Diagnostic accuracy of fine needle aspiration cytology compared to histopathology in salivary gland swellings.

Dr. Nowshad.M; Dr. C.V.Rajendran

Volume : VI, Issue : VII, July - 2017

Diagnostic accuracy of fine needle aspiration cytology compared to histopathology in salivary gland swellings.

Dr. Nowshad. M, Dr. C. V. Rajendran

Abstract :

Background

A swelling arising from the salivary glands poses a diagnostic challenge to the surgeon. A definite preoperative diagnosis is helpful in better treatment planning, including the type of operation and post operative treatment. Fine–needle aspiration helps in reaching a preoperative diagnosis. The results of this investigation vary from institution to institution and depend on the skill of the cytopathologists. Our study aims to compare the diagnostic accuracy of fine–needle aspiration to final post operative histopathological report.

Methods

We conducted this study at the department of surgery, government medical college Trivandrum in accordance with the declaration of Helsinki. We collected informed consent from all patients who participated in this observational study. We excluded patients with recurrent swellings, skin infiltrations and previous history of irradiation from the study. Fine–needle aspiration was done in a standardize manner by the cytopathologists. There after the smears were studied in detail. Patients were operated based upon the FNAC results if indicated. The decision to operate was taken by the attending surgeon. Histopathological reports were collected from the pathology department. All statistical analyses were carried out in R statistical software.

Results

More than 60 % of patients in this study comprising of 122 patients were males. The age of the patients ranged from 14 to 72 years. Pleomorphic adenoma was present in 36(29.5%) of the study sample. Chronic sialadenitis constituted 32(2.2%) of the patients. Among the 122 patients, where FNAC was done, only 104 underwent surgery. The remaining 12 were treated conservatively. 4 did not come for follow up and two refused surgery. The post–operative histopathological report collected from the department of pathology revealed benign tumors in 49(47.2%) patients, chronic sialadenitis in 31(29.8%),malignant malignant tumors in 15(14.4%).In In this study group, out of the total 16 malignant tumours, 11 were diagnosed by FNAC (True Positive), 63 were diagnosed as benign (True negative), 72 were predicted as benign (Predicted negative), 15 were predicted as malignant (Predicted positive) by FNAC. The sensitivity was 73%(44–92) and specificity 71(61–80)

Discussion

We assessed the diagnostic accuracy of FNAC with respect to postoperative histopathological diagnosis in patients operated for salivary gland swellings. This result showed that the diagnostic accuracy of FNAC in our institution is comparable to other results in the literature. Moreover , it showed FNAC can help in better decision making and treatment planning. FNAC with its marked diagnostic significance helps in the better management of salivary gland swellings. The diagnostic accuracy and specificity can be improved by the experience of the cytopathologist and refinement of technique. So it is a cost effective investigative modality. It has an important role in altering the management of salivary gland swellings, especially in those which are clinically benign and cytology showing malignancy and viceversa.