JSSN_vol25i2-cut.pdf www.jssn.org.npJournal of Society of Surgeons of Nepal J Soc Surg Nep. 2022;25(2) Abstract Ethical Clearance: Financial aid: Authors retain copyright and grant the journal right 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) www.jssn.org.np 51 References 1. Leegaard T, Lindean H. 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