www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
ORIGINAL
ARTICLE
Is
fine
needle
aspiration
biopsy
reliable
in
the
diagnosis
of
parotid
tumors?
Comparison
of
preoperative
and
postoperative
results
and
the
factors
affecting
accuracy
夽
Fazilet
Altin
∗,
Yalcin
Alimoglu
,
Resit
Murat
Acikalin
,
Husamettin
Yasar
HealthSciencesUniversity,HasekiTrainingandResearchHospital,OtolaryngologyDepartment,Istanbul,Turkey
Received23February2018;accepted25April2018 Availableonline11June2018
KEYWORDS Parotidgland; Parotidectomy; Fine-needle aspirationbiopsy; Diagnosticaccuracy Abstract
Introduction:Fineneedleaspirationbiopsyisavaluabletoolinpreoperativeevaluationofhead andnecktumors.However,itsaccuracyinmanagementofsalivaryglandtumorsisdebatable.
Objective: Weaimed toinvestigate theefficacy andtheaccuracy offine needleaspiration biopsyinparotidglandtumors.
Methods:Patientswho underwentparotidectomybetween January2008andJune2017due toparotid glandtumorwereexamined retrospectively.Patientswithbothpreoperativefine needleaspirationbiopsyandpostoperativesurgicalpathologieswere included.Preoperative fineneedleaspirationbiopsywascategorizedasbenign,malignantorsuspiciousformalignancy. Surgicalpathologywasgroupedasbenignormalignant.Surgicalpathologywascomparedwith fineneedleaspirationbiopsy,andsensitivity,specificity,accuracyandagreementbetweenboth testswereinvestigated.
Results:217caseswereevaluatedand23caseswereexcludedbecausethefineneedle aspi-rationbiopsydiagnosiswasnon-diagnosticorunavailable.194caseswereincluded.Themean ageofthepatientswas47.5±15.88(7---82).Therewere157benign,37malignantcasesinfine needleaspirationbiopsy,165benignand29malignantcasesinsurgicalpathology.Themost
夽 Pleasecitethisarticleas:AltinF,AlimogluY,AcikalinRM,YasarH.Isfineneedleaspirationbiopsyreliableinthediagnosisofparotid tumors?Comparisonofpreoperativeandpostoperativeresultsandthefactorsaffectingaccuracy.BrazJOtorhinolaryngol.2019;85:275---81.
∗Correspondingauthor.
E-mail:drfaziletaltin@gmail.com(F.Altin).
PeerReviewundertheresponsibilityofAssociac¸ãoBrasileiradeOtorrinolaringologiaeCirurgiaCérvico-Facial. https://doi.org/10.1016/j.bjorl.2018.04.015
1808-8694/©2018Associac¸˜aoBrasileiradeOtorrinolaringologiaeCirurgiaC´ervico-Facial.PublishedbyElsevierEditoraLtda.Thisisanopen accessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).
commonbenigntumorwaspleomorphicadenoma(43.3%),andmalignanttumorwas mucoepi-dermoidcarcinoma(4.13%). Thediagnosticaccuracy forfine needleaspirationbiopsy when detectingmalignancywas86.52%.Sensitivityandspecificitywere68.96%and89.63% respec-tively.Positivepredictivevaluewas54.05%andnegativepredictivevaluewas94.23%.Therewas moderateagreementbetweenfineneedleaspirationbiopsyandsurgicalpathology(Ä=0.52). Thesensitivitywas54.54%intumorslessthan2cmwhile77.77%inlargertumors.Intumors extendingtothedeeplobe,sensitivitywas80%.
Conclusion:Fineneedleaspirationbiopsyisanimportantdiagnostictoolforevaluatingparotid glandtumors.Itismoreaccurateindetectingbenigntumors.Intumorsgreaterthan2cmand extendingtothedeeplobe,thesensitivityoffineneedleaspirationbiopsyishigh.Theuseof fineneedleaspirationbiopsyinconjunctionwithclinicalandradiologicalevaluationmayhelp toreducefalsepositiveandfalsenegativeresults.
