Accuracy, Sensitivity and Specificity of Fine Needle Aspiration Biopsy for Salivary Gland Tumors: A Retrospective Study from 2006 to 2011

Parotid Gland Segmentation Using Purely Transformer-Based U-Shaped Network and Multimodal MRI

Parotid gland tumors account for approximately 2% to 10% of head and neck tumors. Segmentation of parotid glands and tumors on magnetic resonance images is essential in accurately diagnosing and selecting appropriate surgical plans. However, segmentation of parotid glands is particularly challenging due to their variable shape and low contrast with surrounding structures. Recently, deep learning has developed rapidly, and Transformer-based networks have performed well on many computer vision tasks. However, Transformer-based networks have yet to be well used in parotid gland segmentation tasks. We collected a multi-center multimodal parotid gland MRI dataset and implemented parotid gland segmentation using a purely Transformer-based U-shaped segmentation network. We used both absolute and relative positional encoding to improve parotid gland segmentation and achieved multimodal information fusion without increasing the network computation. In addition, our novel training approach reduces the clinician's labeling workload by nearly half. Our method achieved good segmentation of both parotid glands and tumors. On the test set, our model achieved a Dice-Similarity Coefficient of 86.99%, Pixel Accuracy of 99.19%, Mean Intersection over Union of 81.79%, and Hausdorff Distance of 3.87. The purely Transformer-based U-shaped segmentation network we used outperforms other convolutional neural networks. In addition, our method can effectively fuse the information from multi-center multimodal MRI dataset, thus improving the parotid gland segmentation.

Malignant salivary gland tumors: agreement between fine needle aspiration biopsy, incisional biopsy and final histopathological diagnostic

BACKGROUND

Incisional biopsy is indicated for intraoral tumors, but it is a contraindicated surgical procedure for major salivary glands. To avoid complications and facilitate diagnosis, fine needle aspiration biopsy (FNAB) is a type of biopsy widely used for preoperative diagnosis in these glands.

MATERIAL AND METHODS

The aim of this study was to analyze the agreement between the diagnosis by FNAB (major glands), incisional biopsy (minor glands) and histopathological analysis of the surgical specimen in salivary gland tumors from a database (medical records) of patients treated in a cancer treatment reference center in the Northeast region of Brazil.

RESULTS

The sample consisted of 110 cases, being 86 of them malignant tumors in major salivary glands (parotid gland=73; submandibular gland=13) and 24 cases in minor salivary glands (palate). The female gender was the most affected (57.3%), especially in patients over 60 years (42.7%). In the TNM classification, 41.8% of the cases were in T2 at the time of diagnosis, with most of the regional lymph nodes in N0 (85.5%) and 87.3% of the cases in M0. FNAB was able to identify malignant neoplasms in 68.6% of the cases (n=59), while incisional biopsy in palatal tumors obtained agreement of 75% of the cases (n=18). The analysis revealed that tumors classified as T3-T4 (p=0.012) showed greater agreement between pre- and post-surgical diagnosis.

CONCLUSIONS

The results obtained in this study indicate that FNAB has similar accuracy to incisional biopsy in providing satisfactory preoperative diagnoses of malignant tumors in salivary glands.

Salivary gland lesions: diagnostic reliability and challenges of fine needle aspiration cytology

Fine needle aspiration cytology (FNAC) is a valuable, safe and widely used method for preoperative diagnosis of salivary gland lesions. The diagnostic accuracy of FNAC is dependent on the quality and yield of the aspirate, as well as the experience and knowledge of the cytopathologist. 247 cases of FNAC of salivary gland lesions were performed in our 4-year retrospective study. FNAC diagnoses were divided into non-neoplastic lesions, benign and malignant neoplasms. Histopathologic confirmation was done in 101 cases. The cases with discrepancies between the FNAC and histopathologic results were reviewed to establish possible reasons for discordance. The measures of diagnostic validity of FNAC in diagnosing non-neoplastic, benign and malignant lesions were evaluated. Of the 247 FNAC samples, 135 cases were diagnosed as benign neoplasms, 15 as malignant neoplasms, and 97 as non-neoplastic lesions. Out of the 101 cases with histopathologic confirmation, discordant results between cytologic and histopathologic diagnosis were observed in 15 cases. Our study showed no false positive and 4 false negative results for cancer. Cystic presentation of a lesion was a common reason for diagnostic pitfall. Sensitivity of FNAC in various types of salivary gland lesions ranged from 75%-100%, specificity 81-100%, diagnostic accuracy 85-96%, PPV 31-100% and NPV 60-96%. FNAC is a highly sensitive and specific method for diagnosis of most salivary gland lesions. Despite the fact that histopathology remains the gold standard, preoperative FNAC should be considered for preliminary investigation. Due to the diagnostic pitfalls, FNAC should be used in conjunction with clinical information, physical examination, and radiologic findings to reach the right diagnosis.

