Diagnostic role of fine needle aspiration cytology (FNAC) in the evaluation of salivary gland swelling: an institutional experience

Abstract

BackgroundFine needle aspiration cytology (FNAC) is a cytodiagnostic method based on morphologic findings of individual and small group of cells aspirated using a fine needle. The aim of the present study is to evaluate the spectrum of salivary gland lesions in our setting and to assess the diagnostic accuracy of FNAC for salivary gland lesions.MethodsThe study involved 187 cases of parotid and submandibular swellings of patients who underwent FNAC at our institution. Thirty one (31) patients with a FNAC diagnosis of neoplastic lesion subsequently underwent excision biopsies. The results of FNAC and final histology were compared and accuracy of FNAC was determined.ResultsMean age of patients was 42 (±21) years and male to female ratio was 1:1. Chronic sialadenitis was the most common non-neoplastic lesion (33.8%) followed by acute and chronic sialadenitis (29.7%) and chronic granulomatous inflammation (27.0%). Pleomorphic adenoma was the most common benign neoplasm and non-Hodgkin’s lymphoma was the most common malignant lesion (38.9%) followed by acinic cell (27.8%) and adenoid cystic carcinoma (16.7%). Total 31 patients subsequently underwent surgical excision, out of which 21 were benign and 9 were malignant, 20 cases (64.5%) were of pleomorphic adenoma, 3 cases (9.6%) of acinic cell carcinoma, 2 cases (6.4%) each of warthin tumor, adenoid cystic carcinoma and non-hodgkin lymphoma and 1 case (3.2%) each of mucoepidermoid carcinoma and mucinous adenocarcinoma. The overall accuracy of FNAC in our study was found to be 83.8% with 77.7% sensitivity and 86.3%, specificity. The revised sensitivity and specificity after adjusting verification bias were 68.5% and 91% respectively. False negative diagnosis was rendered in mucoepidermoid carcinoma and acinic cell carcinoma whereas false positive diagnosis was given in cases of pleomorphic adenoma.ConclusionWe found a good concordance between FNAC and histology, however pleomorphic adenoma may impart a diagnostic challenge when inadequately aspirated and therefore we advice either immunohistochemical studies (if cell block material is available) or repeat aspiration in difficult cases.

Accuracy of fine‐needle aspiration cytology of head and neck masses

“…In our series the salivary gland group had the highest FN rate (2.8%) which explains its lowest sensitivity (66.7%). The same results were reported by several studies . In the present study, two cases misdiagnosed as pleomorphic adenomas on cytology were proved to be acinic cell carcinomas on histology.…”

“…The same results were reported by several studies. 27,28 In the present study, two cases misdiagnosed as pleomorphic adenomas on cytology were proved to be acinic cell carcinomas on histology. Acinic cell carcinoma is commonly reported as a cause of FN in FNAC of salivary glands.…”

A comparison study of the reporting systems for salivary gland fine needle aspirations: Are they really different?

“…There were not sublingual or minor salivary gland lesions represented in our sample. The majority of cases corresponded to benign / non‐neoplastic lesions, as is the case for most studies . The B category in the old classification encompassed the most number of cases ( n = 246), since it included both non‐neoplastic lesions and benign neoplasms, corresponding fairly to the NN and the BN categories of the Milan classification (245 cases in total).…”

“…The majority of cases corresponded to benign / non-neoplastic lesions, as is the case for most studies. [14][15][16] The B category in the old classification encompassed the most number of cases (n = 246), since it included both non-neoplastic lesions and benign neoplasms, corresponding fairly to the NN and the BN categories of the Milan classification (245 cases in total). The one case that was considered benign in the old classification and was not We evaluated ROM using both the old and the new classification systems (Tables 4 and 5).…”

The impact of FNAC in the management of salivary gland lesions: Institutional experiences leading to a risk‐based classification scheme

“…Fine‐needle aspiration (FNA) cytology (FNAC) can be easily used in an outpatient setting to diagnose and manage superficial salivary gland lesions . This role for FNAC has gained wide acceptance among clinicians because of easier accessibility of the lesions involving salivary glands (especially those affecting the parotid and submandibular glands) and the difficulties in distinguishing between benign and malignant lesions solely based on radiologic evaluation.…”