© 2018 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http://
creativecommons.org/licenses/by/4.0/).
PALAVRAS-CHAVE Glândulaparótida; Parotidectomia; Punc¸ãoaspirativa comagulhafina; Acuráciadiagnóstica
Apunc¸ãoaspirativacomagulhafinaéconfiávelnodiagnósticodetumoresde parótida?Comparac¸ãodosresultadospréepós-operatóriosefatoresqueafetamsua precisão
Resumo
Introduc¸ão:A punc¸ãoaspirativacomagulhafinaéumaferramentavaliosanaavaliac¸ão pré-operatóriadetumoresdecabec¸aepescoc¸o.Noentanto,suaprecisãonotratamentodetumores deglândulassalivaresédiscutível.
Objetivo:Nossoobjetivofoiinvestigaraeficáciaeprecisãodapunc¸ãoaspirativacomagulha finanostumoresdaglândulaparótida.
Método: Pacientessubmetidosàparotidectomia entrejaneirode 2008e junhode2017por tumordeglândulaparótidaforamexaminadosretrospectivamente.Foramincluídospacientes compunc¸ãoaspirativacomagulhafinapré-operatóriaehistopatologiacirúrgicapós-operatória. A punc¸ãoaspirativacomagulha finapré-operatóriafoicategorizadacomo benigna,maligna oucomsuspeitademalignidade. Ohistopatológicocirúrgicofoiagrupadocomo benignoou maligno.Osexameshistopatológicosforamcomparadoscomapunc¸ãoaspirativacomagulha fina, ea sensibilidade, especificidade, acurácia e concordância entre os doistestes foram investigadas.
Resultados: Foramavaliados217casoseexcluídos23porqueodiagnósticodapunc¸ãoaspirativa comagulhafinanãofoiconclusivoouestavaindisponível.Portanto,foramincluídos194casos.A médiadeidadedospacientesfoide47,5±15,88(7---82).Havia157casosbenignos,37malignos napunc¸ãoaspirativacomagulhafinae165casosbenignose29malignosnahistopatologia.O tumorbenignomaiscomumfoioadenomapleomórfico(43,3%)eotumormalignomaiscomum foiocarcinomamucoepidermoide(4,13%).A acuráciadiagnósticadapunc¸ãoaspirativacom agulhafinanadetecc¸ãodemalignidadefoide86,52%.Asensibilidadeeespecificidadeforam de68,96%e89,63%,respectivamente.Ovalorpreditivopositivofoide54,05%eovalorpreditivo negativofoide94,23%.Houveconcordânciamoderadaentreapunc¸ãoaspirativacomagulha finaehistopatológico(=0,52).Asensibilidadefoi54,54%emtumoresmenoresdoque2cme 77,77%emtumoresmaiores.Nostumoresqueseestendiamatéoloboprofundo,asensibilidade foide80%.
Conclusão:Apunc¸ãoaspirativacomagulhafinaéumaimportanteferramentadiagnósticana avaliac¸ãodostumoresdaglândulaparótida.Émaisprecisanadetecc¸ãodetumoresbenignos. Em tumoresmaiores doque2cmquese estendem atéolobo profundo,asensibilidadeda punc¸ãoaspirativacomagulhafinaéalta.Ousodessaferramentaemconjuntocomaavaliac¸ão clínicaeradiológicapodeajudarareduzirosresultadosfalso-positivosefalso-negativos. © 2018 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Publicado por Elsevier Editora Ltda. Este ´e um artigo Open Access sob uma licenc¸a CC BY (http://
Introduction
Majorsalivaryglandtumorsaccountfor3%ofheadandneck cancers.1Benigntumorsaremorecommonthanmalignant
tumors. 85% originate from the parotidgland, while sub-mandibularandsublingualglandtumorsarelesscommon. Pleomorphicadenomaismostcommonbenignand mucoepi-dermoidcarcinoma is themost commonmalignanttumor. Somesystemicdiseasessuchasmetastaticcancers, inflam-matoryconditions,and lymphoma mayalsocause parotid glandmasses.1,2
Fineneedleaspirationbiopsy(FNAB)isavaluabletoolin thepreoperativeevaluationofheadandneckcancers.FNAB for parotid glandlesionshas been used for more than 40 years.2Itisacceptedbymostcliniciansthatitissuperiorto
physicalexaminationandimagingindifferentialdiagnosisof malignantandbenigntumors,howeversomecliniciansare insecureabouttheirutility.Preoperativebenignand malig-nantdifferentiationofparotidglandtumorsmaybeuseful bothforsurgicalplanningandpatientcounseling.
