A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Frozen Section for Parotid Gland Lesions

Schmidt, Robert L.; Hunt, Jason P.; Hall, Brian J.; Wilson, Andrew; Layfield, Lester J.

doi:10.1309/ajcp2sd8rfqeuzjw

Cited by 88 publications

(66 citation statements)

References 27 publications

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“…Although Schmidt et al [8] recommend that one should accept malignant FNA diagnoses and not benign FNAs, our data suggest the opposite. We concur that the specificity of FNA is high and that we have relatively few false positives; however, at our center, we were able to detect these false positives on FS.…”

Section: Discussioncontrasting

confidence: 85%

“…The meta-analysis reported that a malignant diagnosis by FNA is acceptable, whereas benign diagnoses may be unreliable due to a false-negative rate of 20% for FNA [5]. In a subsequent systematic review and meta-analysis, Schmidt et al [8] found FS of parotid lesions to have a diagnostic accuracy of 99%, a specificity of 99%, and a sensitivity of 90%.…”

Section: Discussionmentioning

confidence: 99%

“…In meta-analyses by Schmidt et al [5,8], FS [area under the summary receiver operating characteristic (AUSROC), 0.99; 95% confidence interval (CI), 0.98-1.00] was found to have a significantly higher diagnostic accuracy than FNA (AUSROC, 0.96; 95% CI, 0.94-0.97) in distinguishing between benign and malignant lesions [5,6,7,8]. Studies such as those done by Schmidt et al [5,8] and Olsen et al [9] have reported the diagnostic accuracy of FS or FNA independently, but the role and value of FS after FNA diagnosis remain unclear. Studies such as those done by Arabi Mianroodi et al [7] report that the threshold for doing FS should be low in order to definitively rule out malignant disease and that FS is indeed cost-beneficial.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Retrospective Assessment of the Utility of Imaging, Fine-Needle Aspiration Biopsy, and Intraoperative Frozen Section in the Management of Parotid Neoplasms: The Weill Cornell Medical College Experience

Patel¹,

Scognamiglio

Kutler³

et al. 2015

ORL

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Background/Aims: Preoperative identification of malignant parotid lesions remains challenging, and thus, some surgeons use frozen section (FS) to assist them in their decision making. We evaluated the pathologic and cost benefit of FS after fine-needle aspiration (FNA) at our institution. Methods: We assessed medical data for 260 patients undergoing parotidectomy with FS. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for radiology, FNA, and FS. Results: The sensitivities, specificities, and accuracies of FNA and FS were 75.0, 96.4, and 93.2%, and 75.0, 100, and 96.8%, respectively. FS detected 0% of FNA false negatives and 80% of false positives. The additional pathology charge for FS alone per correctly identified benign lesion after a positive FNA was USD 1,443. Conclusion: FNA and FS are more reliable in the prognostication of the final pathology than radiology. At our center, FS appears to be of limited clinical use after benign FNAs, but may be more useful after positive, indeterminate, and nondiagnostic FNAs.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retrospective Assessment of the Utility of Imaging, Fine-Needle Aspiration Biopsy, and Intraoperative Frozen Section in the Management of Parotid Neoplasms: The Weill Cornell Medical College Experience

Patel¹,

Scognamiglio

Kutler³

et al. 2015

ORL

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“…It is frozen and examined immediately and results can then be telephoned to the surgeon within 2030 min. This is useful where no preoperative diagnosis [29] . IOFS mandates a full SEB and so cannot be reco mmended as a firstline diagnostic technique, parti cularly as patients cannot be consented appropriately.…”

Section: Intra-operative Frozen Sectionmentioning

confidence: 99%

Biopsy of parotid masses: Review of current techniques

Haldar¹,

Sinnott²,

Tekeli³

et al. 2016

WJR

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Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology (FNAC) or ultrasound guided core biopsy (USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section (IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.

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“…The 9-tier system has an overall sensitivity of 61%, specificity of 97%, positive predictive value of 82%, and negative predictive value of 91% for the diagnosis of malignancy. A systematic review and meta-analysis 17 on the diagnostic accuracy of FNA for parotid gland malignancies reported a sensitivity of 80% and a specificity of 97%. The 9-tier system falls short on sensitivity.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Moving Toward a Systematic Approach for Reporting Salivary Gland Cytopathology: An Institutional Experience and Literature Review

Luo

Jhala

Khurana

et al. 2018

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Despite the clinical utility of fine-needle aspiration for the diagnosis of salivary pathologies, salivary lesions remain one of the most challenging areas in cytopathology. This is partially because there is no consensus on how to report salivary gland cytopathology, which has resulted in inconsistent terminology among institutions and individual cytopathologists and in confusion in communication among cytopathologists and ordering providers. Objective.— To summarize our experience with an institutional salivary gland cytopathology reporting system, as an initiative to promote collaborative work toward a consensus on a reporting system. Design.— We developed an empirical 6-tier classification reporting system. Slides of 107 salivary gland fine-needle aspirations with subsequent histology slides were reviewed and reclassified using the 6-tier system. The performance of the cytology reporting system was evaluated with the histology diagnoses serving as the gold standard. Results.— Fine-needle aspiration diagnoses made based on the institutional 6-tier classification system were generally consistent with histology diagnoses for the disease spectrum reported in this study. The sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing malignancies with the system were 86% (12 of 14), 93% (40 of 43), 80% (12 of 15), and 95% (40 of 42), respectively. The risk of malignancy increased from 0% (0 of 13) for negative for neoplasm to 7% (2 of 29) for benign neoplasm, 67% (2 of 3) for suspicious for malignancy, and 83% (10 of 12) for positive for malignancy. Conclusions.— The institutional 6-tier system provides a succinct, risk-of-malignancy–based system to report salivary gland cytology. Our experience with this system helps to pave the way for the adoption of the Milan System for Reporting Salivary Gland Cytopathology.

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A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Frozen Section for Parotid Gland Lesions

Cited by 88 publications

References 27 publications

Retrospective Assessment of the Utility of Imaging, Fine-Needle Aspiration Biopsy, and Intraoperative Frozen Section in the Management of Parotid Neoplasms: The Weill Cornell Medical College Experience

Retrospective Assessment of the Utility of Imaging, Fine-Needle Aspiration Biopsy, and Intraoperative Frozen Section in the Management of Parotid Neoplasms: The Weill Cornell Medical College Experience

Biopsy of parotid masses: Review of current techniques

Moving Toward a Systematic Approach for Reporting Salivary Gland Cytopathology: An Institutional Experience and Literature Review

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