JOURNAL CLUB

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JOURNAL CLUB

• 11/03/02
• Raffi Qasabian

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Journal Club

• CLINICAL QUESTION
• "Could FNAC safely be used to prevent patients
  undergoing surgery for non-neoplastic
  conditions?"

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Journal Club

• RATIONALE
• Complications of Parotid Surgery
• Damage VII
• Frey's Syndrome
• Numbness of ear
• Salivary Fistula
• Xerostomia

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• RATIONALE
• Influence decision to operate
• Planning of most appropriate operative procedure
• Better-informed pre-operative counselling

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• SEARCH STRATEGY
• Ovid Medline search 1966-2001
• exp. PAROTID NEOPLASMS/pa,su Pathology,
  Surgery 3137
• Biopsy, Needle/ 25483
• 1 and 2 233
• Limit 3 to (human english language) 197

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• STUDY
• Que Hee CG, Perry CF. Fine-needle aspiration
  cytology of parotid tumours is it useful? ANZ
  J. Surg. 2001 71, 345-348

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• INCLUSIONS
• 169 patients
• 1995-1999
• FNAC then surgery for parotid tumours
• Patients with non-diagnostic FNAC were not
  excluded

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• STUDY DESIGN METHODS
• Retrospective
• FNAC by multiple surgeons
• Surgery by multiple surgeons/trainees
• Multiple pathologists/trainees in multiple
  centres

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• STUDY DESIGN AND METHODS
• FNAC results compared with histopathological
  diagnosis from surgical specimen
• Sensitivity and specificity calculated

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• EXCLUSIONS
• Patients who had more than one FNAC pre-op -
  number not given

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• STUDY DEMOGRAPHICS
• 169 patients
• Age range 19-91 years
• Mean age 55 years
• 84 men, 85 women
• 113 superficial, 21 total, six lumpectomies, one
  biopsy and 28 unknown procedures

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• RESULTS

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• RESULTS
• 28 FNAC contained "non-specific benign tissue"
  (11 malignant)
• 17 FNAC categorised as non-diagnostic or
  inadequate (three malignant)
• 6 patients had non-neoplastic conditions on
  histopathology

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• RESULTS
• 2 of 3 lymphomas diagnosed on FNAC (1 was
  non-diagnostic)
• Accuracy of identifying malignant tumour - 43
• Accuracy of identifying benign tumour - 62
• Overall accuracy - 56

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• RESULTS
• FNAC able to exclude malignancy well
• FNAC not able to reliably diagnose malignancy
  preoperatively

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• ANALYSIS VE
• Non-diagnostic FNAC were not excluded from the
  statistical analysis
• Statistical analysis simple and effective

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• ANALYSIS - VE
• Retrospective
• Unclear whether blinded
• Confounding - reference standards not able to be
  stipulated due to large amount of individual
  variation in obtaining data

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• CONCLUSION
• This study probably underestimates the usefulness
  of FNAC in parotid tumour surgery - ie.
  underestimates its ability to determine
  difference between non-neoplastic and neoplastic
  conditions