Fine-needle aspiration cytology of salivary glands: Diagnostic pitfalls—revisited

Rajwanshi, Arvind; Gupta, Kirti; Gupta, Neha; Shukla, Rajeev; Srinivasan, Radhika; Nijhawan, Raje; Vasishta, Rakesh Kumar

doi:10.1002/dc.20353

Cited by 67 publications

(71 citation statements)

References 14 publications

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“…A pleomorphic adenoma, due to its unique characteristics, can be easily identified by FNAB (24,25). However, the presence of atypical cytological findings may be indicative of malignancy (26).…”

Section: Discussionmentioning

confidence: 99%

Role of Fine-Needle Aspiration Biopsy in the Management of Salivary Gland Masses

Edızer¹,

Server²,

Yiğit³

et al. 2016

Turk Arch Otorhinolaryngol

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Objective: Fine-needle aspiration biopsy (FNAB) is widely used in the management of salivary gland masses. Its main advantage is its ability to differentiate benign from malignant disease. In this study, we aimed to evaluate the diagnostic ability of FNAB in salivary gland masses. Methods:The records of patients who had undergone FNAB before parotidectomy or submandibular gland excision between 2005 and 2013 were retrospectively analyzed. FNAB results were classified as negative, positive, suspicious for malignancy, and non-diagnostic. Preoperative FNAB results were compared with definitive histopathological results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FNAB results were calculated.Results: A total of 285 patients were enrolled. Among them, 230 (80.7%) had parotid gland and 55 (19.3%) had submandibular gland masses. Following a definitive histopathological examination, the most common benign tumor was pleomorphic adenoma (52.6%), whereas malignant tumors were mucoepidermoid carcinoma (2%) and squamous cell carcinoma (2%). The sensitivity, specificity, PPV, NPV and accuracy of FNAB results were 76.9%, 95.4%, 75%, 95.9%, and 92.6%, respectively. The rate of a suspicious cytology was 5.2% (15 patients) and that of a non-diagnostic cytology was 8.8% (25 patients). Conclusion:FNAB is a safe and simple diagnostic tool for the diagnosis of salivary gland masses and has a relatively high sensitivity and specificity. It may provide valuable information for patient counselling and surgical planning. The major drawbacks include a lower sensitivity than specificity and a relatively high rate of non-diagnostic results.

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Section: Discussionmentioning

confidence: 99%

Role of Fine-Needle Aspiration Biopsy in the Management of Salivary Gland Masses

Edızer¹,

Server²,

Yiğit³

et al. 2016

Turk Arch Otorhinolaryngol

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“…In general, FNA performs well in the distinction between non-neoplastic and neoplastic salivary gland masses, low-grade malignant and high-grade malignant salivary gland neoplasms, and primary and metastatic diseases [9,10]. However, due to the overlapping cytomorphologic features of many benign and low-grade malignant tumors of the salivary gland, underdiagnosing low-grade malignant tumors by their deceptive bland cytology and overdiagnosing malignancy on focal reactive atypia have been reported [12,13,14,15]. Thus, it has been recommended that the primary value of FNA is not to establish a specific diagnosis, but rather plays a role subordinate to the intraoperative findings.…”

Section: Discussionmentioning

confidence: 99%

“…Histologic and cytologic diversity is the hallmark of neoplastic myoepithelial cells. Numerous salivary gland benign and malignant tumors have at least partial myoepithelial differentiation, including, but not limited to, myoepithelioma, BCA, BCAC, EMC and ADCC [11,14,17]. Because almost all neoplastic salivary gland lesions will undergo surgical excision except Warthin’s tumor, the surgical management relies less heavily on a specific preoperative diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Cytopathologic Analysis of Stroma-Poor Salivary Gland Epithelial/Myoepithelial Neoplasms on Fine Needle Aspiration

