Fine needle aspiration cytology in lesions of oral and maxillofacial region: Diagnostic pitfalls

Ultrasound-Enhanced Fine-Needle Biopsy Improves Yield in Human Epithelial and Lymphoid Tissue

OBJECTIVE

Needle biopsy is a common technique used to obtain cell and tissue samples for diagnostics. Currently, two biopsy methods are widely used: (i) fine-needle aspiration biopsy (FNAB) and (ii) core needle biopsy (CNB). However, these methods have limitations. Recently, we developed ultrasound-enhanced fine-needle aspiration biopsy (USeFNAB), which employs a needle that flexurally oscillates at an ultrasonic frequency of ∼32 kHz. The needle motion contributes to increased tissue collection while preserving cells and tissue constructs for pathological assessment. Previously, USeFNAB has been investigated only in ex vivo animal tissue. The present study was aimed at determining the feasibility of using USeFNAB in human epithelial and lymphoid tissue.

METHODS

Needle biopsy samples were acquired using FNAB, CNB and USeFNAB on ex vivo human tonsils (N = 10). The tissue yield and quality were quantified by weight measurement and blinded pathologists' assessments. The biopsy methods were then compared.

RESULTS

The results revealed sample mass increases of, on average, 2.3- and 5.4-fold with USeFNAB compared with the state-of-the-art FNAB and CNB, respectively. The quality of tissue fragments collected by USeFNAB was equivalent to that collected by the state-of-the-art methods in terms of morphology and immunohistochemical stainings made from cell blocks as judged by pathologists.

CONCLUSION

Our study indicates that USeFNAB is a promising method that could improve tissue yield to ensure sufficient material for ancillary histochemical and molecular studies for diagnostic pathology, thereby potentially increasing diagnostic accuracy.

Cell block preparation as an adjunctive tool after fine-needle aspiration cytology for screening oral and maxillofacial diseases

OBJECTIVE

To describe the use of cell block (CB) preparation from fine-needle aspiration cytology for diagnosing oral and maxillofacial diseases.

STUDY DESIGN

We performed a retrospective analysis of 568 samples collected by our laboratory for CB preparation from fine-needle aspiration cytology of the oral and maxillofacial region between January 2001 and October 2021. We performed cytologic diagnoses and compared them with the available histopathologic diagnoses to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CB preparation for identifying malignant lesions.

RESULTS

The most frequent diagnosis was pleomorphic adenoma (n = 44, 7.7%), followed by metastatic squamous-cell carcinoma (n = 28, 4.9%) and odontogenic keratocyst (n = 26, 4.6%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CB preparation, which revealed detailed morphologic and architectural patterns, were 70.0%, 100.0%, 100.0%, 62.5%, and 80.0%, respectively.

CONCLUSIONS

Cell block preparation from fine-needle aspiration cytology of the oral and maxillofacial region may be a useful adjunctive diagnostic tool for diagnosing oral and maxillofacial diseases because it reveals morphologic and architectural patterns similar to those shown on histopathologic slides, leading to the better categorization of diseases.

Primary intraosseous carcinoma in the pediatric and adolescent mandible

BACKGROUND

Primary intraosseous carcinoma (PIOC) is a rare malignant odontogenic tumor that predominantly occurs in males older than 50 years. PIOC can be misdiagnosed as odontogenic cyst because it occasionally shows a well-defined border on radiography. In this study, related literatures of pediatric and adolescent PIOC cases were analyzed under strict PRISMA guidelines along with an adolescent case who was provisionally misdiagnosed as an odontogenic cyst.

METHODS

All case reports for PIOC published in English from 1966 to 2021 were collected. Cases under the age of 20 were classified as pediatric and adolescent populations in this study. A total of 12 pediatric and adolescent cases including 11 PIOCs from the literature and one new case of a 14-year-old female were analyzed. Clinical and radiographic features, diagnosis and treatment approaches, and prognosis were investigated.

RESULTS

Ages ranged from 4 to 18 years. The female to male ratio was 1.4:1. Seven cases occurred in the mandible. Swelling was observed in 11 patients. The radiologic borders were well-defined in six cases and corticated in four cases. Tooth displacement and root resorption were observed in four and six cases, respectively. The provisional diagnosis for seven patients was odontogenic cyst and enucleation was performed in six cases including the new case. During the follow-up period, local recurrence occurred in three patients. The pediatric and adolescent PIOC cases with local recurrence showed poor prognosis. The locally recurred lesion in the new case did not decrease in size despite concurrent chemo-radiation therapy.

