IJCRR - 6(7), April, 2014
FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) - AS A DIAGNOSTIC TOOL IN SALIVARY GLAND LESIONS
Author: Abhishek Raval, Hansa Goswami, Urvi Parikh, Prabhat Sharma, Venu Ghodasara, Safal Patel
Introduction: Fine Needle Aspiration Cytology (FNAC) is well accepted as a safe, reliable, minimal invasive and cost effective method for preoperative diagnosis of salivary gland lesions. Aims and Objectives: The aim of this study is to evaluate diagnostic accuracy, sensitivity and specificity of FNAC in various salivary gland lesions in correlation with their histopathology, which helps in the appropriate therapeutic management. Materials and Methods: A total of 88 FNACs were done on salivary gland lesions from January 2013 to November 2013 in the Pathology Department of one of the largest government tertiary care teaching hospital, Ahmedabad (Gujarat, India). Formalin fixed (10%), surgically resected specimens were received, they were processed and slides were prepared for histopathological diagnosis. The stained cytological and histopathological slides were studied, analyzed and correlated. Results: Our study included 88 patients who underwent preoperative FNAC for salivary gland lesions with subsequent surgical excision. Out of 88, 52 (59.1%) were males and 36 (40.9%) were females. Male to female ratio was 1.4: 1. The median age was 42 years. Parotid gland was involved in 60 (68.2%) cases, submandibular in 26 (29.55%) cases and other minor salivary glands in 2 (2.27%) cases. Out of 88, 79 cases (89.8%) were cytologically diagnosed as benign lesions and 9 (10.2%) were malignant. The most common benign cytological diagnosis was pleomorphic adenoma; 41 out of 79 cases (51.9%). Cytological diagnoses were compared with histopathological ones and were true-negative in 77 (97.5%), true-positive in 8 (88.9%), false-negative in 2 (11.1%) and false-positive in 1 (2.5%) cases regarding detection of malignant tumors. The overall cytological diagnosis achieved a sensitivity of 80%; a specificity of 98.7%, Positive Predictive Value of 88.9%, Negative Predictive Value of 97.5% and diagnostic accuracy of 96.6%. Conclusion: This study indicated that FNAC of salivary gland is a reliable and highly accurate diagnostic method for diagnosis of salivary gland lesions. It not only provides preoperative diagnosis for therapeutic management but also can prevent unnecessary surgery.
Keywords: Diagnostic Accuracy, Fine Needle Aspiration Cytology (FNAC), Salivary Gland Lesions, Sensitivity, Specificity
Abhishek Raval, Hansa Goswami, Urvi Parikh, Prabhat Sharma, Venu Ghodasara, Safal Patel. FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) - AS A DIAGNOSTIC TOOL IN SALIVARY GLAND LESIONS International Journal of Current Research and Review. 6(7), April, 17-25
1. Frable MAS, Frable WJ (1991). Fine needle aspiration biopsy of salivary glands. Laryngoscope, 101, 245-9.
2. Layfield LJ, Glasgow BJ (1991). Diagnosis of salivary gland tumors by fine-needle aspiration cytology: a review of clinical utility and pitfalls. Diagn Cytopathol, 7, 267-72.
3. Cajulis RS, Gokaslan ST, Yu GH, FriasHidvegi D (1997). Fine needle aspiration biopsy of the salivary glands: five-year experience with emphasis on diagnostic pitfalls. Acta Cytol, 41, 1412-20.
4. Buley ID, Roskell DE (2000). Fine-needle aspiration cytology in tumor diagnosis: uses and limitations. Clin Oncol, 12, 166-71
5. Cristallini EG, Ascani S, Farabi R, et al (1997). Fine needle aspiration biopsy of salivary gland, 1985-1995. Acta Cytol, 41, 1421-5.
6. Al-Khafaji BM, Nestok BR, Katz RL (1998). Fine-needle aspiration of 154 parotid masses with histologic correlation: ten-year experience at the university of Texas M.D. Anderson cancer center. Cancer, 84, 153-9.
7. Ellis G, Auclair P (1996). Tumors of the Salivary Glands, 3rd ed. Armed Forces Institute of Pathology. Washington, DC pp 17.
8. Mavec P, Eneroth CM, Franzen S, Moberger G, ZajicekJ. Aspiration biopsy of salivary gland tumours. Acta Otolaryngol 1964;58:471-484.
9. Persson PS, Zettergren L. Cytological diagnosis of salivary gland tumours by aspiration biopsy. Acta Cytol 1973;17:351- 354.
10. Cohen MB, Fisher PE, Holly EA, Ljung BM, Lowhagen T, Bottles K. Fine needle aspiration biopsy diagnosis of mucoepidermoid carcinoma. Statistical analysis. Acta Cytol 1990;34:43–49.