We aimed to investigate the diagnostic efficacy and accuracy ofFNAB in parotidglandtumorsandthe factors affectingthisinourstudy.
Methods
BetweenJanuary2008andJune2017,217caseswhichhave undergoneparotidectomyduetoparotidglandtumorsinour departmentwereexaminedretrospectively.Casesofwhom FNABorfinalhistopathologicaldiagnoseswereunavailable ornon-diagnosticwereexcluded.Age,gender,side, exten-siontothe deeplobe,thesize ofthe tumorasmeasured by ultrasonography,preoperative FNAB diagnosis andfinal histopathologicaldiagnosiswerenoted.
FNABisperformedtheoutpatientsettingusing23gauge needle and 10cc syringe without local anesthesia. The needle is inserted from a single point and moved in 4---5 directionsthroughthetumorwithoutexiting.After obtain-ingenoughsamples,theneedleiswithdrawnanddetached fromthesyringe.Theaspirateissprayedonatleast3---4glass slides,smeared,fixedinalcoholandsenttothepathology lab.
Preoperative FNAB diagnosis was classified as benign, suspicious for malignancy or malignant. If possible, the subtypeswerenoted.Finalhistopathologicaldiagnosiswas grouped as benign and malignant, and typing was noted. TheFNABdiagnosesofmalignantandsuspiciousfor malig-nancy and final histopathological diagnosis of malignancy were categorizedaspositive, and other benign results as negative.
Thecasesareclassifiedastruenegative(FNABandfinal histopathologicaldiagnosisarebenign),falsepositive(FNAB diagnosis is malignant, final histopathological diagnosis is benign),truepositive(FNABdiagnosisandfinal histopatho-logical diagnosis aremalignant) and false negative(FNAB diagnosisisbenign,finalhistopathologicaldiagnosisis malig-nant). Sensitivity, specificity, negative predictive value, positivepredictivevalue,accuracyandagreementbetween both testswereinvestigatedby comparingFNABandfinal histopathologicaldiagnosis.
Multinomiallogisticregressionanalysiswasperformedto investigate anypossible effect ofage, gender, side, deep lobeinvolvement,andsizeaccordingtoultrasonographyon truepositive,truenegative,falsepositiveandfalsenegative results. Cases were grouped according to the parameters foundtobesignificantandthenthesensitivity,specificity, negativeand positivepredictive value and accuracy were
investigatedfor each group (true positive, true negative, false positive, false negative, tumor size and deep lobe extension).
Our study was conducted with the approval of Haseki Training and Research Hospital Ethics Committee (14.09.2017/549).Ourstudywascarriedoutinconcordance withThe Code of Ethicsof the WorldMedical Association (Declaration of Helsinki). Informed consent was obtained fromallpatientsparticipatingthestudy.
Results
Ofthe 217 retrospectively investigatedpatients, 23 were excludedduetounavailableornon-diagnosticFNABresults, 194 caseswere examined retrospectively. The age of the patients was47.5±15.88 (7---82). 88 (45.36%) of patients werefemaleand106(54.64%) weremale.100caseswere locatedintheright parotidgland(51.54%),94caseswere locatedintheleftparotidgland(48.46%);166tumorswere in the superficial lobe and deep lobe involvement was presentin28cases.Thesizeofthetumorwas2.76±1.22 (1.1---9.5)cm.
