Preoperative Assessment of Salivary Gland Neoplasms with Fine Needle Aspiration Cytology and Echography: A Retrospective Analysis of 357 Cases

Abstract

Fine-needle aspiration cytology (FNAC) is a minimally invasive procedure usually well tolerated, easy to perform, quick, cheap and easy to repeat in case of doubts or non-diagnostic results. Echography is also a fast, cheap and non-invasive tool; however, the role of FNAC and echography in the diagnosis of salivary gland pathology is not universally recognised. Three hundred and fifty-seven patients with a cytological diagnosis at FNAC, and 247 of these who were also studied with echography, were enrolled for this retrospective study. The final histopathological diagnoses, obtained after surgery, were then compared to the preoperative FNAC diagnoses and echographic findings. From the analysis of our data, the overall FNAC specificity resulted 93%, sensitivity 83%, and diagnostic accuracy 92%. Echography sensibility was 57.1% specificity 98.2%, while positive and negative predictive value were respectively 80% and 94.8%. While echography can be useful in order to provide a better characterization of salivary gland lesions, FNAC can then be considered a safe diagnostic tool with reliable sensitivity and specificity for the assessment of salivary gland pathology and thus for selecting patients and indicating the best surgical treatment.It has been reported that major salivary gland tumours represent approximately 3% of all head and neck tumours; 80% involve parotid gland and 75% are benign neoplasms (l). According to the most recent WHO histological classification (2005) there is a broad spectrum of different histotypes of major salivary gland tumours (2), thus it is necessary to make a correct preoperative diagnosis in order to decide the best surgical/therapeutical approach. In this way, in order to perform a correct preoperative assessment, we used fine needle aspiration cytology (FNAC) and echography.FNAC is a minimally invasive method that does not require anaesthesia; it is well tolerated by the patient, easy to perform, quick, with rare complications, cheap and can be easily repeated in case of doubts or non-diagnostic results in order to reach a more accurate diagnosis (3). Echography is also a fast, cheap and non invasive tool. However, the role of FNAC and echography in the diagnosis of salivary gland pathology is not universally recognised (4, 5). Since its use is still controversial, most ENT surgeons prefer intraoperative frozen section examination to preoperative FNAC (6-7).The aim of this study is to show the accuracy and reliability of FNAC for the diagnosis of benign and malign tumours of major salivary glands through the evaluation of its diagnostic accuracy-sensibility,

Moving toward a systematic approach for reporting salivary gland cytopathology: cytohistological correlation with the application of the Milan system for risk stratification at a tertiary care center

“…The sensitivity of FNA, as mentioned in different previous studies, varies from 54% to 98% with high specificity values of 88% to 99% for separating benign lesions from malignant lesions. 8,9 Similarly, in the current study, the sensitivity was 76.3% and the specificity was 92.6%.…”

“…8,9 Similarly, in the current study, the sensitivity was 76.3% and the specificity was 92.6%. 8,9 Similarly, in the current study, the sensitivity was 76.3% and the specificity was 92.6%.…”

“…The precision of FNA for salivary gland tumor subtyping is lower and ranges from 62% to 80%. 8,9 The main reasons for false-negative results are sampling mucinous cells, which can be mistaken for histiocytes; this tumor can thus be misdiagnosed as a benign lesion as observed in our study. [7][8][9] It is associated with appreciable false-positive and false-negative rates that may lead to overtreatment or undertreatment.…”

“…However, the exact categorization may be difficult because of the shared cytomorphological features, varied architectural pattern, and significant cytomorphological heterogeneity within the same cell of origin. [7][8][9] It is associated with appreciable false-positive and false-negative rates that may lead to overtreatment or undertreatment. The precision of FNA for salivary gland tumor subtyping is lower and ranges from 62% to 80%.…”

Fnac (Fine Needle Aspiration Cytology) as a Preoperative Diagnostic Tool

“…(7) On the other hand, Pastore et al found a sensitivity and specificity of 83% and 93% respectively to detect malignancy. (8) Fakhry et al evaluated 249 parotid tumours, out of which 75% were benign and 25% were malignant. (9) The sensitivity and specificity to detect malignancy was assessed to be 80% and 89.5% respectively.…”