Metastasis to parotid gland from non Head and Neck tumors

Most primary tumors spreading metastasis to the parotid gland are usually located in the head and neck region, nonetheless, rarely, parotid gland can also be the target of metastatic localization site of distant primary tumors. The purpose of this study was to describe a clinical series of metastasis to the parotid gland from distant primary tumors (non Head & Neck)

Concordance of fine needle aspiration cytology and final histology of salivary gland tumours

BACKGROUND : Fine needle aspiration cytology (FNAC) is a widely used diagnostic tool to evaluate salivary gland tumours. The Milan system for reporting salivary gland cytopathology allows for standardisation and facilitates cytological-histological correlation. However, FNAC findings can still pose a diagnostic challenge. The accuracy of FNAC should be assessed at each centre. The aim of this study was to assess the concordance of FNAC and final histology of salivary gland tumours in three academic hospitals affiliated with the University of Pretoria, South Africa. METHODS : The study was a cross-sectional retrospective analytical study of 214 patients who underwent an operation for salivary gland tumours. All patients with FNAC and histology results between 2007-2017 were included. Patients were recruited from three University of Pretoria, South Africa, affiliated hospitals: Steve Biko Academic, Kalafong Provincial Tertiary and Tembisa Provincial Tertiary Hospital. RESULTS : Of the 214 patients with salivary gland tumours, the majority were located in the parotid gland (56.1%). Pleomorphic adenoma was the most common tumour (62.6%). The FNAC sensitivity, specificity and diagnostic accuracy (receiver operating characteristic) were 92.7%, 98.1% and 0.95 respectively. The concordance between salivary gland tumour FNAC and final histology was 96.95% with a Cohen's kappa coefficient of 0.91 (p = 0.0001. CONCLUSION : There is strong concordance between FNAC and histology of salivary gland tumours. FNAC is an accurate, minimally invasive diagnostic tool with high sensitivity and specificity. It provides the clinician with a reliable preoperative diagnosis determining whether the salivary gland tumour is benign or malignant.https://journals.co.za/journal/m.sajsam2024SurgerySDG-03:Good heatlh and well-bein

Fine needle aspiration cytology of salivary gland lesions: study in a tertiary care hospital of North Bihar

Background: Fine needle aspiration cytology (FNAC) of suspected salivary gland lesions has an established role in preoperative diagnosis and management of patients. The aim of the present study was to evaluate the spectrum of salivary gland lesions in our setting and to assess the diagnostic accuracy of FNAC for salivary gland lesions.Methods: In the present study, 189 cases were included in this study and cytohistological correlation was made in 84 cases only. FNA was performed from different sites of the salivary gland swelling using a 10 mL disposable syringe and 23/24-gauge needle without local anaesthesia. FNA air-dried smears were stained with Giemsa stain and wet smears fixed in 95% ethyl alcohol were stained with haematoxylin and eosin stain. Paraffin embedded tissue sections were stained with haematoxylin and eosin (H & E).Results: Overall diagnostic accuracy of FNAC in our study was found to be 94.05% with 88% sensitivity and 96.6% specificity.Conclusions: The high accuracy, sensitivity, and specificity of FNAC confirm that preoperative cytology is a useful, quick and reliable diagnostic technique indispensable for developing countries

Intraoperative frozen section as a reliable ancillary technique in salivary gland surgery: A cross sectional study

Background. Salivary glands tumours are uncommon, frequently benign lesions, prevalently located in the parotid gland (80%). Surgical decision making is based on the patient's history, examination findings, imaging and fine needle aspiration (FNA). FNA is a pre-operative method with good ability in detecting malignancy. During surgery, therefore, Frozen section (FS) can differentiate benign lesions from malignant tumours, to reduce incorrect treatments, to increase the chances of conservative surgery and to better evaluate surgical margins. The aim of our study is to demonstrate the accuracy of the FS procedure in surgery of the salivary glands and to stress the need for dedicated pathology units specialized in lesions of the oral cavity. Methods. The study included 499 patients who underwent surgery from May 2005 and October 2014. An intra-operative frozen section procedure was done for 288 of them. All frozen sections were compared with the final results. The cases were classified by site, nature of the lesion and histotype, according to the WHO classification. Comparison was made between the intra-operative and the definitive diagnosis. Results. Of the 288 FS procedures, 259 were for neoplastic lesions, 199 of which benign and 60 malignant, and 29 for non-neoplastic lesions. Of the 259 neoplastic FS results, 2 were shown to be false positives and 2 were diagnosed as different malignant types. Of the 29 non-neoplastic FS results, 4 were false negatives. Conclusions. Our results showed that the accuracy of frozen section procedure is 98% for salivary glands tumors. The highest concordance between frozen section and the definitive diagnosis was for inflammatory processes (99%), pleomorphic adenoma (98%), Warthin's tumor (97%) and malignant neoplasms (96%). In conclusion, based on these findings, frozen section of the salivary glands may be proposed as a routine procedure and should be used in decision-making

