Fine needle aspiration cytology in the management of a parotid mass: A two centre retrospective study

doi:10.1016/S1479-666X(05)80064-2

The Surgeon

Volume 3, Issue 2, April 2005, Pages 67-72

https://doi.org/10.1016/S1479-666X(05)80064-2 Get rights and content

Objectives: There is a diversity of opinion regarding the role of fine needle aspiration cytology (FNAC) in the pre-operative evaluation of the parotid mass. This study further investigates the role of FNAC from the standpoint of the clinician attempting to resolve one or more clinical issues. Methods: A retrospective study conducted at two UK Hospitals with no overlap of cytopathologists or surgeons. Patients undergoing parotidectomy at each institution were identified from Pathology department databases. The definitive histopathological diagnosis was compared with any pre-operative FNAC diagnosis. Cytology results were classified as suggestive, non-diagnostic, sampling error, or misleading. Setting: The study was conducted in a District General Hospital and a University Teaching Hospital providing secondary care for each community. Results: For the University Teaching Hospital the sensitivity in distinguishing malignant from benign disease was 79% (95% CI 61–97%) with a specificity 84% (95% CI 73–95%). However, three of eight patients with a primary parotid salivary gland malignancy were reported as having benign disease on FNAC. For the participating District General Hospital the sensitivity in distinguishing malignant from benign disease was 38% (95% CI 13–63%) and specificity 95% (95% CI 73–95%). Conclusions: Fine needle aspiration cytology does not reliably distinguish a benign from a malignant primary salivary gland neoplasm in the participating institutions. Where clinical teams use FNAC in an attempt to resolve this clinical problem, the results should be interpreted with caution and an ongoing audit of performance is required

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The purpose of the present study was to establish the reliability of fine needle aspiration (FNA) in the diagnosis of malignant salivary gland tumors in our population and to compare our results with those of other authors.
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Citation Excerpt :
Subsequently, by the early 1980s, open biopsy was largely superseded by fine needle aspiration cytology (FNAC), which was traditionally done blind and usually in the outpatient department. Although successful results have been reported, it has become increasingly clear that there is considerable variability in the accuracy of FNAC, and high non-diagnostic rates and poor sensitivity or specificity have been reported.4–6 The technique is well established, and is commonly used as it is quick, safe, relatively non-invasive, and cheap.
The optimum technique for histological confirmation of the nature of a parotid mass remains controversial. Fine needle aspiration cytology (FNAC), which has traditionally been used, is associated with high non-diagnostic and false negative rates, and ultrasound (US)-guided core biopsy and frozen section have been explored as alternatives. US-guided core biopsy is more invasive than FNAC, but is safe, well-tolerated, and associated with improved diagnostic performance. Although frozen section offers better specificity than FNAC, it has a number of important drawbacks and cannot be considered as a primary diagnostic tool. US-guided core biopsy should be considered as the initial diagnostic technique of choice, and in units where the accuracy of FNAC is good it can be used when FNAC is equivocal or non-diagnostic.
Diagnostic investigation of parotid neoplasms: A 16-year experience of freehand fine needle aspiration cytology and ultrasound-guided core needle biopsy
2015, International Journal of Oral and Maxillofacial Surgery
This study aimed to examine the diagnostic yield of fine needle aspiration cytology (FNAC) and ultrasound-guided core needle biopsy (USCB) in the diagnosis of parotid neoplasia. A 16-year retrospective analysis was performed of patients entered into our pathology database with a final diagnosis of parotid neoplasia. FNAC and USCB data were compared to surgical excision where available. One hundred and twenty FNAC, 313 USCB, and 259 surgical specimens were analyzed from 397 patients. Fifty-six percent of FNAC and 4% of USCB were non-diagnostic. One hundred and thirty-two (33%) patients had a final diagnosis made by USCB and did not undergo surgery. Surgery was performed in 257 (65%) patients, 226 (88%) of whom had a preoperative biopsy. Most lesions were benign, but there were 62 parotid and 13 haematological malignancies diagnosed; false-negative results were obtained in three FNAC and two USCB samples. The sensitivity and specificity of FNAC were 70% and 89%, respectively, and for USCB were 93% and 100%, respectively. This study represents the largest series of patients with a parotid neoplasm undergoing USCB for diagnosis. USCB is highly accurate with a low non-diagnostic rate and should be considered an integral part of parotid assessment.

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View full text

Fine needle aspiration cytology in the management of a parotid mass: A two centre retrospective study

Br J Oral Maxillofac Surg

Am J Surg

Mod Pathol

Br J Oral Maxillofac Surg

Cytodiagnosis of 112 salivary gland lesions. Correlation with histological frozen section diagnosis

Acta Cytol

The role of fine needle aspiration cytology in the management of parotid tumours: a critical clinical appraisal

Head Neck

Needle aspiration biopsy of major salivary gland tumours. Its value

Cancer

Value of fine needle aspiration cytology of parotid masses

Laryngoscope

Fine needle aspiration biopsy of salivary gland lesions. A reappraisal of pitfalls and problems

Acta Cytol

Needle aspiration biopsy in salivary gland lesions

Am J Surg