Diagnostic accuracy of fine‐needle aspiration cytology and frozen section in primary parotid carcinoma

Abstract

BACKGROUND The low incidence and histologic heterogeneity of primary parotid carcinomas makes it difficult to evaluate the value of preoperative fine‐needle aspiration cytology (FNAC) and intraoperative frozen section (FS) analysis. In the current study, the authors reviewed a single institution's experience regarding the preoperative and intraoperative diagnostic value of FNAC and FS in primary salivary gland carcinomas. METHODS Between January 1990 and December 2002, 108 primary parotid carcinomas were resected at the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Berne, Inselspital (Berne, Switzerland). Included in the study were a total of 101 carcinomas with preoperative FNAC results in 88 tumors and/or intraoperative FS results in 45 tumors. In a retrospective study, the results of FNAC and FS were analyzed and compared with the corresponding histopathologic diagnoses. RESULTS The cytologic findings were true‐positive for malignancy in 63 tumors (72%), false‐negative in 22 tumors (25%), and nondiagnostic in 3 tumors (3%). The tumor grading was correct in 29 of 63 tumors (46%), and the exact tumor typing was correct in 27 of 63 (43%) true‐positive tumors. The FS findings were true‐positive for malignancy in 43 of 45 tumors (96%), the tumor grading was correct in 35 of 45 tumors (78%), and the tumor typing was correct in 32 of 45 tumors (71%). Overall, at the time of surgery, of the 101 parotid carcinomas, the tumor was known to be malignant in 83 tumors (82%), and the correct grade and the exact tumor type were known in 55 tumors (54%) and 48 tumors (48%), respectively. CONCLUSIONS FNAC recognized malignancy in 72% of tumors, but it could not be relied upon to provide an accurate tumor grading or typing. Therefore, FNAC alone is not prone to determine the surgical management of primary parotid carcinomas. The current analysis showed the statistically significant superiority of FS compared with FNAC regarding the diagnosis of malignancy, tumor grading, and tumor typing in primary parotid carcinomas. Cancer 2004. © 2004 American Cancer Society.

Diagnostic accuracy of fine needle aspiration biopsy in preoperative diagnosis of patients with parotid gland masses

“…As we demonstrated previously, the combination of negative malignancy cytology result in absence of clinic-imaging signs indicative of a primary parotid malignancy (irregular borders, tumor size, and Journal of Surgical Oncology heterogeneity of US and/or CT scan) could decrease the possibility of a false-negative result with better À LR regarding carcinoma. On the other hand, high specificity and þ LR are obtained in terms of primary parotid malignancy, with good exact diagnosis frequency (58%), and this information, combined with frozen section analyses as noted by Zbaren et al [7] and Lin and Bhattacharyya [5], could give a better definition of surgical strategy for determination of surgical margins, tumor grade, extent of neoplasm and the consequent need for neck dissection, and extensive or conservative procedures (total vs. lateral parotidectomy, total vs. radical parotidectomy).…”

“…Furthermore, final objective of FNAB has ranged from preoperative prediction of histopathological diagnosis to a ruling-out-malignancy role [6]. In this context, some authors mention the feasibility to change the actual management strategy of parotid neoplasms in the transoperative setting, with the combination of the FNAB test, the frozen section study, and surgical findings [5,7,8].…”

Accuracy of Fine Needle Aspiration Cytology of Salivary Gland Lesions: Routine Diagnostic Experience in Bangkok, Thailand

“…FS analysis of salivary gland tumors has traditionally been used to identify or exclude malignancy and to type the salivary gland lesion. Some authors advocated that FS is superior to FNA for the reason that FNA cannot be relied upon to type or grade malignant salivary gland tumors and FNA should not be used as the sole determinant of surgical management for primary parotid carcinomas (Zbaren et al, 2004). Whereas, some studies found that FNA is more sensitivity, FS is more specific but both FS and FNA provide a similar accuracy (Layfield et al, 1987;Seethala et al, 2005).…”

Differentiation of benign and malignant lesions of the tongue by using diffusion-weighted MRI at 3.0 T

“…However, the biopsy is invasive, and the results are not always conclusive. 4 Therefore, pre-operative imaging plays an important role in treatment selection and surgical planning. CT and conventional MRI are used to localize lingual masses and delineate their extent.…”