涎腺肿块的细针吸取细胞学诊断研究

目的 通过对细针吸取细胞学(fine needle aspiration cytology,FNAC)与病理诊断的比较,评价本组细针吸取细胞学在涎腺肿块术前诊断的价值.方法 采用"友谊式"细针穿刺器,对81例涎腺肿块进行FNAC检查,将其结果与术后组织病理结果对照,得出FNAC诊断准确率,同时计算微小组织病理学诊断的准确率.结果 本组FNAC定性诊断准确率达92.59%,误诊率7.41%;组织学分类完全符合率达67.90%,基本符合率24.69%,不符合率7.41%;微小组织病理学诊断准确率达85.71%,误诊率14.29%.结论 FNAC对涎腺肿块的定性诊断的准确性较高,对术前诊断有重要的参考意义.由于FNAC诊断不同类型涎腺肿块的完全符合率不同,其临床可参考性也不同.     

Fine needle aspiration cytology of salivary gland lesions

247 salivary gland lesions were subjected to fine needle aspiration (FNA) cytology; 179 were designated as neoplastic lesions and 68 as non-neoplastic. Based on cytomorphologic features, the neoplastic and non-neoplastic lesions were subcategorised. All but 36 of the neoplastic lesions were subjected to histopathologic study. The overall diagnostic accuracy of FNA cytology for neoplastic lesions was 91%. The sensitivity rate for detecting malignant tumours was 87.8% and the specificity 98.0%. There was 100% sensitivity for cytodiagnosis of benign tumours. The high sensitivity and specificity of cytodiagnosis makes FNA cytology a valuable diagnostic modality in the evaluation of salivary gland lesions.     

Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions

J Oral Pathol Med (2012) 41 : 106–112 Background: Fine‐needle aspiration cytology (FNAC) is used as the main initial diagnostic investigation for lumps in the head and neck region. Major salivary glands and some minor salivary glands are easily accessible; therefore, they are optimal targets for FNAC. The aim of this study was to discuss the advantages and pitfalls of FNAC as compared to histopathology in the salivary gland lesions. Material and methods: A total of 127 FNAC were carried out on salivary gland lesions from January 2006 to December 2010 – a 5‐year period. Histopathological follow‐up data were obtained in 56 cases. The study was conducted to examine the sensitivity, specificity, and accuracy of FNAC for salivary gland swellings in comparison with histopathology. Results: The male‐to‐female ratio was 2.4:1. Parotid gland was involved in 51.1%, submandibular gland in 37%, sublingual gland in 4.7%, and minor salivary glands in 7% of patients. There were 55.9% cases of non‐neoplastic lesions and 44.1% cases of neoplastic lesions on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for malignant neoplastic lesions were 84.61%, 86.48%, 68.75%, and 94.11%, respectively, whereas for benign neoplastic lesions, they were 84.61%, 91.66%, 91.6%, and 85%, respectively. Conclusion: Fine‐needle aspiration cytology is found to be a good sensitive and specific technique for the diagnosis of most of the salivary gland lesions. FNAC should be adopted as an initial investigation for all salivary gland swellings in conjunction with other investigations where appropriate.     

The accuracy of fine needle aspiration cytology in the clinical diagnosis of minor salivary gland tumours

The objective of this study was to investigate the accuracy of fine needle aspiration cytology (FNAC) and biopsy for the clinical diagnosis of minor salivary gland tumours (MSGTs). This retrospective study of 32 MSGT cases was conducted over a 5-year period. Clinical features including age, sex, and location of the tumour were obtained from the patient clinical records. All cases were also assessed histologically according to the 2017 World Health Organization Classification of Head and Neck Tumours. The results of FNAC and biopsy were correlated with those of histopathology, and their sensitivity, specificity, and diagnostic efficacy were calculated using histopathology as the gold standard. Eighteen malignant MSGTs (56.3%) and 14 benign MSGTs (43.8%) were diagnosed by pathological diagnosis. The most common malignant tumour was mucoepidermoid carcinoma (seven cases, 38.9%). Most benign cases were pleomorphic adenomas (13 cases, 92.9%). FNAC was performed for 23 cases and biopsy for 13 cases. The sensitivity and specificity of FNAC were 66.7% and 91.0%, respectively, while those of biopsy were 90.0% and 100.0%, respectively. Although FNAC is a minimally invasive and cost-effective procedure, it is less accurate than biopsy in the assessment of MSGTs. Repeated FNAC or biopsy should be considered in negative and unsatisfactory FNAC cases.     

