Fine-needle aspiration cytology of submandibular gland lesions

Submandibular triangle masses

OBJECTIVE

The study aims to analyze the demographic data of a large case series operated on because of submandibular triangle mass for more than 10 years and presents a review of the literature.

MATERIALS AND METHODS

The charts of patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic diagnosis were reviewed.

RESULTS

The study included 66 subjects; 12 patients (18.2%) with submandibular sialolithiasis, 18 patients (27.2%) with sialadenitis, 10 patients with lymphadenitis (15.1%), and 26 patients (39.3%) with tumors. Of the tumors, 23% was malignant and 77% was benign. Benign tumors of submandibular gland comprised 22.7% and malign tumors of submandibular gland comprised 3% of all submandibular mass. The most common benign tumor was pleomorphic adenoma. The most frequent histopathologic diagnoses of submandibular masses originated from the submandibular gland, and these comprised 71.2% of all submandibular mass pathologies. The main symptom was a painless mass. Ultrasonography was the most common preoperative diagnostic procedure. Fine-needle aspiration biopsy was performed in 26 patients. A clear diagnosis could not be provided in 3 (12%) patients.

CONCLUSION

Infectious conditions and benign tumors are more frequent than malign tumors in the submandibular region. The histopathologic diagnoses mainly consisted of submandibular sialadenitis, sialolithiasis, pleomorphic adenoma, and lymphadenitis. Ultrasonography is the first option of radiologic evaluation. Fine-needle aspiration biopsy is a very useful and usually sufficient diagnostic procedure for histopathologic diagnosis. Excisional biopsy can be performed when the fine-needle aspiration biopsy failed.

Cytohistopathological study of salivary gland lesions in bundelkhand region, uttar pradesh, India

Background. FNAC is a useful method for evaluating suspicious salivary glands lesions due to its low cost, minimum morbidity, rapid turnaround time, high specificity, and sensitivity. Aim. To know the frequency of the salivary gland lesions and cytohistological correlation in the Jhansi region, Uttar Pradesh, India. Material and Methods. In present study 124 cases were included and cytohistological correlation was made in 86 cases only. FNA was performed by using a 23/24-gauge needle without local anaesthesia. Air dried and 95% ethyl alcohol fixed wet smears were stained with Giemsa stain and Papanicolaou stain, respectively. Paraffin embedded tissue sections were stained with Haematoxylin and Eosin. Results. Parotid gland was the most commonly involved salivary gland. The commonest age group was 20 to 29 years, 30 to 39 years, and 60 to 69 years for nonneoplastic lesions, benign tumours, and malignant tumours, respectively. The overall male to female ratio was 1.17 : 1. The diagnostic accuracy of FNAC was 100%, 93.3%, and 88.2% for nonneoplastic lesions, benign tumours, and malignant tumours, respectively. Conclusion. The high accuracy, sensitivity, and specificity of FNAC confirm that preoperative cytology is a useful, quick, reliable diagnostic technique for rapid diagnosis and suitable for developing countries.

Verification bias in diagnostic accuracy studies for fine- and core needle biopsy of salivary gland lesions in otolaryngology journals: a systematic review and analysis

BACKGROUND

Diagnostic test accuracy (DTA) studies for needle biopsy are frequently published in otolaryngology journals, but this body of literature has not been assessed for verification bias.

METHODS

We conducted a systematic review of DTA studies on needle biopsy of salivary gland lesions appearing in otolaryngology journals. Studies were assessed by 2 reviewers for verification bias.

RESULTS

We identified 95 DTA studies for needle biopsy of salivary gland lesions. Eighty-one studies (84%) had verification bias. Five of the biased studies provided sufficient data to estimate the extent of bias. Verification bias was associated with an overestimate of sensitivity and an underestimate of specificity. Studies on core needle biopsy (CNB) had a lower rate of verification bias than fine-needle aspiration (FNA) studies.

CONCLUSION

Verification bias is common in DTA studies of needle biopsy for salivary gland lesions published in ear, nose, and throat (ENT) journals. Such studies overestimated sensitivity and underestimated specificity.