CONCLUSIONS

Three-dimensional imaging modalities and incisional biopsy with multiple specimens are necessary to rule out PIOC in the lesions with atypical radiographic findings. PIOC should be diagnosed differentially from odontogenic cyst even in pediatric and adolescent populations to properly manage the disease with poor prognosis.

Contribution of the cyto-histopathological diagnosis and ultrastructural parameters to the evaluation of maxillary cysts - a 10-year multidisciplinary approach

Diagnostic and treatment plans in cystic jawbone tumors are often difficult to address. The etiopathogenic links involved in cell–matrix differentiation disorders are complex. Quantification of the inflammatory process in the evolution of cystic odontogenic lesions highlights a particular reactivity of the host, especially age-dependent and the endodontic–periodontal space interrelation, drawing attention to the difficulties of etiopathogenic, evolution, prognostic and treatment of these lesions. Difficulties in histopathological (HP) diagnosis are reported by the lack of morphofunctional integration of dental tissues, both topographically and evolutionarily, especially when odontogenic epithelial remains in the cystic wall, reactive bone condition, appearance and condition of the reactive epithelium are overlooked. In this study, we developed an interdisciplinary approach for the dynamics of tissue morphology found in the walls of maxillary cysts. Failure to recognize the tissues that form the cystic lesion leads to misinterpretations of pathology and to the wrong classification in the group of maxillary cysts. We analyzed by different techniques 564 biopsy fragments from maxillary cystic lesions, most of which are clinically classified as inflammatory or odontogenic ones. From our experience, we reevaluated the lesions with cystic changes and completed the diagnosis in 10–12% of cases. The most common maxillary cystic lesion encountered by us was the root cyst, an inflammatory dental cyst, which has been over diagnosed clinically, radiologically and histopathologically. Recognition and selection of embryonic remnants from odontogenesis is crucial for the HP diagnosis of maxillary cysts, allowing the clinician to monitor treatment or to develop evolutionary-prognostic perspectives of odontogenic cystic lesions.

Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance

Pathogenic Mycobacterium tuberculosis complex organisms (MTBC) primarily cause pulmonary tuberculosis (PTB); however, MTBC are also capable of causing disease in extrapulmonary (EP) organs, which pose a significant threat to human health worldwide. Extrapulmonary tuberculosis (EPTB) accounts for about 20–30% of all active TB cases and affects mainly children and adults with compromised immune systems. EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB, and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum, and the genitourinary system as primary and/or disseminated disease. EPTB diagnosis involves clinical, radiological, microbiological, histopathological, biochemical/immunological, and molecular methods. However, only culture and molecular techniques are considered confirmatory to differentiate MTBC from any non-tuberculous mycobacteria (NTM) species. While EPTB due to MTBC responds to first-line anti-TB drugs (ATD), drug susceptibility profiling is an essential criterion for addressing drug-resistant EPTB cases (DR-EPTB). Besides antibiotics, adjuvant therapy with corticosteroids has also been used to treat specific EPTB cases. Occasionally, surgical intervention is recommended, mainly when organ damage is debilitating to the patient. Recent epidemiological studies show a striking increase in DR-EPTB cases ranging from 10–15% across various reports. As a neglected disease, significant developments in rapid and accurate diagnosis and better therapeutic interventions are urgently needed to control the emerging EPTB situation globally. In this review, we discuss the recent advances in the clinical diagnosis, treatment, and drug resistance of EPTB.