The role of transoral fine needle aspiration in expediting diagnosis and reducing risk in head and neck cancer patients in the coronavirus disease 2019 (COVID-19) era: a single-institution experience

OBJECTIVE

The global coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid alterations to diagnostic pathways for head and neck cancer patients that aim to reduce risk to patients (exposure to the hospital environment) and staff (aerosol-generating procedures). Transoral fine needle aspiration cytology offers a low-risk means of rapidly diagnosing patients with oral cavity or oropharyngeal lesions. The technique was utilised in selected patients at our institution during the pandemic. The outcomes are considered in this study.

METHOD

Diagnostic outcomes were retrospectively evaluated for a series of patients undergoing transoral fine needle aspiration cytology of oral cavity and oropharyngeal lesions during the COVID-19 pandemic.

RESULTS

Five patients underwent transoral fine needle aspiration cytology, yielding lesional material in 100 per cent, with cell blocks providing additional information. In one case, excision biopsy of a lymphoproliferative lesion was required for final diagnosis.

CONCLUSION

Transoral fine needle aspiration cytology can provide rapid diagnosis in patients with oral cavity and oropharyngeal lesions. Whilst limitations exist (including tolerability and lesion location), the technique offers significant advantages pertinent to the COVID-19 era, and could be employed in the future to obviate diagnostic surgery in selected patients.

The role of fine-needle aspiration biopsy (FNAB) in the diagnostic management of parotid gland masses with emphasis on potential pitfalls

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.

A case of carcinoma ex pleomorphic adenoma arising from multinodular pleomorphic adenoma of the buccal region

In multinodular lesions or tumors with mixed benign and malignant components, malignant elements may be undetectable using fine-needle aspiration biopsy/cytology in preoperative pathological diagnosis of some cases, because of sampling error.

CT-guided fine-needle aspiration biopsy of solitary pulmonary nodules under 15 mm in diameter: time for an afterthought?

Background

Many studies on fine-needle aspiration biopsy (FNAB) for undetermined pulmonary nodules reported that diagnostic accuracy tended to decline, whereas complication prevalence raised as the size of nodule decreased. Reconsideration on the effectiveness of FNAB would be appropriate considering the dramatic increase in the identification of small nodules with screening programs and new demands of target therapies. The aim of this study was to verify the efficacy of FNAB in pulmonary nodules smaller than 15 mm.

Methods

A retrospective, cohort study was conducted on patients with undetermined solitary pulmonary nodules (SPNs) who underwent computer tomography (CT) guided FNAB at our Institution from January 2012 to December 2014. Patients with SPNs with diameter up to 15 mm were considered; inclusion criteria comprised ASA 3, FEV1 <70% of predicted, cardiac comorbidity or previous chest surgery. FNAB diagnostic performance and clinical efficacy were calculated.

Results

Out of 225 patients referred for FNAB, 68 covered inclusion criteria. Forty-nine out of 68 smears (72%) were adequate for diagnosis. Specificity was 100% (95% CI: 77-100%), sensitivity was 100% (95% CI: 90-100%). Positive and negative predictive values were 1.0 (95% CI: 0.9-1.0) and 1.0 (95% CI: 0.77-1.0) respectively. A post-biopsy pneumothorax was detected in 27 cases (39%); the pneumothorax rate was significantly affected by the number of passages (P=0.01).

Conclusions

The satisfactory results of our study lead to reconsidering FNAB in patients with pulmonary nodules below 15 mm in diameter, especially in order to avoid unnecessary surgery.