Accuracy of fine needle aspiration cytology of salivary gland lesions: routine diagnostic experience in Bangkok, Thailand

Fine needle aspiration (FNA) cytology is well accepted as a safe, reliable, minimal invasive and cost-effective method for diagnosis of salivary gland lesions. This study evaluated the accuracy and diagnostic performance of FNA cytology in Thailand. A consecutive series of 290 samples from 246 patients during January 2001-December 2009 were evaluated from the archive of the Anatomical Pathology Department of our institution and 133 specimens were verified by histopathologic diagnoses, obtained with material from surgical excision or biopsy. Cytologic diagnoses classified as unsatisfactory, benign, suspicious for malignancy and malignant were compared with the histopathological findings. Among the 133 satisfactory specimens, the anatomic sites were 70 (52.6%) parotid glands and 63 (47.4 %) submandibular glands. FNA cytological diagnoses showed benign lesions in 119 cases (89.5 %), suspicious for malignancy in 3 cases (2.2 %) and malignant in 11 cases (8.3%). From the subsequent histopathologic diagnoses, 3/133 cases of benign cytology turned out to be malignant lesions, the false negative rate being 2.2 % and 1/133 case of malignant cytology turned out to be a benign lesion, giving a false positive rate was 0.8%. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 97.0% (95% CI, 70.6%-99.4%), 81.3% (95% CI, 54.4%-96.0%), 99.1% (95% CI, 95.4%-100%), 92.9% (95% CI, 66.1%-99.8), 97.5% (95% CI, 92.8%-99.5%), respectively. This study indicated that FNA cytology of salivary gland is a reliable and highly accurate diagnostic method for diagnosis of salivary gland lesions. It not only provides preoperative diagnosis for therapeutic management but also can prevent unnecessary surgery.

Diagnostic value of ultrasound-guided core needle biopsy in patients with salivary gland masses

The salivary glands are unique in the diversity and complexity of their pathologies. Because fine needle aspiration cytology and frozen section are associated with major diagnostic difficulties, the authors analyzed the use of core needle biopsy (CNB) for the histologic assessment of salivary gland lesions. A systematic observational clinicopathologic quality assessment study was performed over 81 months including 161 CNB procedures in 76 patients with salivary gland pathologies. Adequate samples containing the target tissue were obtained in 73 patients. These samples revealed malignant disease in 45 (62%) patients, benign disease in 26 (36%) patients, and were inconclusive in 2 (3%) patients. Follow-up uncovered no false-positive or false-negative results. On the basis of secondary histologic and clinical follow-up, the statistical parameters were calculated as follows: sensitivity 94%; specificity 100%; accuracy 96%; positive predictive value 100%; negative predictive value 90%. The advantages and potential limitations of CNB in patients with salivary gland masses are discussed. CNB is a reliable biopsy technique for the assessment of salivary gland pathologies, although limitations remain for the subclassification of some neoplastic lesions. The authors recommend CNB as the biopsy technique of choice for a selection of indications.

Submandibular Mass Excision in an Asian Population: A 10-year Review

Objectives: The objectives of this study were to compare the prevalence of submandibular gland neoplasia in an Asian population with a Western population and to evaluate the accuracy of fi ne needle aspiration cytology (FNAC) and computed tomography (CT) scan in the study of submandibular gland pathologies. Materials and Methods: We conducted a 10-year retrospective review of 101 submandibular mass excisions. Data on the demographic profile of patients, clinical features, correlation of fi ne needle aspiration cytology, CT scans and histology and morbidities related to surgery were collected. Results: The prevalence of submandibular gland neoplasia was 27.1%. Most (78.9%) of these were benign. FNAC and CT scans were accurate for benign neoplasia. However, the accuracy of FNAC and CT scans for sialadenitis without sialolithiasis was low. Conclusion: The prevalence of submandibular gland malignancy was lower in the Asian population. FNAC and CT scans were accurate for benign neoplasia of the submandibular gland. Key words: CT scan, Fine needle aspiration cytology, Submandibular gland diseases, Surgery

Primary epithelial submandibular salivary gland tumours--review of management in a district general hospital setting

Primary epithelial submandibular gland (SMG) tumours are uncommon, accounting for 8-12% of all salivary gland neoplasms, and most studies come from large specialised centres. There is little published about the relative frequency and outcome of SMG tumours treated in general hospitals. A retrospective study from two district general hospitals over a 10 year period (1996-2005). Seventeen benign (68%) and eight malignant (32%) tumours were included. A painless mass was the most common presentation. Pain and paraesthesia were not pathognomonic of malignancy. Pleomorphic adenoma accounted for all 17 benign tumours and adenoid cystic carcinoma was the commonest malignant tumour. Fine needle aspiration cytology (FNAC) accurately identified 78% of the benign tumours but none of the malignant tumours. Pre-operative imaging was also unable to distinguish malignant from benign tumours. Incomplete excision was reported in 20% of cases and was more common for malignant tumours. It may be difficult to distinguish benign from malignant SMG tumours on clinical examination and pre-operative investigations. Any suspected submandibular tumour should be considered for early treatment even when FNAC is suggestive of a benign tumour.

