Correlation of Fine Needle Aspiration Cytology and Histopathological Evaluation in Salivary Gland Masses: A Single Center Retrospective Study

Year 2023, Volume: 5 Issue: 2, 361 - 6, 15.05.2023

Seda Gün Bilge  Can

https://doi.org/10.37990/medr.1230522

Abstract

Aim: Fine-needle aspiration cytology (FNAC) in the preoperative diagnosis of salivary gland (SG) masses is a very fast, inexpensive, and reliable diagnostic method. In our study, the correlation of cytological-histopathological diagnosis in cases diagnosed with fine needle aspiration cytology in our clinic was investigated, and possible causes of diagnostic entrapment in discordant cases were discussed.
Material and Methods: Salivary gland FNAC cases with histopathological diagnosis between 2008 and 2019 were retrospectively analyzed.The age, gender, localization of the lesion, preoperative cytology, and postoperative histopathological diagnosis of the patients were recorded. Cytology results were analyzed in 5 categories: unsatisfactory, uncategorized, benign, suspected malignancy, and malignant. Histopathology results were recorded in 2 groups benign-nonneoplastic and malignant. Statistically significant difference level was accepted as p<0.05. The validity of the cytology result according to the biopsy result was evaluated by sensitivity, specificity, positive predictive value, and negative predictive value.
Results: 316 cases of salivary gland fine needle aspiration were detected. 156 (49.4%) of 316 cases had histopathological diagnosis. When calculating the cytological-histopathological diagnosis, the cases that were found to be inadequate and uncategorized by cytology were not taken into consideration. The suspected malignancy group was evaluated within the malignant category. Therefore, diagnostic agreement was calculated in 124 cases. Of these 124 cases, 116 (93.6%) cytology-histopathology diagnosis were compatible, and 8 (6.4%) were not.
In our series, the overall sensitivity and specificity were 83.3% and 97.7%, respectively. The positive predictive value was 93.7% and the negative predictive value was 93.4%. The accuracy rate was calculated as 93.5%.
Conclusion: In our study, high sensitivity and specificity values were determined by FNAC in accordance with the literature. It should be kept in mind that there may rarely be differences between preoperative cytological and histopathological diagnoses, possibly due to experience, method, and lesion-related limitations and pitfalls.

Keywords

Salivary gland, fine needle aspiration cytology, histopathology, sensitivity, specificity