The accuracy of fine needle aspiration cytology in the clinical diagnosis of minor salivary gland tumours

The objective of this study was to investigate the accuracy of fine needle aspiration cytology (FNAC) and biopsy for the clinical diagnosis of minor salivary gland tumours (MSGTs). This retrospective study of 32 MSGT cases was conducted over a 5-year period. Clinical features including age, sex, and location of the tumour were obtained from the patient clinical records. All cases were also assessed histologically according to the 2017 World Health Organization Classification of Head and Neck Tumours. The results of FNAC and biopsy were correlated with those of histopathology, and their sensitivity, specificity, and diagnostic efficacy were calculated using histopathology as the gold standard. Eighteen malignant MSGTs (56.3%) and 14 benign MSGTs (43.8%) were diagnosed by pathological diagnosis. The most common malignant tumour was mucoepidermoid carcinoma (seven cases, 38.9%). Most benign cases were pleomorphic adenomas (13 cases, 92.9%). FNAC was performed for 23 cases and biopsy for 13 cases. The sensitivity and specificity of FNAC were 66.7% and 91.0%, respectively, while those of biopsy were 90.0% and 100.0%, respectively. Although FNAC is a minimally invasive and cost-effective procedure, it is less accurate than biopsy in the assessment of MSGTs. Repeated FNAC or biopsy should be considered in negative and unsatisfactory FNAC cases.

Accuracy of fine needle aspiration cytology in the preoperative diagnosis of malignant non-odontogenic tumors of the orofacial region

BACKGROUND

This study aims to determine the association between preoperative cytopathological diagnosis and the histopathological diagnosis of orofacial non-odontogenic tumors. It is also, to determine the sensitivity, specificity and accuracy of fine needle aspiration cytology (FNAC) in the preoperative diagnosis of orofacial malignant non-odontogenic tumors in a Nigerian population.

METHODS

A 9-month prospective study in which preoperative FNAC followed by open biopsy for confirmatory histopathological evaluation was performed for consenting patients with orofacial swellings. Patients histopathologically diagnosed as non-odontogenic tumors were selected for the study.

RESULTS

There were 40 (83.3%) histopathologically diagnosed non-odontogenic tumors. The female to male ratio was 1.7:1 and the patients' mean age was 36 + 21.9 years. The mandible (n = 4, 10.0%) and the preauricular area (n = 4, 10.0%) were the most common sites affected. The cytopathological diagnosis showed 28 (70.0%) of the lesions were malignant, 7 (17.5%) were benign neoplasms and 5 (12.5%) were reactive/inflammatory swellings. The histopathological diagnosis was predominantly malignant (n = 29, 72.5%), consisting mostly of non-Hodgkin's lymphoma (n = 12, 30.0%). There was significant association (P = .000) between cytopathological diagnosis and histopathological diagnosis of the malignant orofacial non-odontogenic tumors. The sensitivity of FNAC to detect malignant orofacial nonodontogenic tumors was 93.1%, the specificity was 90.9%, the positive predictive value was 96.4%, the negative predictive values was 83.3% and the accuracy was 92.5%.

CONCLUSION

The accuracy of FNAC in the diagnosis of orofacial malignant non-odontogenic orofacial tumors is high and hence recommended as a routine preoperative diagnostic tool.

Pathologist-performed palpation-guided fine needle aspiration cytology of lingual actinomycosis: A case report and review of literature

"Lingual actinomycosis" is an uncommon, suppurative inflammation of lingual mucosa, caused by Actinomyces. Infectious oral lesions can mimic benign or malignant neoplasms and fine needle aspiration cytology (FNAC) is a simple, minimally invasive procedure for the assessment of patients with such lesions. Here, we describe the case of a 28-year old patient presented with an asymptomatic, submucosal nodular mass of the tongue. Then, FNAC was performed by an experienced fine needle aspiration (FNA) pathologist (^* ) in our pathology department and the lesion diagnosed with actinomycosis. We also report a detailed review of cases in the literature, with clinical findings.

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.

Cell-block as ancillary tool for the diagnosis of cystic and cyst-like jaw lesions

BACKGROUND

The cell-block technique is a cytological diagnostic method that decreases cellular dispersion; however, its usefulness regarding intraosseous lesions is underexplored. Therefore, this study aimed to assess the diagnostic usefulness of cell-block for cystic and cyst-like jaw lesions.

METHODS

Individuals with cystic or cyst-like jaw lesions who underwent aspiration biopsy were considered eligible. Aspiration of luminal content was prepared and processed by the cell-block technique. Cytological evaluations were blindly performed by two trained PhD students (in a single evaluation) and one oral and maxillofacial pathologist (OMP). Cohen's kappa statistic was used to measure inter-rater agreement.