There were 157 benign, 37 suspicious for malignancy andmalignantcasesonFNAB,165benignand29malignant casesinfinalhistopathologicaldiagnosis.Themostcommon benignlesionwaspleomorphicadenoma(43.3%);themost commonmalignanttumorwasmucoepidermoidcarcinoma (4.13%).Truenegative,falsepositive,truepositiveandfalse negativecasesareshowninTables1---4.
For detection of malignancy, the diagnostic accuracy, specificityandspecificityforFNABwere86.52%,68.96%and 89.63%,respectively.ThePositivePredictiveValue(PPV)was 54.05%andtheNegativePredictiveValue(NPV)was94.23%. TherewasmoderateagreementbetweenFNABdiagnosisand finalhistopathologicaldiagnosis(Ä=0.52).
Intumorslessthan2cmthesensitivitywas54.54%while in larger tumors it was 77.77%. Also in tumors extend-ing to the deep lobe, sensitivity was 80%. Agreement betweenFNABandfinalhistopathologicaldiagnosiswas cor-relatedwithtumor size(p=0.0)anddeeplobe(p=0.004) involvement.TheefficacyofFNAB accordingtodeeplobe involvementandtumorsizeisseeninTables5and6.
Discussion
Parotid gland tumors constitute 3% of head and neck tumors.1 Benigntumorsaremorefrequentthanmalignant
tumors. In our study, benign tumors were more common with85.05%, withthemost common typebeing pleomor-phicadenoma(43.3%)inaccordancewiththeliterature.3,4
The second most common benign tumor was Warthin’s tumor (23.71%).3,4 Malignant tumors were seen in 14.95%
of cases with the most common pathologic type being mucoepidermoidcarcinoma(4.13%),alsoinaccordancewith the literature.3 The distribution of benign and malignant
finalhistopathological diagnoses oftumors in ourstudy is showninTables7and8,respectively.
Parotidglandtumorsaremorecommoninmales.3Inour
study,theageof thepatientswas47.5±15.88(7---82).88 (45.36%) of patients were female and 106 (54.64%) were male. There was slight male predominance in our cases. Benignparotidtumorsaremostcommonlyseenin the5th decadeandmalignantlesionsinthe6thdecade.3,4Themean
agewas47.2forbenignand50.2formalignanttumors. How-ever,therewasnosignificantdifferencebetweenthemean ageofbenignandmalignantcasesinourstudy(p>0.05).
Table1 FNABdiagnosisandfinalhistopathologicaldiagnosisoftruenegativecases.
FNABdiagnosis Patients Finalhistopathologicaldiagnosis Patients
Pleomorphicadenoma 75 Pleomorphicadenoma 72
Warthin’stumor 3
Warthin’stumor 38 Warthin’stumor 33
Oncocytoma 2
Tuberculosis 2
Pleomorphicadenoma 1
Lymphoidhyperplasia 6 Lymphadenoma 5
Chronicsialadenitis 1
Lipoma 4 Lipoma 4
Inflammation 8 Pilomatrixoma 2
Chronicsialadenitis 2
Benignepithelialcyst 2
Chronicgranulomatousinflammation 1
Warthin’stumor 1
Cyst 8 Benignepithelialcyst 7
Chronicgranulomatousinflammation 1
Monomorphicadenoma 2 Basalcelladenoma 2
Benignepithelialtumor 6 Pleomorphicadenoma 3
Warthin’stumor 3
Total 148 Truediagnosis 130
Falsediagnosis 18
FNAB,fineneedleaspirationbiopsy.
Table2 FNABdiagnosisandfinalhistopathologicaldiagnosisoffalsepositivecases.