References

• El-Naggar AK, Chan JKC, Grandis JR, et al. World Health Organization WHO Classification of Head and Neck Tumours. 4th ed. Lyon; IACR Press. 2017:159-202.
• Sikdar N, Sriram V, Ivan EA. Cytological and Histopathological Correlation of Salivary Gland Lesions. JMSCR. 2018;6:127-39 .
• Mairembam P, Jay A , Beale T, et al. Salivary gland FNA cytology: role as a triage tool and an approach to pitfalls in cytomorphology Cytopathol. 2016;27:91-6.
• Singh A, Haritwal A, Murali BM. Correlation between cytology and histopathology of the salivary gland. Australas Med J. 2011;4:66-71.
• Stewart CJ, MacKenzie K, McGarry GW, et al. Fine-needle aspiration cytology of salivary gland: a review of 341 cases. Diagn Cytopathol. 2000;22:139–46.
• Wei S, Layfield LJ, LiVolsi VA, et al. Reporting of fine needle aspiration (FNA) specimens of salivary gland lesions: A comprehensive review. Diagn cytol. 2017;45:820-827.
• Farahani SJ, Baloch Z. Retrospective assessment of the effectiveness of the Milan system for reporting salivary gland cytology: A systematic review and meta-analysis of published literatüre. Diagn Cytopathol. 2019;47:67-87.
• Rossi ED, Faquin WC, Baloch Z, et al. The Milan System for Reporting Salivary Gland Cytopathology: Analysis and suggestions of initial survey. Cancer Cytopathol. 2017;125:757-66.
• Wu HH, Alruwaii F, Zeng BR, et al. Application of the Milan System for Reporting Salivary Gland Cytopathology: A Retrospective 12-Year Bi-institutional Study. Am J Clin Pathol. 2019;3;151:613-21.
• Kaushik R, Bhatia K, Sarin H, et al. Incorporation of the Milan system in reporting salivary gland fine needle aspiration cytology—An insight into its value addition to the conventional system. Diagn cyto. 2020;48:17-29.
• DF Eytan, LX Yin, Z Maleki, et al.Utility of preoperative fine needle aspiration in parotid lesion. Laryngoscope. 2018;128:398-402.
• Vaidya S, Sinha A, Narayan S, et al. A comparative study of ne-needle aspiration cytology and histopathology in salivary gland lesions.
Nepal J Pathol. 2011;1:108–13.
• Ersöz C, Uguz AH, Tuncer Ü, et al. Fine needle aspiration cytology of the salivary glands: a twelve years’ experience . Aegean Pathol Soc. 2004;1:51-6.
• Das DK, Petkar MA, Al-Mane NM, et al. Role of fine needle aspiration cytology in the diagnosis of swellings in the salivary gland regions: A study of 712 cases. Med Princ Pract. 2004;13:95-106.
• Daneshbod Y, Daneshbod K, Khademi B. Diagnostic difficulties in the interpretation of fine needle aspirate samples in salivary lesions: Diagnostic pitfalls revisited. Acta Cytol. 2009;53:53-70.
• Ashraf A, Shaikh AS, Kamal F, et al. Diagnostic reliability of FNAC for salivary gland swellings: A comparative study. Diagn Cytopathol. 2010;38:499-504.
• David O, Blaney S, Hearp M. Parotid gland fine needle aspiration cytology: An approach to differential diagnosis. Diagn Cytopathol. 2007;35:47-56.
• Das DK, Anim JT. Pleomorphic adenoma of salivary gland: To what extent does fine needle aspiration cytology reflect histopathological features? Cytopathol. 2005;16:65-70
• Aydoğdu I,Salturk Z,Uyar Y et al. The Role of Fine Needle Aspiration Biopsy in the Diagnosis of Parotis Masses.Eur Arch Med Res. 2015;31:175-8.
• Özdamar K, Aydın S, Altaş, B, et al. The importance of fine-needle aspiration biopsy in parotid gland masses. Praxis of ORL. 2015;3:20-4.
• Grasl S, Kadletz L, Janik S, et al. Fine-needle aspiration cytology and intraoperative frozen section in parotid gland tumour surgery: a retrospective multicenter analysis of 417 cases. Clin Oto-laryngol. 2019;44:461-5.
• Que Hee CG, Perry CF. Fine-needle aspiration cytology of parotid tumours: is it useful? NZ J Surg. 2001;71:345–8.
• Postema RJ, van Velthuysen MLF, van den Brekel MWM, et al. Accuracy of ne needle aspiration cytology of salivary gland lesions in the Netherlands Cancer Institute. Head Neck. 2004;26:418-24.
• Akhter J, Hirachand S, Lakhey M. Role of FNAC in the diagnosis of salivary gland swellings. KUMJ. 2008;6:204-8. 
 Bandyopadhyay A, Das TK, Raha K, et al. A study of fine needle aspiration cytology of salivary gland lesions with histopathological corroboration. J. Indian Med Assoc. 2005;103:312–6.
• Jan IS, Chung PF, Weng MH, et al. Analysis of fine-needle aspiration cytology of the salivary gland. J Formos Med Assoc. 2008;107:364-70.
• Tan LG, Khoo ML. Accuracy of fine needle aspiration cytology and frozen section histopathology for lesions of the major salivary glands. Ann Acad Med Singapore. 2006;35:242–8.
• Alphs HH, Eisele DW, Westra WH. The role of ne needle aspiration in the evaluation of parotid masses. Curr Opin Otolaryngol Head Neck Surg. 2006;14:62-6.
• Al Salamah SM, Khalid K, Khan IAR, et al. Outcome of surgery for parotid tumours: 5-Year Experience of a General Surgical Unit in a Teaching Hospital. ANZ J Surg. 2005;75:948-52.
• Yıldız S, Seneldir L, Tepe Karaca C, Zor Toros S. Fine-Needle Aspiration Cytology of Salivary Gland Tumors Before the Milan System: Ten Years of Experience at a Tertiary Care Center in Turkey. Medeni Med J. 2021;36:233-40.
• Cohen EG, Patel SG, Lin O, et al. Fine-Needle Aspiration Biopsy of Salivary Gland Lesions in a Selected Patient Population. Arch Otolaryngol Head Neck Surg. 2004;130:773–8.
• Zurrida S, Alasio L, Tradati N, et al. Fine-needle aspiration of parotid masses. Cancer. 1993;72:2306–11. Chhieng DC, Cangiarella JF, Cohen JM. Fine-needle aspiration cytology of lymphoproliferative lesions involving the major salivary glands. Am J Clin Pathol 2000;113:563–71.
• Balakrishnan K, Castling B, McMahon J, et al. Fine needle aspiration in the management of a parotid mass: a two centre retrospective study. Surgeon 2005;3:67-72.
• Rivera Rolon M, Schnadig VJ, Faiz S, et al. Salivary gland fine-needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6-year study. Diagn Cytopathol. 2020;48:1067-74.
• Hughes JH, Volk EE, Wilbur DC et al. Pitfalls in salivary gland fine-needle aspiration cytology: lessons from the College of American Pathologists Interlaboratory Comparison Program in Nongynaecologic Cytology. Arch Pathol Lab Med. 2005;129:26–31.
• Darvishian F, Lin O. Myoepithelial rich cell neoplasms: Cytologic features of benign and malignant lesions. Cancer. 2004;102:355-61.
• Viswanathan K, Maleki Z, Pantanowitz L, et al. Cytomorphology and diagnostic pitfalls of sebaceous and nonsebaceous salivary gland lymphadenoma: A multi-institutional study. Diagn Cytopathol. 2021;49:83-95.
• Pastore A, Ciorba A, Soliani M, et al. Secondary malignant tumors of the parotid gland: not a secondary problem! BUON. 2017;22:513-8.
• Mezi S, Pomati G, Botticelli
A, et al. Primary squamous cell carcinoma of major salivary gland: “Sapienza Head and Neck Unit” clinical recommendations. Rare Tumors.
2020;12:1–10.