RESULTS

The sample was composed of 52 lesions, represented by 25 radicular cysts (RC), 17 odontogenic keratocysts (OKC), 5 idiopathic bone cavities (IBC), and 5 unicystic ameloblastomas (UA). The kappa coefficient of cell-block compared to histopathological diagnosis was 0.390 (95% confidence interval [95%CI], 0.195-0.585) for PhD students and 0.612 (95%CI, 0.433-0.791) for the OMP. The highest concordance rates between cell-block and histopathological diagnosis were observed for RC (PhD = 76.0%; OMP = 80.0%) and OKC (PhD = 58.8%; OMP = 76.5%). Conflicting results were found regarding IBC (PhD = 40.0%; OMP = 80.0%) and UA, that presented the overall lowest concordance rates (PhD = 20.0%; OMP = 40.0%).

CONCLUSION

The cell-block technique presented a high diagnostic usefulness for detecting RC and OKC and, if associated with clinical and radiographic characteristics, might be sufficient for final diagnosis of these diseases. Regarding IBC and UA, an analysis with a higher number of cases is recommended to determine the true usefulness of the cell-block as ancillary tool for the diagnosis of these lesions.

Utility of Fine Needle Aspiration in Diagnosis of Intraoral Minor Salivary Gland Tumors

Objective:

To evaluate the utility of intraoral fine-needle aspiration cytology (FNAC) in diagnosis of minor salivary gland neoplasms (MSGN) with application of Milan system of reporting salivary gland cytopathology; keeping histopathology as gold standard and to detail the cytological findings of MSGNs.

Method:

Retrospective study between Jan 2008 and June 2017 (appro × 10 years) on the cytology of the minor salivary gland tumor along with the histopathological correlation. The relevant clinical data was collected from the medical record.

Result:

Sixty-four cases of MSGNs were included in the study. The histodiagnosis of the 41 were available. Twenty-one cases were diagnosed as malignant, while rest 20 cases were reported as benign. The most common tumor diagnosed was pleomorphic adenoma (PA) (50% cases), followed by mucoepidermoid carcinoma (14%) and adenoid cystic carcinoma (12.5%). The most common site of MSGT was found to be hard palate (44%), followed by soft palate (23%), floor of the mouth (12%), lip (11%), buccal mucosa (5%), and tongue (5%) with no gender predilection. Sensitivity of FNAC for detection of malignancy was 81% while specificity 95%. For malignancies, positive predictive value for malignancies was 17/18 (94.4%) and negative predictive value was 19/23 (82.3%). According to Milan system out of 21 cases in category IV B, 4 cases were found malignant (Category VI), while 1/18 case in category VI turned out to be nonneoplastic lesion (Category II).

Conclusion:

FNAC is imperative in early diagnosis and subsequent management of MSGNs

Abrasive cytohistology of squamous epithelial lesions

Objective:

To describe a method to retrieve cellular and tissue elements of oral squamous epithelium obtained by abrasive methods and to conduct investigations by cytohistology.

Method:

We developed a special gelatine pocket suitable for paraffin embedding of sparse material obtained from brush biopsies (BBs). This was subjected to combined evaluation of a cytological (smear) and histological examination of the ‘tissue sections’ – referred as cytohistology. Four diagnostic categories were applied for evaluation. Other special diagnostic methods were also applied in addition to recording dysplasia.

Results:

A total of 51, 755 BBs from suspicious lesions of the oral mucosa (mostly oral potentially malignant disorders – OPMD) were evaluated for the presence of carcinoma or dysplasia; in all, 1.7% were positive, 78.2% were negative for any epithelial atypia, 16.8% atypical and 3.3% inadequate. All BBs also had cytohistological evaluation. A ‘positive’ diagnosis by cytohistology was a reliable indicator of dysplasia or carcinoma, requiring further incisional/excisional biopsy. In the ‘atypical’ category, a variety of lesions were found, about half being dysplasia or carcinoma. This category challenges the clinician for further clinical, therapeutic and/or excisional examination. In ‘negative’ cases with persistence of the lesion, a re-examination in 1-year sequence is recommended.

Conclusion:

Cytohistology of material derived by abrasive methods allows earlier detection of dysplasia/carcinoma. A number of additional oncological and non-oncological findings make this method a valuable non-invasive diagnostic procedure for oral mucosal lesions.

