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www.jssn.org.npJournal of Society of Surgeons of Nepal
J Soc Surg Nep. 2022;25(2)

Abstract

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journal.

Comparative study of Fine-Needle Aspiration Cytology and 
Histopathological diagnosis of salivary gland swelling

Introduction

FNAC is more accurate than other methods of FNAC. It is simple and 

be repeated if needed. 

Methods: This study is a prospective study of 80 patients subjected to 

with the preoperative FNAC reports. In all 80 cases, informed consent 
was obtained prior to surgery.

Results: True-positive, true-negative, false-positive, and false-negative 
rates for carcinomatous lesions of salivary gland swelling were assessed. 

respectively for FNAC when compared against histopathology. 

Conclusion
test used for the preoperative evaluation of patients with salivary 
gland swelling. FNAC is very commonly used as an initial routine 
investigation.

Keywords: FNAC; Histopathology; Salivary gland swelling; Sensitivity; 

Taken

None

None

Original article

Balaprasanth J1, Vinod PB2

Associate Professor, 

Alappuzha, Kerala, India                                                                                                                                            

Email: pbdrvinod@gmail.com

srudy of Fine needle aspiration cytology 
and histopathological diagnosis of salivary 
gland swelling. J Sosc Surg Nep. 2022; 

1 Department of Plastic surgery, Christian 

India.

2

Alappuzha, Kerala,India    



Journal of Society of Surgeons of Nepal
J Soc Surg Nep. 2022;25(2)

www.jssn.org.np

Introduction
The salivary glands consist of the parotid, submandibular, 
sublingual, and minor glands. The minor salivary glands are 

salivary gland tumors.1

and the remainder is distributed between the sublingual 
and countless minor salivary glands.2 Major salivary gland 
tumors tend to be benign, whereas minor tumors tend to be 
malignant.3 

in the 1920s and quickly gained wide acceptance among 
clinicians due to the ease of its performance and its rapid 
diagnosis.4 FNAC is the main diagnostic tool used for the 

location and easy accessibility.  Due to the large variety 
of salivary gland neoplasms and the lack of tumor markers, 
diagnosing submandibular tumors is challenging for 
clinicians and pathologists.

The inherent morphological heterogeneity of the lesions, 

of the cytopathologist in reviewing and diagnosing the 
lesions alter the ultimate diagnosis, treatment protocol, and 
outcome.

able to distinguish benign from malignant lesions.11 FNAC 
can better identify malignancy than any other investigations 

of cases. FNAC for salivary gland lesions has been shown 

treating salivary gland pathologies12,13 and is simple, safe, 

many study-reports on the use of FNAC are available in the 
literature, those addressing populations from coastal areas 
attending rural medical colleges with no access to frozen 

between FNAC and histopathology in salivary gland 
swelling.

Methods

Committee and the Institutional Ethics Committee, this 
prospective study was launched. Patients attending surgery 
outpatient department with swelling in the neck and oral 

were conducted to identify salivary gland swelling. Data 
were obtained using a pre-structured proforma after the 
study participants gave their written informed consent. 

2019. The study enlisted the participation of 80 patients.
Male and female patients with salivary gland swelling 

patients subjected to FNAC followed by surgery and 

swelling were included. Patients below age 13 are referred 
to pediatric surgery, so they were not included. Patients 

Patient histories were collected and detailed clinical 

nerves, skin, or bone, a CT scan was also done. In cases 

were done prior to FNAC. In straightforward cases, FNAC 

our institution, so it was not utilized in our study.

After consent was obtained, aspiration was done directly 
on the percutaneous or transoral root as an operative 
procedure. All the aspiration was done by the same team 

by the same team of cytopathologists. The aspirate was 
obtained under aseptic conditions with a 23-gauge needle 

needle was passed in multiple directions without taking 
it out of the tumor, and for large tumors, aspiration was 
done at various sites. Smear-prepared on multiple slides 

Papanicolaou’s stain. After the FNAC report was obtained, 
patients were re-evaluated, and additional investigations 
like a CT scan were conducted for selected cases, after 
which patients were subjected to surgery with a proper 
anesthesia check-up. For all cases, informed written 
consent was obtained. Since there is no facility for the 
frozen sections in our center, surgery for the swelling was 

scan report. Specimens were assessed by post-operative 
histopathological evaluation. Cytologically benign 

swelling arising from the deep lobe. For cytologically 
malignant cases, total parotidectomy with removal of 
the lymph nodes was done. For submandibular swelling, 

the gland with removal of the lymph nodes and adjacent 
structures was done in indicated cases. For minor salivary 

Cytological diagnosis and histopathological diagnosis 

predictive value, and negative predictive value of FNAC 
were calculated, and the diagnostic accuracy of FNAC 
was assessed.