FNABdiagnosis Patients Finalhistopathologicaldiagnosis Patients
Suspiciousformalignancy 15 Pleomorphicadenoma 6
Warthin’stumor 5
Chronicsialadenitis 2
Myoepithelioma 1
Monomorphicadenoma 1
Malignant 2
Aciniccellcarcinoma 1 Pleomorphicadenoma 1
Mucoepidermoidcarcinoma 1 Warthin’stumor 1
Total 17
FNAB,fineneedleaspirationbiopsy.
Table3 FNABdiagnosisandfinalhistopathologicaldiagnosisoftruepositivecases.
FNABdiagnosis Patients Finalhistopathologicaldiagnosis Patients
Suspiciousformalignancy 14 Mucoepidermoidcarcinoma 4
Aciniccellcarcinoma 3
Adenoidcysticcarcinoma 2
DiffuseBcelllymphoma 2
Squamouscellcarcinoma 1
Tubularcarcinoma 1
Basalcellcarcinoma 1
Malignant 5
Squamouscellcarcinoma 2 Squamouscellcarcinoma 2
Adenoidcysticcarcinoma 1 Adenoidcysticcarcinoma 1
Ductalcarcinoma 1 Ductalcarcinoma 1
Mucoepidermoidcarcinoma 1 Mucoepidermoidcarcinoma 1
Total 19 2
Table4 FNABdiagnosisandfinalhistopathologicaldiagnosisoffalsenegativecases.
FNABdiagnosis Patients Finalhistopathologicaldiagnosis Patients
Benign 2 Aciniccellcarcinoma 1
Mucoepidermoidcarcinoma 1
Warthin’stumor 4 Mucoepidermoidcarcinoma 1
MALTlymphoma 1
Adenocarcinoma 1
DiffuseBcelllymphoma 1
Pleomorphicadenoma 3 Mucoepidermoidcarcinoma 1
Lymphoma 1
Myoepithelialcarcinoma 1
Total 9
FNAB,fineneedleaspirationbiopsy;MALT,mucosa-associatedlymphoidtissue.
Table5 FNABefficacyaccordingtodeeplobeextension. Extension (n=28) Noextension (n=166) Sensitivity(%) 80 63.15 Specificity(%) 82.35 90.34 PPV(%) 72.72 46.15 NPV(%) 87.5 94.92 Accuracy(%) 81.48 87.19
FNAB, fine needle aspiration biopsy; PPV,positive predictive value;NPV,negativepredictivevalue.
Table6 FNABefficacyaccordingtotumorsize. 0---2cm (n=57) 2.1---4cm (n=119) >4.1cm (n=18) Sensitivity(%) 54.54 75 100 Specificity(%) 82.60 92 93.33 PPV(%) 42.85 60 66.66 NPV(%) 88.37 95.98 100 Accuracy(%) 77.19 89.65 94.11
FNAB,fineneedleaspirationbiopsy;PPV,positivepredictive value;NPV,negativepredictivevalue.
Clinical examination, imaging and FNAB can be used in preoperative evaluation of parotid gland tumors. High resolution Ultrasound(USG) is themost accepted imaging modality.5---7OtherimagingtechniquesareComputed
Tomo-graphy(CT)andMagneticResonanceImaging(MRI).CTand MRI aremore expensive and contrastmaterial is needed. EasierimplementationandthepossibilitytoperformFNAB withUSGguidancearethereasonsforchoosingUSGoverCT orMRI.8,9Similarly,ourpatientsunderwentUSGforimaging
andsimultaneousFNAB.Brennanetal.10suggestedthatUSG
providesadequateinformationforinitialimagingin super-ficial lobeparotidglandtumorsand somedifficulties may beencounteredincasesextendingtothedeeplobe.Inthat case,theuseofMRIispreferred.Ifextensiontothedeep lobeand/orsuspicionofmalignancyisdetectedwitheither USGorFNAB,CTscanand/orMRIwasperformedforfurther evaluation.