Fine-needle aspiration cytology as a useful diagnostic adjunct in the management of ameloblastoma: A report of four cases

Ameloblastoma is a locally aggressive common odontogenic tumor of the jaws. Although histopathological and radiological findings have been extensively studied for the diagnosis of ameloblastoma, usefulness of fine-needle aspiration cytology (FNAC) has not been explored much. Here, we have reported four cases of ameloblastomas diagnosed by FNAC and subsequently confirmed by histopathology.

Trans-oral fine needle aspiration cytology in cervical (C1 and C2) vertebral lesions: a novel diagnostic approach

OBJECTIVE

Fine needle aspiration (FNA) cytology is a relatively non-invasive method for diagnosing both superficial and deep-seated neoplastic and non-neoplastic lesions. In this study, we evaluated the diagnostic utility of trans-oral FNA in cervical (C1 and C2) vertebral and paravertebral lesions.

MATERIAL AND METHODS

Eighteen FNA cases of cervical vertebral and paravertebral lesions performed by a trans-oral route without any image-guidance between 1995 and 2014 were retrieved from the archives of the cytology department at PGIMER, Chandigarh and reviewed.

RESULTS

Out of 18 cases, a definite diagnosis was given in 15 cases (83.3%). The commonest diagnosis seen was granulomatous inflammation consistent with tuberculosis (33.3%).

CONCLUSION

Trans-oral FNA is a quick, inexpensive and relatively safe outpatient procedure for sampling C1 and C2 vertebral and paravertebral lesions, which are clinically and radiologically difficult to approach. It helps in the early diagnosis and management of these patients.

Optimization of FNAC findings as a preoperative diagnostic aid for odontogenic cysts

BACKGROUND

Fine-needle aspiration cytology (FNAC) is not a definitive preoperative diagnostic procedure done for all cases of odontogenic cysts. This is because of the inconsistent results obtained with it.

AIMS

This study was done to optimize FNAC findings and help in preoperative characterization of odontogenic cysts.

MATERIALS AND METHODS

Cystic fluid was collected and centrifuged from 50 odontogenic cysts that were planned for excision. Three smears were prepared from the cell sediment obtained after centrifugation and stained. The stained sections were examined for presence and type of epithelial cells, to formulate a preopererative diagnosis.

RESULTS

Epithelial cells were detected in 46% cases in smear 1, 48% cases in smear 2, and 52% cases in smear 3. When all three smears from one case were studied, 86% cases showed epithelial cells for evaluation.

CONCLUSION

Cystic aspirate should be centrifuged and the entire cell sediment should be examined by making multiple smears for evaluation of cystic epithelial lining cells.

Diagnostic role and limitations of FNAC in oral and jaw swellings

BACKGROUND

Fine-needle aspiration cytology (FNAC) of oral lesions has not been widely utilized for diagnosis due to rarity and diversity of lesions, peculiar anatomy of maxillofacial region, difficulty in aspirating these lesions, and limited experience. Aim of this study was to determine the role of FNAC in the diagnosis of oral and jaw swellings.

MATERIALS AND METHODS

One hundred and forty two patients underwent FNAC over a period of 7 years (2007-2013), of which 127 (89.4%) aspirates were diagnostic. Histopathologic correlation was available in 83 cases and diagnostic accuracy of FNAC was calculated.

RESULTS

Of the minor salivary gland lesions, 41 out of 55 lesions (74.5%) were benign and 14 (25.4%) were malignant. Mucocele was the most common lesion in oral cavity (30 cases) and pleomorphic adenoma was the commonest salivary gland neoplasm (9 cases). Of the 72 non-salivary-gland lesions, 22 lesions were inflammatory, 4 were epidermal inclusion cysts, 21 were neoplastic, and the remaining 25 presented as radiolucent jaw bone lesions. Diagnostic accuracy of FNAC in our study was 91.6% with 6 false negatives and 1 false positive. Four glandular malignancies and one case of cystic ameloblastoma were misdiagnosed as false negative on cytology.

CONCLUSION

Cytological features are diagnostic in certain inflammatory lesions of infective etiology and neoplastic conditions like Langerhans cell histiocytosis, lymphoma, plasmacytoma, Ewing's tumor, and squamous cell carcinoma. However, accurate subtyping of giant cell lesions, salivary gland tumors, odontogenic tumors, and cystic lesions may not be always feasible on FNAC. FNAC is highly accurate in early diagnosis of oral and jaw lesions.