11. Auclair PL, Ellis GL, Gnepp DR, Wenig BM, Janney CG (1991). Salivary gland neoplasms: general considerations. In ‘Surgical pathology of the salivary glands. Major problems in pathology’, Eds Ellis GL, Auclair PL, Gnepp DR. WB Saunders, Philadelphia pp 135-64.
12. Fernandes GC, Pandit AA. Diagnosis of salivary gland tumours by FNAC. Bombay Hospital Journal 2000;42:108-111.
3. Qizilbash AH, Sianos J, Young JE, Archibald SD. Fine needle aspiration biopsy cytology of the major salivary glands. Acta Cytol 1985;29:503-512.
14. Spiro RH. Salivary neoplasms- An overview of 35 years of experience with 2807 patients. Head Neck Surg 1986;8:177-184.
15. Layfield LJ, Tan P, Glasgow BJ (1987). Fine needle aspiration of salivary gland lesions. Arch Pathol lab Med, 111, 346-353.
16. Stanley MW, Bardales RH, Farmer CE, et al (1995). Primary and metastatic high grade carcinomas of the salivary glands: a cytologichistoligic correlations study of twenty cases. Diagn Cytopathol, 13, 37-43.
17. Zhang S, Bao R, Bagby J, Abreo F (2009). Fine needle aspiration of salivary glands: 5- year experience from a single academic center. Acta Cytol, 53, 375-82.
18. Owen EERTC, Banerjee AK, Prichard AJN, Hudson EA, Kark AE (1989). Role of fineneedle aspiration cytology and computed tomography in the diagnosis of parotid swellings. Br J Surg, 76, 1273-4.
19. Stewart CJR, MacKenzie K, McGarry GW, Mowat A (2000). Fine needle aspiration cytology of salivary gland: a review of 341 cases. Diagn Cytopathol, 22, 139-46.
20. Kraft M, Lang F, Mihaescu A, Wolfensberger M (2008). Evaluation of clinician-operated sonography and fine-needle aspiration in the assessment of salivary gland tumors. Clin Otolaryngol, 33, 18-24.
21. Zbaren P, Nuyens M, Loosli H, Stauffer E. Diagnostic accuracy of fine-needle aspiration cytology and frozen sections in primary parotid carcinoma. Cancer 2004;100:1876- 1883.
22. Frable WJ. Thin needle aspiration biopsy. Philadelphia, WB Saunders. 1983, 119-151.
23. Qizilbash AH, Young J. Guides to clinical aspiration FNAC of Salivary Gland Lesions biopsy: Head & Neck. New York, IgakuShoin. 1988, 15-116.
24. Shiantani S, Matsura H, Hasegawa Y. Fine needle aspiration of salivary gland tumors. Int J Oral Maxillo Fac Surg. 1997, 26: 284-286.
25. Schindler S, Nayar R, Dutra J, Beddrossian CWM. Diagnostic challenges in aspiration cytology of the salivary glands. Semin Diagn Pathol. 2001, 18: 124-146.
26. Orell SR. Diagnostic difficulty in the interpretation of FNA of salivary lesions. Cytopathol. 1995, 6: 285-300.
27. Lowhagen T, Tani EM, Skoog L. Salivary glands and rare head and neck lesions: In Comprehensive Cytopathology, Edited by M Bibbo. Philadelphia, WB Saunders. 1991, 621- 648.
28. O’Dwyer P, Farrar WB, James AG, Mc Cabe DP. Needle aspiration biopsy of major salivary gland tumors. Its value. Cancer. 1986, 57: 554-557.
29. Koss LG, Melamed MR. Salivary glands. In: Diagnostic cytology & its histopathologic bases. 5th ed. Pheladilphia. Lippincott Williams & Wilkins. 2006, 1230-60.
30. Rajwanshi A, Gupta K, Gupta N, Shukle R, Nijhwa R, Vasishta R. Fine needle aspiration cytology of salivary glands: Diagnostic pitfalls. Diagnostic Cytopathol. 2005, 34: 580- 584.
31. Mistry M, Sood S. Benign salivary gland tumors. J Otolaryngol Head & Neck Surg. 2004, 8: 49-52.
32. Abrari A, Ahmed S, Baksh V. Cytology in the otorinolaryngologist’s domain, a study of 150 cases, emphasizing diagnostic utility and pitfalls. Indian J Otolaryngol Head & Neck Surg. 2002, 54: 107-10.
33. Boccato P, Altavilla G, Blandamura S. Fine needle aspiration biopsy of salivary gland lesions. Acta Cytol. 1998, 42: 888-898.
34. Orell S, Sterrett G, Whitaker D. Fine needle aspiration cytology. Head & Neck. Livingstone Inc, New York. 2005, 41-82.
35. Elsheikh M. Salivary gland aspiration cytology. In: Atlas of difficult diagnoses in cytopathology. Atkinson B & Silverma J editors. 1st ed. New York. WB Saunders 1998, 451-80.