Tükürük bezi lezyonlarının tanısında ince iğne aspirasyon biyopsinin yeri: Histopatolojik karşılaştırmalı çalışma

Öz

Amaç: Tükürük bezi non-neoplastik ve neoplastik lezyonlarının tedavileri farklılık gösterdiği için, preoperatif dönemde ayrımlarının yapılması önemlidir. İnce iğne aspirasyon biyopsisi (İİAB) bu amaçla en yaygın kullanılan tanı yöntemlerinden biridir. Burada tükürük bezi lezyonlarının sitolojik-histopatolojik tanılarının karşılaştırılması, İİAB sonuçlarının sensitivite, spesifite, prediktif değer (PV) ve tanısal doğruluğunun değerlendirilmesi amaçlandı. Materyal ve metod: Bölümümüzde incelenen İİAB ve eksizyon materyali olan 156 olgu sitolojik-histopatolojik tanıları ile karşılaştırıldı. Bulgular: Lezyonlar 132 (%84.6) olguda parotis bezinde, 22 (%14.1) olguda submandibuler bezde ve 2 (%1.3) olguda minör tükürük bezinde lokalizeydi. İİAB’lerin sitomorfolojik sonuçlarına göre % 7.05’i (n=11) nondiagnostik, %78.21’i (n=122) benign, % 7.05’i (n=11) kuşkulu ve % 7.69’u (n=12) malign olarak sınıflandırıldı. Olguların sitolojik-histopatolojik tanıları karşılaştırıldığında; malign lezyonlar içinde 12 olgunun (12/12; %100) ve benign lezyonlar içinde 121 olgunun (121/122; %99.2) tanıları uyumluydu. False negatif bir olgu (%0.8) (warthin tümör→mukoepidermoid karsinom) saptandı. False pozitif olgu saptanmadı (%0). Kuşkulu lezyonlar içinde üç olgunun histopatolojik incelemeleri ektopik tiroid dokusu, sialadenit ve pleomorfik adenom tanıları ile sonuçlandı. Sensitivite, spesifite, pozitif PV, negatif PV ve doğruluk analizi değerlendirmesinde sırasıyla % 92.3, % 100.0, % 100.0, % 99.2 ve % 99.3 sonuçları elde edildi. Sonuç: İİAB’lerinde yeterli örnekleme ile birlikte değerlendirmelerindeki deneyim, çalışmamızda olduğu gibi false pozitif/negatif sonuçları en aza indirgeyecek ve preoperatif dönemde doğru tanıya ulaştıracaktır. Bununla birlikte tükürük bezi lezyonlarının geniş yelpazesi ve örtüşebilecek sitomorfolojik bulguların varlığı da akılda tutulmalıdır.

Anahtar Kelimeler

• Tükürük bezi
• ince iğne aspirasyon biyopsisi
• pleomorfik adenom
• mukoepidermoid karsinom

The role of fine-needle aspiration biopsy in the diagnosis of salivary gland lesions: a comparative histopathological study

Abstract

Objective: As the treatment of neoplastic and non-neoplastic lesions of salivary gland differs, their differentiation in preoperative period is crucial. Fine-needle aspiration biopsy (FNAB) is among the common diagnostic methods for this purpose. We intended to compare the cytological-histopathological diagnosis of salivary gland lesions, and evaluate sensitivity, specificity, predictive value (PV) and diagnostic accuracy of the FNAB results. Methods: 156 cases examined in our department, having FNAB and excision material, were compared with their cytological-histopathological diagnosis. Results: Lesions were localized in parotid gland in 132 cases, in submandibular gland in 22 cases, and in minor salivary gland in 2 cases. FNABs were categorized based on their cytomorphological results into nondiagnostic (7.05%), benign (78.21%), suspicious (7.05%) and malignant (7.69%) groups. When the cytological-histopathological diagnosis of cases was compared, the diagnosis of 12 cases among malignant lesions (100%, 12/12) and 121 among benign lesions (99.2%, 121/122) were found to be compatible. One false negative case (0.8%) (warthin tumor→mucoepidermoid carcinoma) was detected, but no false positive (0%) was the case. Histopathological examinations of three cases among suspicious lesions resulted in diagnosis of ectopic thyroid tissue, sialadenitis and pleomorphic adenoma. Results of sensitivity, specificity, positive PV, negative PV and accuracy analysis examinations were respectively 92.3%, 100%, 100%, 99.2% and 99.3%. Conclusion: Evaluating FNABs with sufficient sampling minimizes false positive/negative results, leading to accurate diagnosis in preoperative period. Wide range of salivary gland lesions and overlapping cytomorphological findings should also be minded.

Keywords

• Salivary gland
• fine-needle aspiration biopsy
• pleomorphic adenoma
• mucoepidermoid carcinoma

Kaynakça

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