Comparative study of Fine-Needle Aspiration Cytology and Histopathological diagnosis of salivary gland swelling



Journal of Society of Surgeons of Nepal
J Soc Surg Nep. 2022;25(2)

www.jssn.org.np
48

Results
Eighty patients with salivary gland swelling subjected 
to FNAC followed by surgery and histopathological 

duration of swelling ranged from 3 months to 15 years; the 
Table 

1

cystic carcinoma. After FNAC, no patients had major 

site, and three showed bruising at the site.

In the postoperative histopathological diagnosis, out 

the same diagnosis as FNAC and three cases showed 

cases of mucoepidermoid carcinoma, four showed the 

adenoid cystic carcinoma, three showed the same diagnosis 

Table 3

False-positive cases included one mucoepidermoid 
carcinoma of the parotid gland in a 45-year-old male 
who underwent total parotidectomy that proved to be a 

55-year-old female proved to be a pleomorphic adenoma. 
False-negative cases were two cases of pleomorphic 
adenoma, one from the parotid gland and one from the 

adenoma and mucoepidermoid carcinoma, respectively. 
For the former, since it arose from the deep lobe, the patient 
underwent total parotidectomy. For the latter, arose from 

malignancy.

Age Total Female Male
3 2 1

3 3
21 12 9
24 14 10
19 10 9

4 3
Total 80 45 35

The male: female ratio was 1:1.28.

Site Number Percentage
Parotid
Submandibular 20
Minor salivary 
gland

1 1.25

Discussion
Salivary gland swelling in male and female patients 

the study. The highest number of patients was seen in the 

1:1.28, consistent with a study that claimed that salivary 
gland lesions are more common in females.11

In our study, the frequency of swelling in the parotid, 

results of the majority of previous studies. Most patients 
had a history of a gradually increasing mass of variable 
duration. Facial nerve involvement was seen in one case, 

and lymphadenopathy was seen in two cases. Most of the 
instances of malignant swelling were clinically similar 
to those of benign swelling, so the primary challenge of 

of malignancy.14



Journal of Society of Surgeons of Nepal
J Soc Surg Nep. 2022;25(2)

www.jssn.org.np
49

et al,

15 
In our study using FNAC, pleomorphic adenoma was the 

and mucoepidermoid carcinoma was the most common 

corroborate with those of a study conducted in Pakistan 
on 129 cases of parotid gland lesions.23 In our study 
using FNAC, neoplastic, benign, and malignant lesions 

is comparable with other studies, in which the percentages 
24 

Among the benign cases, pleomorphic adenoma was the 

common benign and malignant tumors were pleomorphic 
adenoma and mucoepidermoid carcinoma, respectively. 
These results agree with those of Pratap and Jain,25 Panchal 
and Shah,
 

cases were reported in the study. False negatives have 
been reported in various studies, with rates ranging 

 In this study, there was one case 
of mucoepidermoid carcinoma and one case of carcinoma 

as pleomorphic adenoma by FNAC. FNAC can quite 
easily diagnose pleomorphic adenoma, but occasionally, 

adenoma from mucoepidermoid carcinoma, adenoid cystic 
28

 
There were two occurrences of false positives. The 

carcinoma of the parotid gland. The patient underwent total 
parotidectomy, and pleomorphic adenoma was diagnosed 

substance of pleomorphic adenoma could be misinterpreted 

may indicate low-grade mucoepidermoid carcinoma or 
mucoepidermoid carcinoma originating in the pleomorphic 
adenoma.29 Because the morphological patterns of 
epithelial components show diversity in both pleomorphic 
adenoma and low-grade mucoepidermoid carcinoma, 

Cases N(%) (FNAC) Same HPR Discordant Cases Total Cases 
HPR

Pleomorphic adenoma 44 3

Chronic sialadenitis 8 2 Pleomorphic adenoma: 2
8 0 -

Cystic lesions 4 4 0 -
Mucoepidermoid carcinoma 4 1

Acinic cell carcinoma 2 0 -
Adenoid cystic carcinoma 3 1

adenoma
0 0 0 -

Total 73 7 -

Test Evaluated 
(FNAC)

Histopathology 
Positive

Histopathology 
Negative

Total

FNAC positive 9 2 11

FNAC negative 2

Total 11 69

Comparative study of Fine-Needle Aspiration Cytology and Histopathological diagnosis of salivary gland swelling



Journal of Society of Surgeons of Nepal
J Soc Surg Nep. 2022;25(2)

www.jssn.org.np
50

aspirated material lacking the stromal component may 
result in a false-positive diagnosis. This misdiagnosis can 
be avoided by using multiple samples.

For the second false positive, the cytological diagnosis 
indicated adenoid cystic carcinoma arising from the 
parotid gland. CT scan showed swelling arising from 

parotidectomy. The histopathological report showed 

between adenoid cystic carcinoma and pleomorphic 

acellular material and hyaline globules. The hyaline 
globules characteristic of adenoid cystic carcinoma may 
also be seen in pleomorphic adenoma.  The stromal 
component of pleomorphic adenoma may thus be 
misinterpreted as basement membrane-like material seen 
in adenoid cystic carcinoma. 

