Parotid gland lesions: Diagnosis of malignancy with MRI and flow cytometric DNA analysis and cytology in fine-needle aspiration biopsy

Abstract

Background The purpose of this study was to assess the capability of magnetic resonance imaging (MRI) and cytology and flow cytometric (FCM) deoxyribonucleic acid (DNA) analysis in fine‐needle aspiration biopsy (FNAB)–derived materials for diagnosing malignancy of the parotid lesions and the efficacy of FCM analysis in FNAB. Methods Magnetic resonance imaging findings and FCM results (ploidy and S + G2 + M phases [S + G2M] fraction) and cytology in FNAB‐derived materials in 26 patients with 26 parotid lesions (12 benign lesions, 14 malignancies) were assessed for predicting malignancy. Flow cytometric results in aspirates were compared with those in surgically resected tissues. Results When a single predictor was used, cytology (92% accuracy) was most accurate for malignancy, followed by ill‐defined margin (88% accuracy) and aneuploidy (88% accuracy). The combination of FCM and cytology raised the rate of sufficient materials from 92% to 100% and accuracy from 92% to 96% compared with cytology alone. The same highest accuracy (96%) was obtained with the combination of the ill‐defined margin or other findings such as cytology, aneuploidy, or a high (S + G2M) fraction (6% <). Deoxyribonucleic acid ploidy in the FNAB showed full agreement with that in the surgical specimens. Receiver operating characteristic curves showed that the diagnosis of malignancy with (S + G2M) fraction in FNAB was superior to that in surgical specimens, but no significant difference was noted. Conclusions A combination of MRI findings, cytology, and FCM results is optimal for diagnosing malignancies of the parotid lesions, and FNAB may replace the surgical specimens in FCM analysis. © 1999 John Wiley & Sons, Inc. Head Neck 21: 43–51, 1999.

The role of fine-needle aspiration cytology and magnetic resonance imaging in the management of parotid mass lesions

“…When this definition was applied to our series, sensitivity, specificity, and accuracy were 52%, 80%, and 73%, respectively. Alternatively, they reported an accuracy of 88% from the viewpoint of unsharp margin [11]. Although Bartels et al showed a sensitivity, specificity, and accuracy of 88%, 77%, and 83%, respectively, they did not refer to MRI features in detail by which to discriminate malignant from benign parotid lesions [8].…”

“…A series of reports have demonstrated the superiority of MRI over CT in delineating parotid mass lesions [6,7]. Although several reports describe which characteristics seen on MRI can effectively differentiate between benign and malignant parotid mass lesions [7Á11], only a few have statistically analyzed such capability of MRI [8,10,11].…”

DNA ploidy analysis in salivary gland tumours by image cytometry

“…A vast majority of studies have used FCM to evaluate DNA content in salivary gland tumours, and the samples have been obtained from fresh tumour tissue or paraffin blocks (10–13, 18, 22–34). Takashima et al (13) suggested that a combination of magnetic resonance, cytology and FCM is optimal for diagnosing malignancies of parotid gland, and fine needle aspiration biopsy (FNAB) derived materials can replace the surgical specimens in FCM analysis.…”

“…According to some authors, DNA flow cytometric parameters have prognostic value in some salivary gland carcinomas (10–12). However, there are few series published in the literature focusing on ploidy analysis for prediction of tumour aggressiveness, prognosis, and for differentiating benign from malignant salivary gland tumours (12, 13).…”

Salivary Gland Tumors: Diagnostic Value of Gadolinium-enhanced Dynamic MR Imaging with Histopathologic Correlation

“…Aggressive resection of any tumor, whether the neoplasm is benign or malignant, can cause serious complications such as facial nerve palsy, and surgeons use the more aggressive approach when they perform surgery to treat malignant tumors (1)(2)(3)(4). Furthermore, preoperative aspiration cytology results are not always conclusive because insufficient specimens are sometimes obtained owing to a small sample size or the deep location of the tumor (5)(6)(7). Therefore, preoperative imaging has an important role in surgical planning.…”