Citopatologia, Presidio Ospedaliero Dei Pellegrini; Napoli Italy
| | - Claudia Martinuzzi
- Dipartimento Di Medicina Interna E Specialità Mediche; Università Di Genova; Genova Italy
| | - Sabina Nasti
- Dipartimento Di Medicina Interna E Specialità Mediche; Università Di Genova; Genova Italy
| | - Gerardo Botti
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
| | - Franco Fulciniti
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
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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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Song IH, Song JS, Sung CO, Roh JL, Choi SH, Nam SY, Kim SY, Lee JH, Baek JH, Cho KJ. Accuracy of Core Needle Biopsy Versus Fine Needle Aspiration Cytology for Diagnosing Salivary Gland Tumors. J Pathol Transl Med 2015; 49:136-43. [PMID: 26148740 PMCID: PMC4367109 DOI: 10.4132/jptm.2015.01.03] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/16/2014] [Accepted: 01/03/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Core needle biopsy is a relatively new technique used to diagnose salivary gland lesions, and its role in comparison with fine needle aspiration cytology needs to be refined. METHODS We compared the results of 228 ultrasound-guided core needle biopsy and 371 fine needle aspiration procedures performed on major salivary gland tumors with their postoperative histological diagnoses. RESULTS Core needle biopsy resulted in significantly higher sensitivity and more accurate tumor subtyping, especially for malignant tumors, than fine needle aspiration. No patient developed major complications after core needle biopsy. CONCLUSIONS We recommend ultrasoundguided core needle biopsy as the primary diagnostic tool for the preoperative evaluation of patients with salivary gland lesions, especially when malignancy is suspected.
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Affiliation(s)
- In Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ohk Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ho Choi
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Yuhl Nam
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yoon Kim
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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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Ahn D, Kim H, Sohn JH, Choi JH, Na KJ. Surgeon-performed ultrasound-guided fine-needle aspiration cytology of head and neck mass lesions: sampling adequacy and diagnostic accuracy. Ann Surg Oncol 2014; 22:1360-5. [PMID: 25297899 DOI: 10.1245/s10434-014-4119-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies of surgeon-performed ultrasound-guided fine-needle aspiration cytology (US-FNAC) have been limited largely to thyroid nodules. This study evaluated the sampling adequacy and diagnostic accuracy of surgeon-performed US-FNAC for a large range of head and neck mass lesions, including lesions of the thyroid, salivary glands, and lymph nodes. METHODS The study included 617 cases of US-FNAC performed by a single surgeon between 2009 and 2013. Their medical histories and ultrasound (US) findings were retrospectively reviewed. Sample adequacy was analyzed according to the surgeon's experience, anatomic tumor location, and US tumor characteristics. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of FNAC were calculated after correlation with the surgical histopathologic results. RESULTS The overall adequacy rate for surgeon-performed US-FNAC was 91.9 % (567/617). Inadequate specimens were obtained from 9.7 % (29/282) of the thyroid glands, 6.1 % of the salivary glands (6/98), and 6.3 % (15/237) of the lymph nodes. The effect of the surgeon's experience plateaued (inadequate sampling rate, 6-8 %) after 100 US-FNAC procedures. Inadequate sampling was associated with tumor characteristics such as cystic change and rim calcification. Overall, US-FNAC showed a sensitivity of 88.2 %, a specificity of 98.2 %, a PPV of 98.5 %, an NPV of 85.7 %, and a diagnostic accuracy of 91.6 %. CONCLUSION With proper training and experience managing at least 100 US-FNAC cases, surgeons can ensure a low inadequate sampling rate and good diagnostic accuracy for a range of head and neck mass lesions.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea,
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