Primary treatment of malignant parotid gland tumors is usually surgery. The extent of surgery depends on the histopathologictype.3 Withcorrectpreoperative diagnosis
a better assessment of the possible extent surgery could
Table 7 Benign parotid tumors according to final histopathologicaldiagnosis.
Finalhistopathologicaldiagnosis Patients %
Pleomorphicadenoma 84 43.3
Warthin’stumor 46 23.71
Benignepithelialcyst 9 4.65
Lymphoidhyperplasia 5 2.58
Chronicsialadenitis 5 2.58
Chronicgranulomatousinflammation 4 2.06
Lipoma 4 2.06
Pilomatrixoma 2 1.03
Basalcelladenoma 2 1.03
Oncocytoma 2 1.03
Monomorphicadenoma 1 0.51
Myoepithelioma 1 0.51
Total 165 85.05
Table 8 Malignant parotid tumors according to final histopathologicaldiagnosis.
Finalhistopathologicaldiagnosis Patients %
Mucoepidermoidcarcinoma 8 4.13
Aciniccellcarcinoma 4 2.07
DiffuseBcelllymphoma 4 2.07
Squamouscellcarcinoma 4 2.07
Adenoidcysticcarcinoma 3 1.55
Adenocarcinoma 1 0.51
Tubularcarcinoma 1 0.51
Ductalcarcinoma 1 0.51
Basalcellcarcinoma 1 0.51
MALTlymphoma 1 0.51
Myoepithelialcellcarcinoma 1 0.51
Total 29 14.95
MALT,mucosa-associatedlymphoidtissue.
help the surgeon with preoperative planning and patient counseling since neck dissection and sacrification of the facialnervemaybenecessaryincaseofamalignanttumor. Althoughimagingtechniquesprovidealotofinformationin theevaluationofparotidglandtumors,histopathologicalor cytologicalexamination shouldbeneeded forcorrect sur-gicalplanning. USG-guided tru-cut biopsy or open parotid
gland biopsy are not preferred due to risks of serious complications such asdeterioration of the tumor capsule andpossibilityoftumorspread.5,11In1987,Layfieldetal.12
conductedastudyinwhichtheyshowed58%ofconsistency betweenFNABandfinalhistopathologicdiagnosis forhead andnecktumors.AlthoughtheFNABwasdescribedlongtime ago,itbegantogainpopularityafterthisstudyand nowa-daysisroutinelyperformed.FNABisacheap,fastandeasy methodfor preoperative diagnosis and has a low compli-cation rate and morbidity.13---15 Rarely, complications such
asbleeding,facialnerveinjury,fibrosis,andtumorerosion havebeenreportedintheliterature.7Nocomplicationsdue
toFNABwereobservedinourstudy.
FNAB has been shown to be an important modality in the evaluation of the thyroid gland and lymph node pathologies, but there is no consensus about its use in majorsalivary glandtumors.The heterogeneousstructure of salivaryglands has been shown asa reason for a wide rangeofsensitivityreportedinmanystudies.16Accordingto
someresearchers,parotid tumorsother thanpleomorphic adenomasareuncommon andcytopathologistsmay misdi-agnoseFNABiftheyarenotspecializedinparotidtumors. Therefore,theysuggestedthatFNABmaybehelpfulin pre-operativeplanning,butitshouldnotovercomethesurgeon’s clinicalexperienceandintraoperativefindings.17
Forhighersensitivity, FNAB shouldbemade by experi-enced clinician. FNAB must include the cortexof parotid glandtumorandsamplesmustbeexaminedthebyexpert cytopathologists.11Especiallyincysticlesions,ifthe
speci-mentakenfromthecore anddoesnotcontainthecortex, the probabilityof containing necrotic material increases, leadingtonon-diagnosticor false negativeresults.Viguer etal.18recommendedaspirationfromseveralpointsinthe
sametumortoreducethefalsenegativeresultrate.Inour study,FNABs were performed by experienced radiologists underUSGguidance;syringewasmovedin 4---5 directions throughthetumorwithoutexitingtoobtainenoughmaterial fordiagnosisandevaluatedbyexpertpathologists.
