FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES

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FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES

• DIONYSIOS E. KYRMIZAKIS, MD, DDS, PhD
• GENERAL HOSPITAL VEROIA, GREECE

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SALIVARY GLANDS DISEASES

• INFECTIONS
• INFLAMATIONS
• CYSTIC MASSES
• LYMPH NODES MASSES
• NEOPLASMS
• TRAUMATIC LESIONS

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FINE NEEDLE ASPIRATION BIOPSY or CYTOLOGYFNAB ?
FNAC
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TWO MEN FNAB TECHNIQUE

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WHO IS PERFORMING THE FNAB?

• THE SURGEON
• THE CYTOPATHOLOGIST
• THE RADIOLOGIST

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FNAB IS VERY USEFUL INDIFFERENCIAL DIAGNOSIS OF

• THYROID NODULES-MASSES
• LYMPH NODES ENLARGEMENT
• OTHER NECK MASSES

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IS FNAB NECESSARY FOR D.D. OF SALIVARY GLANDS
DISEASES?
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OPTIONS VARIES

• YES FNAB IS NECESSARY
• FNAB IS SIMPLY USEFUL
• FNAB IS NOT NEEDED AT ALL

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HERAKLION VENIZELEIONHOSPITAL EXPERIENCE

• FIRST YEAR (MANY NON DIAGNOSTIC SPECIMENS)
• SECOND AND THIRD YEAR A HUGE IMPROVEMENT OF THE
  NUMBERS OF DIAGNOSTIC SPECIMENS

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UTRECHT ORL (KNO) DEPARTMENT EXPERIENCE

• THIS IS A TERTIARY UNIVERCITY CENTER
• THEY HAVE THE OPINION THAT FNAC IS ALWAYS NEEDED
• SOME TIMES UNDER ECHO
• ACCURACY ALMOST 100

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PERSONAL EXPERIENCE THE LAST SEVEN YEARS
(2004-2011) A

• ACINIC CELL CA 1 CASE-Right diagnosis with FNA
• ADENOID CYSTIC CA 1-Right (R)
• MUCOEPIDERMOID CA 1- R
• S.C. CA (METASTATIC) 3-2 R-1 False (F)
• LYMPHOMA 3-2 R-1 F
• LIPOMA 1- R
• WARTHIN TUMOURS 8 7R-1F
• PLEOMORPHIC ADENOMA 12 parotid2 extraparotid
• 13 R-1F
• MONOMORHIC ADENOMA 1-R

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PERSONAL EXPERIENCE THE LAST SEVEN YEARS B

• RECCURENT PLEOMORPHIC ADENOMA 3
• 3R
• LYMPHOEPITHELIAL CYSTS 3 (2 HIV)-3R
• TBC 2-1R-1F
• BASAL CELL ADENOMA 1-R

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FNAB CAN HELP IN

• D.D. OF NEOPLASTIC FROM NON NEOPLASTIC LESIONS
• D.D. OF LYMPHOMA FROM OTHER NEOPLASMS
• D.D. OF BENIGN FROM MALIGNANT NEOPLASMS
• TO COLLECT MATERIAL FOR CULTURE
• FOR D.D. CYSTIC AND METASTATIC LESIONS (RENAL
  CELL CA, MELANOMA)

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Pleomorphic adenoma
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LYMPHOEPITHELIAL CYSTS
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Giant Pleomorphic Adenoma of Parotis Jiannis K.
Hajiioannou M.D. ,Yannis Vlastos M.D. , Vasillios
Lachanas M.D., Dionysios Kyrmizakis M.D., D.D.S.
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COMPLICATIONS

• PAIN (RARELY)
• INJURY OF NERVES (FACIAL, LINGUAL, HYPOGLOSSAL)
  OR OTHER STRUCTURES -VERY RARELY
• HEMATOMA
• BLEEDING (IN CASE OF COUMARIN OR ASPIRIN USE)
• TUMOUR SEEDING (ALMOST NEVER)
• INFECTION
• SYNCOPE (The procedure should be performed while
  the patient is lying down)

