No abstract

Objective. To evaluate the utility and safety of ultrasound-guided fine-needle aspiration of the salivary glands for diagnosis of focal masses in the salivary glands, including the prevalence of nondiagnostic sampling, the impact of the presence of a cytologist during the procedure, and the usefulness of flow cytometry. Methods. A retrospective analysis of 43 ultrasound-guided fine-needle aspirations of the salivary glands from 36 lesions in 33 patients was performed. Fine-needle aspirations were obtained under sonographic guidance, and 1 to 6 punctures were made with 20-to 25-gauge needles. Ultrasound-guided fine-needle aspirations obtained in the presence of a cytologist were compared with those performed without a cytologist regarding the adequacy of the specimen and the number of punctures performed. Postprocedural complications and the frequency with which flow cytometry was performed were noted. Cytopathologic diagnosis was correlated with clinical follow-up (n = 33) and surgical pathologic findings (n = 10). Results. Cytologic diagnosis was made in 31 (94%) of 33 patients, confirming a neoplastic process in 18 (50%) of 36 and a non-neoplastic process in 16 (44%) of 36. Although the presence of a cytologist at the bedside resulted in a higher prevalence of diagnostic sampling (P < .05), it did not alter the number of punctures performed (mean, 3 punctures). No complications were encountered except for pain in 2 patients. Flow cytometry was helpful in 8 (22%) of 36 patients. Conclusions. Ultrasound-guided fine-needle aspiration of the salivary glands is a safe procedure with a low prevalence of nondiagnostic sampling. Approximately 44% of patients can be spared surgical intervention through diagnosis of a non-neoplastic process. The presence of a cytologist increases the likelihood of obtaining a diagnostic sample. Flow cytometry was helpful in 22% of patients.

The most common pattern of injectate spread seen on MRI with both approaches to PCB was spread within the body of the psoas muscle around the lumbar branches (L2-4), with cephalad spread to the lumbar nerve roots. One catheter resulted in injectate between the psoas and quadratus lumborum muscles.