Role of fine needle aspiration cytology in the diagnosis of parotid gland tumors: Analysis of 193 cases

Introduction: Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective: To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods: A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results: Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion: Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis

Utility of clinical features with fine needle aspiration biopsy for diagnosis of Warthin tumor.

BACKGROUND:Conservative management of Warthin tumor (WT) may be a viable alternative to surgery, but there are concerns of missed malignancies on fine needle aspiration biopsy (FNAB). The purpose of this study is to measure the sensitivity and positive predictive value of FNAB for WT, and to identify clinical features associated with WT that can aid in this diagnosis. METHODS: Retrospective analysis of patients from January 1, 2006 to April 30, 2017 at a tertiary care center in London, Ontario, Canada. All patients with a diagnosis of WT on FNAB or resection were included. Electronic medical records were identified for 177 patients that fit the criteria. Study outcomes included the sensitivity and positive predictive value of FNAB alone for WT, and, when including clinical features associated with WT. RESULTS: The mean age of patients in this study was 63.2 years (SD 10.4); 115 (65%) were male, and 157 (89%) were past or present smokers. The measured sensitivity and positive predictive value of FNAB for WT were 95.8 and 97.2% respectively. Two cases were classified as WT on FNAB but confirmed at resection as mucoepidermoid carcinoma and acinic cell carcinoma. When only patients with multifocal, bilateral or incidental tumors were assessed, sensitivities and positive predictive values for each were 100%. Isolating for inferior pole location also resulted in a positive predictive value of 100%. CONCLUSIONS: The sensitivity and positive predictive value of FNAB for WT in this study are high, with two false negatives on FNAB. Multifocal, bilateral, incidentaloma and inferior pole location were identified as potential clinical features that may increase the diagnostic confidence for WT, strengthening the argument for conservative management in these patients. Overall, this study serves as an initial exploration into whether clinical features may be included with FNAB results to improve the sensitivity and positive predictive value of diagnosing WT. Further research is necessary before these findings can be translated into clinical practice

Overview of cytopathology in the oral and maxillofacial region : 18-year experience

Orientador: Pablo Agustin VargasDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo desse estudo foi realizar um levantamento dos casos submetidos para o diagnóstico citopatológico para demonstrar as diversas aplicações desse exame complementar na região oral e maxilofacial. Uma análise retrospectiva foi realizada no Laboratório de Patologia Oral da Faculdade de Odontologia de Piracicaba num período de 18 anos. Informações clínicas e citológicas foram coletadas. Associações entre as variáveis clínicas e citológicas foram realizadas através do teste do qui-quadrado de Pearson ou teste de Fisher, com um nível de significância de 5%. Quando disponível, o diagnóstico histopatológico foi comparado com o diagnóstico citológico para identificar a porcentagem de concordância entre esses exames e foram calculadas a especificidade, sensibilidade e acurácia da citopatologia em identificar neoplasias malignas. 1.082 casos foram identificados compreendendo 65 diferentes diagnósticos. A citologia esfoliativa (CE) foi realizada em 312 casos (29,1%) e a punção aspirativa por agulha fina (PAAF) em 770 casos (70.9%). CE foi empregada principalmente para diagnóstico de lesões infecciosas e PAAF para diagnósticos do grupo de neoplasias, lesões císticas, reacionais e de patologia variada. Cell Block (CB) foi realizado em 555 casos (51.3%) derivados da PAAF. Colorações de Panótico, Papanicolaou e hematoxilina-eosina foram realizadas na PAAF e Ácido periódico de Schiff na EC. Em 211 casos (19.5%) o diagnóstico histopatológico estava disponível e a porcentagem de concordância com o diagnóstico citopatológico foi de 40.3%. Sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia da citologia em identificar neoplasias malignas foi 84.6%, 100%, 77.8% e 90.0%, respectivamente. Em conclusão, a Citopatologia forneceu diferentes diagnósticos de lesões da região de cabeça e pescoço. A CE foi realizada principalmente para o diagnóstico de lesões infecciosas e a PAAF para o diagnóstico de tumores de glândula salivar, lesões odontogênicas, lesões reacionais e rastreamento de metástases cervicaisAbstract: The aim of this study was to perform a survey of oral and maxillofacial specimens submitted for cytologic diagnosis to verify the importance of this complementary exam. A retrospective analysis of our institutional cytopathology database was performed over an 18-year period. Clinical information and cytological data were collected. Associations between independent variables and outcomes were assessed using the Pearson chi-square test or Fisher's test, with a 5% significance level. When available, the histologic diagnosis was compared with cytologic diagnosis to identify the percentage of agreement and the specificity, sensitivity and accuracy of cytology in identifying malignant neoplasms. A total of 1,082 cases were identified that comprised 65 different cytological diagnoses. Exfoliative cytology (EC) was performed in 312 cases (29.1%) and fine-needle aspiration cytology (FNAC) in 770 cases (70.9%). EC was mainly employed to diagnose oral infectious diseases and FNAC to diagnose neoplasms, cystic, reactive and miscellaneous lesions. Cell block was performed in 555 FNAC cases (51.3%). Panoptic, Papanicolaou and hematoxylin-eosin staining was performed in FNAC and periodic acid-Schiff in EC. In 211 cases (19.5%), the histologic diagnosis was available and the percentage agreement with the cytologic diagnosis was 40.3%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy to identify malignant neoplasms were 84.6%, 100%, 100%, 77.8% and 90.0%, respectively. In summary, the cytology provided several different diagnoses of lesions of the oral and maxillofacial region. EC was mainly performed for diagnosis of infectious diseases and FNAC for diagnosis of salivary gland tumours, odontogenic lesions, reactional lesions and cervical metastasisMestradoPatologiaMestra em EstomatopatologiaCAPE

