A Study of Clinicopathological Profile of Salivary Gland Swellings

Comparison Study of FNAC Using the Milan System Cytopathology versus Definitive Histology for the Diagnosis of Salivary Gland Tumors

INTRODUCTION

Salivary gland tumors (SGT) represent 6 to 8 percent of head and neck tumors. The cytologic diagnosis of SGT is performed by fine-needle aspiration cytology (FNAC) with variable sensitivity and specificity. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) categorizes the cytological results and provides the risk of malignancy (ROM). The aim of our study was to evaluate the cytological findings with the definitive pathological findings to assess the sensitivity, specificity, and diagnostic accuracy of FNAC in SGT according to MSRSGC classification.

METHOD

An observational, retrospective, single-center study was carried out at a tertiary referral hospital over a period of 10 years. Patients that underwent FNAC for major SGT and that have undergone surgery to remove the tumor were included. A histopathological follow-up was performed on the surgically excised lesions. Results from the FNAC were categorized into one of the six MSRSGC categories. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of FNAC for determining benign and malignant cases were calculated.

RESULTS

A total of 417 cases were analyzed. The cytological prediction of ROM was 10% in nondiagnostic, 12.12% in non-neoplastic, 3.58% in neoplasm benign group, 60% in AUS and SUMP groups, and 100% in suspicious and malignant group. The statistical analysis of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for determining benign cases was 99%, 55%, 94%, 93%, and 94%, respectively, and for determining malignant neoplasm was 54%, 99%, 93%, 94%, and 94%, respectively.

CONCLUSION

In our hands, MSRSGC is highly sensitive for benign tumors and highly specific for malignant tumors. The low sensitivity to differentiate malignant from benign cases makes it necessary to apply an adequate anamnesis, physical examination, and imaging tests to consider surgical treatment in most cases.

Salivary Gland Diseases: A Retrospective Clinicopathological Study of 159 Cases

Background

Salivary gland diseases include a variety of conditions (inflammatory, immunological, infectious, or neoplastic pathologies). Salivary gland diseases hold the interest of clinicians and pathologists due to their varied clinical presentation and histological diversity. In this study, we aimed to assess the various aspects of clinical and pathological characteristics of salivary gland diseases.

Methodology

We reviewed the records of patients with various salivary gland diseases at Ramadi Teaching Hospital, Rashid Hospital, Razi Hospital, and Zuhur Hospital in Iraq. The study covered the years 2010 to 2021.

Results

Of 159 patients, there were 61.64% female patients. The age group most affected was 51-60 years (26.4%). The most involved salivary gland was the parotid (44.65%). Swelling was seen in 74% of the patients. Obstructive lesions were seen in 52.2% of patients. Obstructive pathologies occurred exclusively in the age group 51-60 years, infective cases involved the age group 71-80 years (64.3%), and tumors affected the age group 41-50 years (77.4%). Women were affected more than men by all pathologies. The parotid gland was mostly affected by tumors (32/71), while other glands were mostly affected by obstructive lesions (17/18). A significant association was found between salivary gland pathologies with age and the affected gland. The most common clinical entity of the obstructive lesions was xerostomia (20.1%). While pleomorphic adenoma was the most common tumor (n = 40/50). The most common cause of xerostomia was smoking (31.2%) and the least cause was antidepressants (9.4%).

Conclusions

Salivary gland diseases were mostly seen in women and in the age group 51-60 years. Parotid was the most involved gland. A three-quarter of the cases presented with swelling and obstructive pathologies comprise above 50% of causes. The age and the involved gland can determine the type of salivary gland diseases. Xerostomia was the common clinical entity of obstructive pathologies. The most common tumor was pleomorphic adenoma and the most common cause for xerostomia was smoking.