Chen

Ray

et al. 2012

Acta Cytologica

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Objective: Fine needle aspiration (FNA) diagnosis of salivary gland neoplasms with epithelial/myoepithelial cells but rare or no stroma is usually difficult. Our aim was to study the cytomorphology of this cohort of FNA cases and evaluate the clinical follow-up. Study Design: The diagnostic terminology for this group of aspirates was ‘favor an epithelial/myoepithelial neoplasm of the salivary gland’. The cytologic smears of 32 such cases were retrieved and showed cellular smears with bland-appearing or mildly atypical epithelial and myoepithelial cells without typical chondromyxoid stroma seen in pleomorphic adenoma (PA). Results: Twenty of the 32 cases had histologic follow-up. Ten of these 20 cases were PAs, including 8 cellular PAs. Two cases were basal cell adenomas, 1 case myoepithelioma and 1 case benign adenoma, not otherwise specified. Among the 6 malignant tumors on surgical resections, there were 3 epithelial-myoepithelial carcinomas, 1 myoepithelial carcinoma, 1 basal cell adenocarcinoma and 1 adenoid cystic carcinoma. Conclusions: Although 14 of the 20 (70%) cases were benign neoplasms, a substantial amount of cases (30%) were malignant salivary gland neoplasms. The generic diagnostic terminology of ‘epithelial/myoepithelial neoplasm of the salivary gland’ and appropriate clinical follow-up are recommended for these cases.

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“…86% to 98%. 9 (Table 2). The present study had two false negative cases, wherein adenoid cystic carcinoma was rendered as non-neoplastic on FNAC and a diagnosis of chronic sialadenitis was given.…”

Section: Discussionmentioning

confidence: 99%

Fine Needle Aspiration of Salivary Gland Lesions- Diagnostic Pitfalls

Sushma¹,

Shashidhar²,

Meghashree³

et al. 2017

jemds

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BACKGROUNDThe use of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of salivary gland lesions has seen a significant rise. In majority of cases, FNAC is helpful in differentiating between benign and malignant lesions. However, many a times it becomes quite challenging to give a precise diagnosis. The sensitivity of diagnosis of malignant lesions is high, though specificity is low. Aims-Objectives-1. To study the cytomorphology of salivary gland lesions. 2. To examine the sensitivity, specificity and diagnostic accuracy of FNAC of salivary gland lesions by cytohistopathological correlation and to identify the discrepancies that contri bute to false diagnosis. MATERIALS AND METHODSFifty one salivary gland FNAC cases received at the Department of Pathology, A. J. Institute of Medical Sciences were reviewed to identify the cytological characteristics. A cytohistopathological correlation was done wherever available and discordant cases were analysed. RESULTSIn the present study, out of 51 cases majority were males (33 cases, 65%). Twenty (40%) were diagnosed non-neoplastic, eighteen (35%) were rendered benign, while thirteen (25%) were malignant on cytology. Pleomorphic adenoma was the most common benign tumour (77% of the benign lesions) and mucoepidermoid carcinoma was the most common malignant tumour (30% of the malignant lesions). Biopsy confirmation of the cytological diagnoses were available in twenty one (41%) cases; 42.8% of the total cases showed discordant diagnosis. CONCLUSIONFNAC is a reliable tool in distinguishing benign and malignant salivary gland lesions in the hands of an experienced cytopathologist. A specific cytological diagnosis is often possible. However, due to the diagnostic pitfalls in FNAC, a biopsy confirmation may be necessary.

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Fine-needle aspiration cytology of salivary glands: Diagnostic pitfalls—revisited

Cited by 67 publications

References 14 publications

Role of Fine-Needle Aspiration Biopsy in the Management of Salivary Gland Masses

Role of Fine-Needle Aspiration Biopsy in the Management of Salivary Gland Masses

Cytopathologic Analysis of Stroma-Poor Salivary Gland Epithelial/Myoepithelial Neoplasms on Fine Needle Aspiration

Fine Needle Aspiration of Salivary Gland Lesions- Diagnostic Pitfalls

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