Retrospective study and cito-histopathological correlation of 176 cases of salivary gland neoplasms diagnosed by fine needle aspiration (FNA)

Orientador: Pablo Agustin VargasDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo:A punção aspirativa por agulha fina (PAAF) é um método simples, seguro, rápido e eficaz, amplamente utilizado no diagnóstico citológico de lesões de glândulas salivares. O objetivo deste estudo foi analisar a eficácia e a reprodutibilidade do diagnóstico citológico das neoplasias de glândulas salivares obtidos com a PAAF, realizado através da correlação dos diagnósticos citológicos e histológicos dos espécimes cirúrgicos correspondentes, além de avaliar a concordância e a reprodutibilidade inter-observador dos diagnósticos citológicos. Foram analisados retrospectivamente 236 casos de neoplasias benignas e malignas oriundos do Departamento de Anatomia Patológica do Hospital das Clínicas de São Paulo-FMUSP entre 2000 e 2006. Os resultados encontrados foram submetidos à análise estatística pelo teste do Qui-quadrado de Pearson e a concordância inter-examinadores pelo teste de Kappa. Os valores foram considerados estatisticamente significantes quando o valor de p<0,05. A média de idade dos pacientes foi de 48,8±17,0 anos, com idade mínima e máxima de 13 e 94 anos, respectivamente. A quinta década de vida foi a mais acometida (23,73%) e o gênero feminino foi o mais acometido (60,59%). A glândula parótida foi a localização mais comum (77,54%) (p<0,05), e a neoplasia de glândula salivar mais frequente foi o adenoma pleomorfo (73,86%) (p<0,05). Dos 236 casos, 176 (74,58%) foram avaliados quanto aos aspectos citológicos e histopatológicos e 60 (25,42%) casos foram avaliados apenas quanto aos aspectos citológicos. Dos 176 casos, 9 (5.11%) foram excluídos da análise para a correlação cito-histopatológica, visto que não representaram benignidade ou malignidade no diagnóstico citológico final. Dos 167 casos restantes, detectamos 94,1% de sensibilidade, 100% de especificidade e uma acurácia diagnóstica de 99,4%. A análise da reprodutibilidade dos diagnósticos citológicos inter-observadores apresentou uma concordância estatisticamente significante (p<0,05). A partir dos resultados obtidos pôde-se concluir que a PAAF de neoplasias de glândulas salivares é uma ferramenta eficaz, de alta sensibilidade, especificidade e acurácia diagnóstica quando realizada por patologistas com experiência em citopatologia. O diagnóstico citológico prévio realizado por meio da PAAF possibilitou aos pacientes um melhor planejamento pré-cirúrgico e tratamento.Abstract: The fine needle aspiration cytology (FNAC) is a simple, safe, fast and effective method widely used on cytologic diagnosis of salivary glands lesions. The objectives of this study were to assess the efficacy and reproducibility of the cytological diagnosis of the salivary glands tumors obtained using FNAC, to correlate the cytological and histological diagnosis of surgical specimens that correspond to each other, also to evaluate the concordance and reproducibility inter-observer of the cytological diagnosis. Two hundred and thirty six cases of benign and malignant salivary tumors were retrospectively analyzed from the files of the Division of Pathology of the Clinics Hospital of Sao Paulo between 2000 and 2006. The results obtained were submitted to statistical analysis by the "Qui-square" test of Pearson and the concordance inter-examining for Kappa. There were 93 male (39.4 %) and 143 female (60.6 %) patients (male to female ratio 1:1.5). Our 236 cases of salivary gland tumors showed a wide age range (13 to 94 years), with a mean of 48.9±17.0 years, and mainly affected the fifth decade of life (23.73%). The female gender was the most affected (60.59%) (p<0.05) and the parotid gland was the main location (77.54%) (p<0.05). Pleomorphic adenoma was the most frequent salivary gland neoplasm (73.86%) (p<0.05). Among the 236 cases analyzed, 176 (74.58%) where evaluated within the cytologic and histopathological aspects and 60 (25.42%) cases where only evaluated within the cytological aspects. Of the 176 cases, 9 (5.11%) counted with an inconclusive cytologic diagnosis and where excluded from the statistical analysis. The diagnostic correlation of 167 (70.76%) cases was carried out and found 94.1% of sensibility, 100% of specificity and 99.4% of diagnostic accuracy. The reproducibility analysis of the inter-observer cytological analysis presented a significant statistical concordance (p<0.05). From the obtained results it can be proved that the FNAC in salivary tumors is an effective tool, of high sensibility, specificity and diagnostic accuracy when applied by experienced pathologists. In the current study, the previous cytological diagnosis performed by the FNAC allowed a better pre-surgical planning and treatment.MestradoPatologiaMestre em Estomatopatologi