Intraoral and Oropharyngeal Lesions: Role of Fine Needle Aspiration Cytology in the Diagnosis

The oral cavity is affected by a wide range of pathologic lesions, for which a morphologic diagnosis is required for proper management. Fine needle aspiration (FNA) is being increasingly used for preliminary diagnoses of such lesions. This is retrospective analysis of intraoral and oropharyngeal lesions diagnosed with FNAC over a period of 7 years. Out of total 55 cases, a definite diagnosis could be made on cytology in 50 cases (90.9 %). These 50 cases were further included in the study. Thirty cases were reported as non-neoplastic and 20 as neoplastic (11 benign and nine malignant). The diagnoses were made taking into account the background material (blood, mucin) and the predominant cells present (neutrophils, lymphoid cells, macrophages, hemosiderin laden macrophages, squamous cells, basaloid cells, spindle cells, giant cells). Histopathological diagnosis was available in 17 cases and corresponded with FNA diagnosis in 16 cases (94.12 %). No significant complications were seen in patients undergoing these FNAs. It can be concluded that FNA is a simple and rapid diagnostic test that can be useful for preliminary assessment of oral and oropharyngeal lesions.

Role of FNAC in the diagnosis of intraosseous jaw lesions

Background

FNAC of intraosseous jaw lesions has not been widely utilized for diagnosis due to rarity and diversity of these lesions, limited experience and lack of well established cytological features. Aim of the study was to determine the role of FNAC in the diagnosis of intraosseous jaw swellings.

Material and Methods

42 patients underwent FNAC over a period of 7 years (2007-2013), of which 37 (88.1%) aspirates were diagnostic. Histopathology correlation was available in 33 cases and diagnostic accuracy of FNAC was calculated.

Results

Lesions were categorized into inflammatory 3, cysts/hamartomas 15 and neoplasms 19. Mandibular and maxillary involvement was seen in 21 and 16 patients respectively. Of these, benign cysts and malignant lesions were commonest, accounting for 27% lesions (10 cases) each. One case of cystic ameloblastoma was misdiagnosed as odontogenic cyst on cytology. Overall, sensitivity and specificity of FNAC were 94.7% and 100% respectively with a diagnostic accuracy of 97.3%. Definitive categorization of giant cell lesions, fibro-osseous lesions, odontogenic tumors and cystic lesions was not feasible on FNAC.

Conclusions

FNAC is a simple, safe and minimally invasive first line investigation which can render an accurate preoperative diagnosis of intraosseous jaw lesions, especially the malignant ones in the light of clinic-radiological correlation.

Key words: Jaw swellings, intraosseous, FNAC.

Diagnostic value of cytological analysis of tumours and tumour-like lesions of the oral cavity in dogs and cats: a prospective study on 114 cases

Neoplastic or non-neoplastic masses are common findings in the oral cavity of cats and dogs. The aim of this prospective study was to compare the results of cytological examinations of lesions of the oral cavity following fine-needle aspiration (FNA), fine-needle insertion (FNI), and impression smear (IS) with histopathological results being considered as the diagnostic gold standard. In total, 85 dogs and 29 cats were included in the study. Cases were included when histology and cytology (FNA, FNI, and/or IS) were available from the same lesion; κ-agreement and accuracy between cytological and histopathological results were calculated. Eighteen cytological specimens were excluded, with a retrieval rate of 84.2%. Of the 96 samples analysed, FNA, FNI, and IS were available from 80, 76, and 73 animals, respectively. Overall, 60/67 (89.6%) and 21/29 (72.4%) lesions were neoplastic in dogs and cats, respectively, with the remaining being non-neoplastic. For all lesions, κ-values obtained by FNA, FNI, and IS were in dogs 0.83 (95% confidence interval [CI]: 0.77-0.90), 0.87 (95% CI: 0.81-0.93) and 0.75 (95% CI: 0.67-0.84), respectively, and in cats 0.92 (95% CI: 0.87-0.96), 0.92 (95% CI: 0.88-0.97) and 0.86 (95% CI: 0.79-0.92), respectively. The diagnostic accuracies of FNA, FNI, and IS in dogs with neoplasia were 98.2%, 98.1%, and 91.8%, respectively, and in cats with neoplasia were 95.6%, 95.6% and 95.8%, respectively. In conclusion, the high agreement with histopathology suggests that cytological examinations by FNI, FNA, and IS are all appropriate methods to correctly diagnose lesions of the oral cavity in dogs and cats.