There were two false-negative cases in the parotid gland, 
both of which were diagnosed as pleomorphic adenoma by 

in many studies. In a study by Kotwal et al, three out of 
four mucoepidermoid carcinomas were diagnosed as 
pleomorphic adenoma cytologically.

adenoma, for which the cytological diagnosis was 
pleomorphic adenoma. This misdiagnosis is of great 
clinical importance since this malignancy is very 

problem was emphasized in a study by Klijanienko et 

salivary gland swelling.38

value, negative predictive value, and accuracy were 

those of most previous studies because we had a limited 
able 

oversaw the cytology division. Additionally, more than 

site aspiration and repeated aspiration are usual practices. 
These could be the reasons for this study’s high accuracy 

Inadequate aspirate or sampling errors remain important 
limitations of this technique and impose a great demand 

limitation in the number of malignant cases can contribute 
to the drawbacks of FNAC. This can be overcome by 
conducting studies with larger samples. 

authors to reduce non-diagnostic aspiration due to false 
positioning of the needle outside the tumor or in the 
necrotic, hemorrhage, and cystic area. According to 
Brennan et al,5 clinically suspicious cases should be re-
evaluated using appropriate imaging techniques and 
FNAC should be repeated under ultrasound guidance 

cytopathologist. 

Conclusion
   

used for the preoperative evaluation of patients with salivary 

procedure with no major complications. It can be done as 
an outpatient procedure with good patient compliance and 
can be repeated if necessary. It is, therefore, of immense 
value in the diagnosis of benign and malignant lesions. 
FNAC provides a more rapid and accurate diagnosis of 
salivary gland swelling than any other test. 

Authors No. of Cases Accuracy
31 50

33
93.84

Naz, Hashmi, Khurshid et al. 
30

83.3

Present study 80 95

Authors Year of 
Study

Sensitivity 
(%) (%)

Sikdar, Sriram, & 
Ivan31 

2018 100 85

Naz, Hashmi, 
Khurshid et al.30

2015

Poudel, Shrestha, & 2020 90.32

Present study
2019

81.82



Journal of Society of Surgeons of Nepal
J Soc Surg Nep. 2022;25(2)

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51

 References

1. Leegaard T, Lindean H. Salivary gland tumors: 

2. Nagarkar NM, Bansal S, Dass A, Singhal SK, Mohan 

3. Epker BN, Henry FA. Clinical histopathologic and 
surgical aspects of intraoral minor salivary gland 

4. 
rapid microscopical diagnosis of tumors. Br J Surg. 

5. Brennan PA, Davies B, Poller D, et al. Fine needle 

repeat aspiration provides further information in 
cases with an unclear initial cytological diagnosis. 

needle aspiration cytology in salivary glands lesions. 

show wide variation in reporting of study population 

8. 

for diagnosing salivary gland tumors. J Pathol Transl 

9. 

509.
10. 

a comprehensive review. Diagn Cytopathol. 

11. 

12. 

13. 

14. 
epithelial parotid tumors. J Coll Physicians Surg 

15. 
the diagnosis of salivary gland swellings. Kathmandu 

MH. Diagnostic reliability of FNAC for salivary 
gland swellings: a comparative study. Diagn 

aspiration cytology in diagnosis of salivary gland 
lesions: a study with histologic comparison. 

18. 

parotid gland masses: a clinicopathological study of 

19. 
aspiration cytology in parotid lumps. J Pak Med 

20. Mihashi H, Kawahara A, Kage M. Comparison 

diagnosis and histopathological diagnosis of salivary 

21. Chakrabarti S, Bera M, Bhattacharya PK. 

aspiration cytology and histopathology along 
with immunohistochemistry. J Indian Med Assoc. 

22. 
Pilotti S. Fine needle aspiration of parotid masses. 

23. Ali NS, Akhtar S, Junaid M, Awan S, Aftab K. 

24. 
Fine needle aspiration biopsy of the salivary glands. 

25. 
salivary gland tumors - a hospital-based study. Inter 

comparative study of salivary gland lesions at 

gland lesions with histopathological correlation in 
a district hospital of Jammu region. Indian J Pathol 

28. 

29. 

30. Naz S, Hashmi AA, Khurshid A. Diagnostic role 

evaluation of salivary gland swelling: an institutional 

Comparative study of Fine-Needle Aspiration Cytology and Histopathological diagnosis of salivary gland swelling



Journal of Society of Surgeons of Nepal
J Soc Surg Nep. 2022;25(2)

www.jssn.org.np
52

31. 
histopathological correlation of salivary gland 

32. 

33. 

34. 

35. Qizilbash AH, Sianos J, Young JE, Archibald SD. 
Fine needle aspiration biopsy cytology of major 

Khandekar MM, Kavatkar AN, Patankar SA. FNAC 
of salivary gland lesions with histopathological 

preoperative diagnosis or a cytopathologist’s riddle. 

38. 

adenomas: diagnostic pitfalls and clinical 