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FNAB IS VERY USEFUL BUT MANY CONDITIONS MUST BE
EXISTED

• A GOOD PERFORMER MUST BE AVAILABLE
• AN EXCELLENT CYTOPATHOLOGIST
• HIGH LEVEL OF COLLABORATION
• TECHNOLOGY-SOPHISTICATED EQUIPMENT (FLOW
  CYTOMETRY, IMMUNOHISTOCHEMISTRY, LIQUID PHASE
  CYTOLOGY ETC) MUST BE AVAILABLE
• MANY STAINS (PAP, GIEMSA-ROMANOWSKY etc)

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CONCLUSIONS 1

• FNAB IS VERY USEFUL AND COST EFFECTIVE METHOD
• A LOT OF MONEY AND ANXIETY CAN BE SAVED
• MANY PATIENTS CAN AVOID SURGERY
• (TBC, LYMPHOMA,WARTHIN, LYMPHOEPITHELIAL CYSTS)

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CONCLUSIONS 2

• BUT IF YOU DONT HAVE RELIABLE, LOYAL AND
  DETERMINANT CYTOPATHOLOGIST THE RESULTS CAN BE
  VERY POOR

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CONCLUSIONS 3From thesis of J. A. de Ru UTRECHT
2005ltParotid gland tumors-diagnostics, surgical
aspects, follow up, and suggestionsgt

• FNAC SHOULD BE PERFORMED IN ALL PATIENTS WITH A
  PAROTID TUMOUR
• BY PERSONS WITH EXPERIENCE IN THE TECHNIQUE OF
  ASPIRATION AND INTERPRETATION OF SMEARS

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Jonas T. Johnson, MD, FACS emedicine-FNA of neck
masses (updated April 2012)

• When the diagnosis is uncertain, an FNA can
  almost always help.
• The results of FNA may contribute to establishing
  the diagnosis but should not be accepted as
  absolute when clinical or other information
  contradicts the FNA findings.
• The accuracy of FNA is increased by providing the
  cytopathologist accurate clinical information. It
  may be further enhanced by having the pathologist
  chairside during the procedure.
• Further enhancement of results is achieved with
  the use of ultrasonographic guidance to assure
  accurate placement of the needle during
  aspiration.

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F?01 (?????sa ?)?e????????? ??????? ?????? (e?de??e??-te??????) ??pa?de?t?? ?as???? ?a?????d?? F?02 (?????sa ?)? FNAB st?? ?a??µ??a O?? p?a?t?????pa?de?t?? ?????s??? ?. ???µ?????? ???d???? S?d???p????? F?03 (?????sa G)??e???e?? st?? t?µpa??µet??a??pa?de?t?? ??e??????? Fe?e??d??
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References

• 1.Kesse KW, Manjaly G, Violaris N, Howlett DC.
  Ultrasound-guided biopsy in the evaluation of
  focal lesions and diffuse swelling of the parotid
  gland. Br J Oral Maxillofac Surg 2002403849.
• 2. Verma K, Kapila K. Role of fine needle
  aspiration cytology in the diagnosis of
  pleomorphic adenoma. Cytopathology 2002131217.
  
• 3. Balakrishnan K, Castling B, McMahan J, Imrie
  J, Feeley KM, Parker AJ, et al. Fine needle
  aspiration cytology in the management of parotid
  mass a two centre retrospective study. Surgeon
  200526772.
• 4. Parwarni AV, Ali-Sayed Z. Diagnostic accuracy
  and pitfalls in the fine needle aspiration
  interpretation of Warthin's tumour. Cancer
  20039916671.
• 5.  de Ru JA, van Leeuwen MS, van Benthem PP,
  Velthuis BK, Sie-Go DM, Hordijk GJ.
• Do MRI and ultrasound add anything to the
  preoperative work up of parotid gland tumors?
• J Oral Maxillofac Surg. 2007
  May65(5)945-52

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