Fine needle aspiration cytology of lymphoproliferative lesions of the oral cavity

OBJECTIVE

Oral cavity non-Hodgkin lymphoma (OCL) is a rare condition that may be clinically and radiologically indistinguishable from other pathologies of the mouth. A complete excision or adequate biopsy of the OCL may be difficult. Fine needle aspiration (FNA) cytology has been successfully utilized in the pre-operative diagnosis of oral masses and in lymphoma involving other anatomical areas. Our experience with FNA pre-operative cytological diagnosis of 16 OCLs is reported herein.

METHODS

The results of FNA cytology on 16 consecutive lymphoproliferative lesions of the oral cavity collected over an 8-year period in three institutions were retrieved. Sampled lesions were submucosal masses of different sizes bulging into the oral cavity. Rapid on-site evaluation (ROSE) and routine cytological staining were performed. Immunocytochemistry (ICC), flow cytometry (FC) and polymerase chain reaction (PCR) of the IGH (immunoglobulin heavy) locus were performed on additional passes according to ROSE.

RESULTS

Fourteen OCLs, one myeloma and one florid reactive lymphoid hyperplasia (FRLH) were diagnosed by FNA. OCLs were diagnosed as large B-cell (eight cases) and small B-cell (six cases) lymphomas. Histology revealed eight diffuse large B-cell lymphomas (DLBCL), four lymphomas of mucosa-associated lymphoid tissue (MALT), two follicular lymphomas and one FRLH; no false-negative or false-positive results were diagnosed, but accurate subclassification was obtained in four cases only.

CONCLUSIONS

FNA diagnosis of OCLs may be hampered by the rare incidence, anatomical context and difficulties in obtaining a sufficient amount of cells. Ancillary techniques should be used according to ROSE; a pre-operative FNA cytology diagnosis can avoid unnecessary extensive surgery and speed up the institution of therapeutic procedures.

Diagnostic accuracy, sensitivity, specificity and positive predictive value of fine needle aspiration cytology (FNAC) in intra oral tumors

OBJECTIVE

The objective of this study was to establish the diagnostic accuracy, specificity and sensitivity of fine needle aspiration cytology(FNAC) for intra-oral tumors, comparing with histopathology as the gold standard.

MATERIALS AND METHODS

Forty cases of FNA cytology from intraoral tumors was performed in AFID along with the demographic data and clinical information and then diagnosed at AFIP, Rawalpindi. Then the cytology results obtained per FNAC were compared with the histopathological biopsy results of the same lesions. The following variables were recorded for each patient: Age, gender, site of biopsy, diagnosis. The data were entered and analyzed using Open-epi version 2.0. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Cohen Kappa was further applied to compare the agreement between the biopsy and FNAC diagnoses. A p-value of <0.05 was considered as statistically significant.

RESULTS

Among the total patients included in the study there were 24 males and 16 females, with a ratio of 1.5:1. Age of the patients ranged from 24 to 80 years with a mean of 52 years. A total of six sites were aspirated from the oral cavity with maximum (11) aspirates taken from alveolar ridge. The results of FNAC revealed that there were 32 malignant and 8 benign aspirates. Confirmation through histopathological analysis came for 31/32 malignant cases while one was falsely given positive for malignancy on FNAC. Among a total of 40 cases, 31(77%) cases diagnosed were found to be malignant and remaining 9(23%) were benign. The FNAC results revealed 32 malignant and 8 benign lesions. Histopathology of the subsequent surgically excised specimen showed malignant lesions in 31(77%) and benign in 9(23%) patients. As a whole, it was found that the absolute sensitivity for intra oral FNAC was 100% and specificity 89% with positive predictive value of 97% and negative predictive value of 100%.

CONCLUSION

Cytological diagnosis was almost corroborative with final histopathological diagnosis in all cases, with very few exceptions, exhibiting high diagnostic accuracy.