Reported FNAB sensitivity and specificity values also varyindifferentpopulations.19,20Sensitivityvariesbetween
38%21 and 97%22 and specificity varies between 81%13 and
100%.23Wehavefounddiagnosticaccuracy;sensitivityand
specificity were 86.52%, 68.96% and 89.63% for FNAB in detectingmalignancy,respectively.Thepositivepredictive value was 54.05% and the negative predictive value was 94.23%.
Tumorsizeanddeeplobeinvolvementwerefoundtobe associatedwiththeefficacyofFNAB.5Ghantousetal.found
theaccuracyofFNABtobehigher5inpatientswithparotid
glandtumorslargerthan24mmonCT.SensitivityofFNABin tumorssmallerthan2cmwas54.54%,andthatoflargerthan 2cmwas77.77%inourstudy.Inparotidglandtumorswith deeplobeextension,FNABsensitivitywascalculatedas80% andin superficial lobe tumorsas 63.15%. In ourpatients, no isolated deep lobe parotid tumor was found; usually caseshaveadeeplobeextensionofthesuperficiallobe.We thinkthatthehighersensitivityofFNABinparotidtumors withdeep lobe extension may be due to larger size and morepatientswithisolateddeeplobeinvolvementshould beexamined.
Ourstudyhassomedisadvantagesduetoitsretrospective nature. Since pathologists who have studied FNAB speci-mensfor10yearsmayhavebeendifferent,somevariability intheinterpretationmayhaveoccurred.Pathologyresults which were not available could also have affected our results.However,duetothelowerincidenceofparotidgland tumorsalongerperiodoftimeisnecessarytoaccumulatea largernumberofcasesandtheseeffectscanbeconsidered
inevitable. Moreover, ourresults are similarto previously publishedresults.
Conclusion
FNAB is an importantdiagnostic tool in the evaluation of parotidglandtumors.The FNABspecificity,sensitivityand accuracychange dependingonthelocationofthe superfi-cialanddeeplobesoftheparotidglandandthesizeofthe tumor.Itsaccuracyisbetterfor benigntumors.Sensitivity intumorslargerthan2cmandwithextensiontodeeplobe ishigher.TheuseofFNABincombinationwithclinicaland radiologicalevaluation mayhelp reducefalsepositiveand falsenegativediagnosis.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.AliNS,AkhtarS,JunaidM,AwanS,AftabK.Diagnosticaccuracy offineneedleaspirationcytologyinparotidlesions.ISRNSurg. 2011;721525.
2.MavecP,EnerothCM,FranzenS,MobergerG,ZajıcekJ. Aspira-tionbiopsyofsalivaryglandtumours.Correlationofcytologic reportsfrom652aspirationbiopsieswithclinicalandhistologic findings.ActaOtolaryngol.1964;58:471---84.
3.TakahamaA,DeAlmeidaOP,KowalskiLP.Parotidneoplasms: analysisof600patientsattendedatasingleinstitution.BrazJ Otorhinolaryngol.2009;75:497---501.
4.ComogluS,OzturkE,CelikM,AvciH,SonmezS, BasaranB, etal.Comprehensiveanalysisofparotidmass:aretrospective studyof369cases.AurisNasusLarynx.2018;45:320---7. 5.Ghantous Y, Naddaf R, Barak M, Abd-Elraziq M, Abu
Eln-Naaj. The role of fineneedle aspiration in the diagnosis of parotidglandtumors:correlationwithpreoperative computer-izedtomographytumorsize.JCraniofacSurg.2016;27:192---6. 6.Yakkioui Y, van Overbeeke JJ, Santegoeds R, van Engeland M, Temel Y. Chordoma: the entity. Biochim Biophys Acta. 2014;1846:655---69.
