Utility and Safety of Ultrasound‐Guided Fine‐Needle Aspiration of Salivary Gland Masses Including a Cytologist's Review

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 Value of Fine-Needle Aspiration Cytology in Salivary Gland Lesions, 1994–2004

“…Many investigators believe that the common practice of FNAC performed by clinicians produces suboptimal results in salivary gland masses. With immediate assessment of the material by a cytopathologist, the combined approach of ultrasound-guided FNAC in salivary gland masses is more accurate than with specimens obtained with other techniques [3,4,21] . In contrast, some investigators believe that training and ability in specimen interpretation are the most important features.…”

Sonographic diagnosis of parotid gland lesions: Correlation with the results of sonographically guided fine‐needle aspiration biopsy

“…21 Sonographically guided FNAB is a safe procedure with a low rate of nondiagnostic sampling. 20 In previous studies, the sensitivity of US-guided FNAB for detecting malignant lesions was reported at 82-85% and specificity at 86-96%. 17,19 FNAB is currently regarded as a minimally invasive, accurate, and cost-effective technique in the evaluation of parotid and other salivary gland lesions.…”

“…18 FNAB is a well-established tool to diagnose salivary gland lesions. 2,3,16,17,[19][20][21][22][23][24] Although it is generally accepted that FNAB is useful in the preoperative setting, its accuracy is highly dependent on both operator experience and the interpretative skills of the cytopathologist. 21 Sonographically guided FNAB is a safe procedure with a low rate of nondiagnostic sampling.…”

“…17,19 FNAB is currently regarded as a minimally invasive, accurate, and cost-effective technique in the evaluation of parotid and other salivary gland lesions. 19,20 However, there are limitations to US-guided FNAB. In a recent study, Howlett et al 23 reported sensitivity of only 64% and a specificity of 100% in the evaluation of salivary glands and suggested strategies to minimize the nondiagnostic rate of FNAB.…”

US of the Major Salivary Glands: Anatomy and Spatial Relationships, Pathologic Conditions, and Pitfalls

“…Focal involvement may also be encountered, with a focal hypoechoic heterogeneous lesion within a normally shaped gland (36,37). In all doubtful cases, verification with fine-needle aspiration biopsy is recommended (38,39).…”