Likelihood of Neoplasia for Diagnoses Modified by Probability Terms in Canine and Feline Lymph Node Cytology: How Probable Is Probable?

Background: Descriptive probability modifiers are used often to convey the uncertainty of a pathology diagnosis, but they also contribute to ambiguity in communication between pathologists and clinicians.Objectives: Our goal was to determine the frequency and use of probability modifiers in canine and feline lymph node cytology diagnoses, and to determine the actual likelihood of neoplasia for diagnoses with and without modifiers, based on the histologic outcome.Methods: Canine and feline lymph node cytology and histology reports over an 11-year period (2001–2011; n = 367) were evaluated retrospectively. Diagnoses were categorized as neoplastic/malignant (lymphoma, metastatic) or non-neoplastic/benign. The frequency and type of modifier, and the sensitivity, specificity, and predictive values for neoplasia were determined for modified and unmodified diagnoses using histology as the gold standard.Results: Ninety-one of 367 (24.8%) cytology diagnoses were modified by probability terms, including 25/204 (12.2%) diagnoses of non-neoplastic lesions and 66/163 (40.5%) diagnoses of neoplasia. In addition, 26 unmodified diagnoses of neoplasia were followed by a probability phrase indicating specific tumor type. Based on the histologic outcome, modified diagnoses had higher sensitivity (87.3%, confidence interval [CI] 75.5, 94.7%) but lower specificity (50.0%, CI 32.9, 67.1%) for neoplasia than did unmodified diagnoses (60.6 and 100%, respectively; P &lt; 0.0001, Chi square). Modified phrases indicating the probability of a specific tumor type were accurate in 22/26 (84.6%) cases. Positive predictive values for neoplasia were 100% (CI 96.2, 100%) for unmodified and 72.7% (CI 60.4, 83.0%) for modified diagnoses. Negative predictive values were 65.9% (CI 58.5, 72.8%) for unmodified and 72.0% (CI 60.4, 83.0%) for modified diagnoses. No significant difference was found in the likelihood of neoplasia for individual terms used to modify a cytologic diagnosis except for “cannot rule out” (P = 0.0368).Conclusions: Most modified diagnoses of cancer in canine and feline lymph node cytology have a 60–83% likelihood of neoplasia based on histologic outcome, compared with 96–100% for unmodified diagnoses. Non-neoplastic lesions, regardless of modifiers, have a 12–49% likelihood of neoplasia. A limited number of risk categories based on these likelihoods may be a more effective and accurate way to communicate the risk of malignancy in lymph node cytology