7.Gudmundsson JK, Ajan A, Abtahi J. The accuracy of fine-needleaspirationcytologyfordiagnosisofparotidglandmasses: a clinicopathologicalstudy of114 patients. JAppl OralSci. 2016;24:561---7.
8.Inohara H, Akahani S, Yamamoto Y, Hattori K, Tomiyama Y, TomitaY,etal.Theroleoffine-needleaspirationcytologyand magneticresonanceimaginginthemanagementofparotidmass lesions.ActaOtolaryngol.2008;128:1152---8.
9.Kovacevi´c DO, Fabijani´c I. Sonographic diagnosis of parotid gland lesions: correlation with the results of sonographi-callyguidedfine-needleaspiration biopsy.JClinUltrasound. 2010;38:294---8.
10.BrennanPA,Herd MK,HowlettDC, GibsonD,Oeppen RS. Is ultrasoundalonesufficientforimagingsuperficiallobebenign parotid tumours before surgery? Br J Oral Maxillofac Surg. 2012;50:333---7.
11.Al-KhafajiBM,NestokBR,KatzRL.Fine-needleaspirationof154 parotidmasseswithhistologiccorrelation:ten-yearexperience attheUniversityofTexasM.D.AndersonCancerCenter.Cancer. 1998;84:153---9.
12.LayfieldLJ,TanP,GlasgowBJ.Fine-needleaspirationofsalivary glandlesions.Comparisonwithfrozensectionsand histologic findings.ArchPatholLabMed.1987;111:346---53.
13.Ramírez-PérezF,González-GarcíaR,Hernández-VilaC, Monje-GilF,Ruiz-LazaL.Isfine-needleaspirationareliabletoolinthe
diagnosisofmalignantsalivaryglandtumors?JCraniomaxillofac Surg.2017;45:1074---7.
14.FakhryN,SantiniL,LagierA,DessiP,GiovanniA.Fineneedle aspirationcytologyandfrozensectioninthediagnosisof malig-nantparotidtumours.IntJOralMaxillofacSurg.2014;43:802---5. 15.Sahai K, Kapila K, Dahiya S, Verma K. Fine needle aspira-tioncytologyof minorsalivarygland tumoursofthepalate. Cytopathology.2002;13:309---16.
16.ShettyA,GeethamaniV.Roleoffine-needleaspirationcytology inthediagnosisofmajorsalivaryglandtumors:astudywith histologicaland clinicalcorrelation.JOralMaxillofac Pathol. 2016;20:224---9.
17.AlphsHH,EiseleDW,WestraWH.Theroleoffineneedle aspira-tionintheevaluationofparotidmasses.CurrOpinOtolaryngol HeadNeckSurg.2006;14:62---6.
18.ViguerJM,VicandiB,LimeresMA.Fine-needleaspiration cytol-ogyofthepleomorphicadenoma:ananalysisof212cases.Acta Cytol.1997;41:786---94.
19.NazS,HashmiAA,KhurshidA,FaridiN,EdhiMM,KamalA,etal. Diagnosticroleoffineneedleaspirationcytology(FNAC)inthe evaluationof salivarygland swelling:aninstitutional experi-ence.BMCResNotes.2015;8:101.
20.Singh A, HaritwalA, Murali B.Correlation between cytology and histopathology of the salivary gland. Australas Med J. 2011;4:66---71.
21.StowN,VeiversD,PooleA.Fine-needleaspirationcytologyin themanagementofsalivaryglandtumors:anAustralian expe-rience.EarNoseThroatJ.2004;83:128---31.
22.Zbären P, Schär C, Hotz MA, Loosli H. Value of fine-needle aspiration cytology of parotid gland masses. Laryngoscope. 2001;111:1989---92.
23.LonguetM,NalletE,GuedonC,DepondtJ,GehannoP,BarryB. Diagnosticvalueofneedlebiopsyandfrozensection histologi-calexaminationinthesurgeryofprimaryparotidtumors.Rev LaryngolOtolRhinol.2001;122:51---5.
