Fine-Needle Aspiration Biopsy of Salivary Gland Lesions in a Selected Patient Population

Abstract

To report the role of selective use of preoperative fine-needle aspiration biopsy (FNAB) in patients with major salivary gland lesions at a tertiary care cancer center. Design: Retrospective review of FNAB results compared with final histologic diagnosis as the criterion standard. Setting: An academic tertiary care cancer center. Patients: A consecutive series of 258 patients who underwent FNAB of major salivary gland lesions between 1996 and 2000, of whom 169 had surgical resection.

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

“…The most common primary salivary gland malignant tumors were lymphoma (25%, 4/16) and mucoepidermoid carcinoma (18.8 %, 3/16). The high rate of malignant lymphoma is similar to previous studies (Chai et al, 1997;Al-Khafaji et al, 1998;Cohen et al, 2004).…”

“…High grade lymphomas are easier to diagnose than low grade lymphomas. The FNA specimen with predominantly lymphocytes without salivary epithelium was frequently associated with lowgrade lymphoma on final histological diagnosis in both suspicious and malignant cytological diagnosis so it should prompt further study for lymphoma (Cohen et al, 2004). FNA cytology along with various ancillary studies, such as immunocytochemistry and flow cytometry can be helpful to diagnostic and classification lymphomas and separate them from reactive hyperplasia (Stewart et al, 1998;Dong et al, 2001).…”

“…The smears of follicular cell carcinoma showed predominantly small lymphocytes, scattered with histiocytes and some tangible body macrophages. This may lie with the reason that lymphoma may arise in a background of a reactive lymphoid proliferation, sometime may contain a mixed population of lymphoma cells and benign inflammatory cells, as well as lack of cellular atypia, makes this diagnosis difficult by cytology alone and leading to an erroneous diagnosis of the reactive process (Qiziblash et al, 1985;O'Dwyer et al, 1986;Zurrida et al, 1993;Cohen et al, 2004). Such false negative cases may result from experience, the more experience cytopathologist, the more improves diagnosis accuracy (O'Dwer et al, 1986).…”

“…Nevertheless, other studies have reported wide variation in sensitivity and specificity of FNA cytology of salivary gland in detecting malignant tumors, ranging from 29% to 97% and 84% to 100%, respectively (reviewed in Cohen et al, 2004). Factors contributing to a wide range are unclear, but they may be related to technical factor, experience of clinician performing the FNA and experience of cytopathologist (Cohen et al, 2004).…”

Prospective evaluation of Quasistatic Ultrasound Elastography (USE) compared with Baseline US for parotid gland lesions: preliminary results of elasticity contrast index (ECI) evaluation

“…Furthermore misdiagnosis could result in both hazardous under-treatment, and potentially avoidable overtreatment with permanent facial static and dynamic disfigurement. Fine-needle aspiration cytology (FNAC) guided by ultrasound (US) imaging is widely used to evaluate both neoplastic and inflammatory lesions of the salivary glands, albeit with variable success; sensitivity ranges from 57% to 98%, specificity from 56% to 100%, and accuracy from 78% to 98% [5][6][7][8][9][10][11][12][13][14][15][16] which also depends on the expertise and experience of the pathologist. FNAC is obtained in all salivary gland nodules, and normally performed in reference centers dealing with parotid gland tumors.…”