Evaluation of fine needle aspiration cytology in the diagnosis of cervical lymph node lymphomas

Purpose

Surgical biopsy examination is the gold standard for the diagnosis of lymph node lymphomas. Fine-needle aspiration cytology (FNAC) is a quick and safe method in the management of cervical lymph nodes. Its value in confirming recurrent or residual lymphoma is well established. However, its role in the primary diagnosis of lymph node lymphoma remains controversial. The aim of this study was to assess, in our experience, the reliability of FNAC in the diagnosis of cervical lymph node lymphomas.

Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours

The aim of this study was to determine the value of fine needle aspiration cytology (FNAC) and frozen section (FS) in the diagnosis of malignant parotid tumours. One hundred and thirty-eight patients who underwent FNAC and FS of a parotid tumour between 2006 and 2011 were analyzed retrospectively. The sensitivity, specificity, and positive and negative predictive values of FNAC and FS were determined using final histological diagnosis as the gold standard. Of the 138 tumours assessed in our study, 30 were malignant and 108 benign. For FNAC, the sensitivity was 73%, specificity 87%, positive predictive value 61%, and negative predictive value 90%. For FS, the sensitivity was 80%, specificity 98%, positive predictive value 92%, and negative predictive value 94%. Four false-negative results by FNAC were corrected by FS, and surgery was completed. Two false-positive results were identified by both FNAC and FS. FNAC is an important examination that provides valuable information for the preoperative diagnostic work-up and alerts the surgeon to the possible presence of malignancy. However, FNAC cannot be used alone, and FS has a very important place in the intraoperative management of parotid tumours.     

CT灌注成像与细针穿刺细胞学检查在涎腺肿瘤诊断中的应用

目的:探讨CT灌注成像与细针穿刺细胞学检查对涎腺肿瘤良恶性的鉴别诊断价值.方法:36 例涎腺肿瘤(腮腺26 例,下颌下腺8 例,舌下腺1 例,腭部1 例)患者,术前均行细针穿刺细胞学检查和CT灌注扫描,并取得相应的灌注参数:血流量(blood flow,BF),血容量(blood volume,BV),平均通过时间(mean transit time,MTT)和表面渗透性(permeability surface,PS),所有涎腺肿瘤术后均行病理检查.结果: 36 例患者中,最终病理确诊为涎腺恶性肿瘤者13 例,细针穿刺细胞学检查对恶性肿瘤检测的敏感性为84.6 %(11/13),特异性为95.7% (22/23),符合率为91.7%(33/36).CT灌注成像恶性肿瘤组BF、BV、PS值均高于良性肿瘤组(P<0.05),而2 组之间的MTT参数则无统计学差异(P>0.05).其诊断恶性肿瘤的敏感性为92.3%(12/13),特异性为86.9%(20/23),符合率为88.9%(32/36).细针穿刺细胞学检查假阴性的涎腺恶性肿瘤可通过CT灌注成像检查得到正确诊断.结论:CT灌注成像能提供涎腺肿瘤微循环灌注方面的信息,有利于肿瘤良恶性的鉴别,与细针穿刺细胞学检查并联应用,能够明显提高涎腺肿瘤诊断的准确性.     

Prognostic factors in malignant tumours of the salivary glands

Salivary gland tumours are a relatively rare group of lesions best managed in specialist centres. We review some of the factors that influence their prognosis. Clinical stage is the most important, with large malignancies having a poor prognosis regardless of histological grade and other features such as perineural invasion. Even high grade neoplasms may do well when they are small. A helpful guide to the management of salivary cancers is the “4 cm” rule.     

细针吸取细胞学在口腔颌颈部包块诊断中的应用

目的:探讨细针吸取细胞学检查(FNAC)对口腔颌颈部包块的诊断价值.方法:运用细针穿刺器对195例口腔颌颈部包块进行FNAC检查,并与包块切除术后病理组织学(HPD)的诊断结果进行对比.结果:FNAC检查定性诊断准确率90.8%,误诊率9.2%:HPD的结果与FNAC的组织学结果相比两者间无差异性(p＞0.05).FNAC检查后无并发症发生,也未发现肿瘤转移与复发.结论:细针穿刺器吸取细胞对口腔颌颈部包块诊断具有安全,简便等优点,有较高的诊断准确率.     