Pleomorphic adenoma of the submandibular gland: an evolving change in practice following review of a personal case series

We reviewed patients with submandibular gland pleomorphic adenoma treated at a tertiary referral centre in the United Kingdom (1988-2004). Thirty-seven patients were identified, 32 newly diagnosed cases and 5 cases of recurrent disease previously treated elsewhere. The exact pre-operative diagnosis was "unknown" in 76% of the new cases. All cases were surgically excised (41% with extracapsular gland excision and 59% by selective level Ib, IIa and III neck dissection). Temporary marginal mandibular nerve neuropraxia was documented in 25% of cases. All 32 new cases remain clinically tumour free at the time of writing. In patients with recurrent disease, complete microscopic tumour clearance was achieved in three of the five cases, however all remain clinically tumour free. Pleomorphic adenomas of the submandibular gland are uncommon, with good prognosis following complete tumour excision. Recurrent tumours, however, are frequently multi-focal and difficult to excise completely. The adequacy of primary surgery is crucial and supports an approach for a more radical excision primarily by a selective level lb, IIa and III neck dissection; ensuring complete disease clearance for pleomorphic adenoma, avoiding the risks of tumour spillage associated with a limited excision and tumour handling; and removing the primary echelon of lymph nodes at risk of metastasis if the pathology turns out to be malignant.

Salivary gland cancer in Finland 1991--96: an evaluation of 237 cases

CONCLUSION

In this material consisting of various salivary gland carcinomas, stage I, male gender and age were the most powerful predictors of patient outcome.

OBJECTIVES

To retrieve the records of all salivary gland cancer (SGC) patients diagnosed in Finland between 1991 and 1996 and to evaluate the incidence, histological type and location of SGC, the treatment given and the outcome.

MATERIAL AND METHODS

The records for all SGCs (n =286) diagnosed in Finland between 1991 and 1996 and reported to the Finnish Cancer Registry were retrieved. The histological re-evaluation and retrospective study involved 237 SGC patients.

RESULTS

The study population consisted of 125 males and 112 females. The mean age was 59 years (males 61 years, females 58 years). Follow-up was at least 5 years. The commonest tumor location was the parotid gland (n = 152; 64%), followed by the minor salivary glands (n =46; 19%), the submandibular gland (n =38; 16%) and the sublingual gland (n = 1; 0.4%). The most frequent histological types of SGC were adenoid cystic carcinoma (n =65; 27%), mucoepidermoid carcinoma (n =45; 19%) and acinic cell carcinoma (n =41; 17%). Surgery, either alone or in combination with other treatment modalities, was used in 209 cases (88%). Radiotherapy was given to 136 patients (57%), 13 of whom (5%) did not undergo surgery. The 5-year overall survival rate was 56.5%, and for stages I-IV it was 78%, 25%, 21% and 23%, respectively (p <0.001; log-rank test). Of the commonest tumor types, the best 5-year relative survival rate was for patients with acinic cell carcinoma (96%), followed by those with mucoepidermoid (79%) and adenoid cystic carcinoma (74%).

Palpation, ultrasound, and ultrasound-guided fine-needle aspiration cytology in the assessment of cervical lymph node status in head and neck cancer patients

BACKGROUND

Lymph node status of the neck is the most important prognostic factor in head and neck cancer patients. Assessment of the lymph nodes status is still often based on palpation only, although the low accuracy of palpation is known.

METHODS

Altogether 105 consecutive head and neck cancer patients were examined using ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (FNAC) to evaluate the additional information obtained by these methods.

RESULTS

Of the 86 patients with palpable normal necks, FNAC taken under US-guidance showed malignancy in 13. The US size criteria for malignancy were fulfilled in 7 of these patients, whereas the lymph nodes were of normal size in 6 of them. In the whole patient material, US-guided FNAC showed bilateral metastasis in 3 patients although only unilateral or no metastasis was found by palpation.

CONCLUSION

US combined with US-guided FNAC can be recommended as a method for evaluating for regional metastases in head and neck cancer patients, both for those with and those without palpable metastasis.

Surgical management of nonneoplastic diseases of the submandibular gland. A follow-up study

A total of 233 patients with nonneoplastic diseases of the submandibular gland were treated between 1966 and 1992 at the otorhinolaryngology department of the University of Göttingen. Of them, 212 patients (91%) suffered from sialadenitis with or without sialolithiasis, and 21 (9%) suffered from other diseases. The first part of the present study analyzes the clinical data with regard to history, symptoms, and therapy. It was found that in most cases (77%) extirpation of the affected gland had been the standard operation. In the second part, the surgical procedures applied are critically assessed. Extirpation of the submandibular gland proved to be an effective therapy in all patients. Side-effects were rare. The management of chronic sialadenitis caused by calculi should include extirpation of the submandibular gland. In case of calculi not causing inflammatory disease, lithotripsy should be considered.