下颌切迹入路细针穿吸细胞学检查在面侧深部肿物诊断中的应用价值

目的:评价经下颌切迹入路的细针穿吸细胞学检查(FNAC)在面侧深部肿物诊断中的应用价值。方法:应用细针穿吸方法,对40例面侧深部肿物患者进行细胞学检查。男24例,女16例;年龄3～75岁,平均年龄43.28岁。将细胞学检查结果与术后组织病理学检查结果或随访资料进行比较,计算FNAC诊断准确率及在区别肿瘤与非肿瘤、恶性肿瘤与良性病变上的敏感度和特异度。结果:FNAC诊断准确率为80.00%;诊断肿瘤与非肿瘤的敏感度为80.77%,特异度为100.00%,5例患者为假阴性,假阴性率为19.23%,假阳性率为0;诊断恶性肿瘤与良性病变的敏感度为80.00%,特异度为88.00%。3例患者为假阴性,假阴性率为20.00%,3例患者为假阳性,假阳性率为12.00%。结论:FNAC是一种安全性好,操作简单,患者易于接受的诊断方法,在不易做切除及切取活检的面侧深部肿物的定性诊断中有较高的准确率,能准确区别肿瘤与非肿瘤、恶性肿瘤与良性病变,为临床治疗提供依据。     

Immunohistochemical expression of epithelial cell adhesion molecule (EpCAM) in mucoepidermoid carcinoma compared to normal salivary gland tissues

ObjectivesMucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor which displays biological, histological and clinical diversity thus representing a challenge for its diagnosis and management. Epithelial cell adhesion molecule (EpCAM) is a transmembrane glycoprotein identified as a tumor specific antigen due to its frequent overexpression in the majority of epithelial carcinomas and its correlation with prognosis. It is considered to be a promising biomarker used as a therapeutic target already in ongoing clinical trials. The purpose of this study was to investigate the pattern, cellular characterization and level of EpCAM expression in MEC and demonstrate its correlation with histologic grading which may benefit future clinical trials using EpCAM targeted therapy.Materials and methods48 specimens (12 normal salivary gland tissue and 36 MEC) were collected and EpCAM membranous expression was evaluated by immunohistochemistry. Total immunoscore (TIS) was evaluated, the term ‘EpCAM overexpression’ was given for tissues showing a total immunoscore >4.ResultsA highly significant difference was observed between TIS percent values in control and different grades of MEC (p < 0.001). High grade MEC (HG-MEC) was the highest EpCAM expressor. In addition, EpCAM expression pattern differed among the different grades.ConclusionEpCAM expression was detected in MEC, and its overexpression correlated with increasing the histological grade. The diffuse membranous expression in HG-MEC could be of diagnostic value in relation to the patchy expression observed in both low grade and intermediate grade MEC.     

应用细针穿刺制作细胞块技术诊断腮腺区肿块的临床意义

目的 探讨超声引导下细针穿刺制作细胞块在诊断腮腺区肿块方面的应用价值。方法在彩色超声仪引导下,对285个腮腺区肿块进行细针穿刺,将穿刺标本制成细胞块,以进行病理学诊断。对非肿瘤性肿块采取保守治疗,囊肿与肿瘤性肿块采取手术治疗。对术后病理确诊为腺样囊性癌（ACC）与多形性腺瘤（PA）对应的细胞块行干细胞因子受体CD117免疫组织化学检测。结果标本制作满意率为95.1%（271/285）,诊断准确率为94.5%（256/271）;诊断敏感度为87.0%（67/77）,特异度为98.1%（157/160）。CD117在ACC中的阳性表达率为95.2%（20/21）,在PA中为20.3%（25/123）,ACC中阳性表达率明显高于PA,二者差异有统计学意义（P<0.01）。结论超声引导下腮腺区肿块细针穿刺制作细胞块结合分子标志物检测,对腮腺区肿块的诊断具有重要意义。     

磁共振导航下细针穿吸诊断头颈深部肿块的应用价值

目的:评价磁共振导航下细针穿吸诊断头颈深部肿块的应用价值。方法:对12例头颈深部肿块患者行磁共振导航定位引导下细针穿吸细胞学检查,男9例,女3例,年龄15-63岁。肿块位于颞下窝6例,腮腺深叶3例,翼下颌间隙2例,咽旁间隙1例。结果:所有12例肿块经磁共振导航下穿吸针均显示达到肿块中心;穿吸细胞学检查6例与术后病理符合,1例不符:另5例穿吸细胞学为炎症,未进行手术探查,现随访正常。穿吸诊断准确率为91.67％,敏感度为80％,特异度为100％;穿吸过程中无明显并发症。结论:磁共振导航下细针穿吸细胞学检查是一种定位准确、诊断准确率高且安全的检查方法,尤其适应于头颈部深部肿块的诊断。     

Androgen receptor in salivary gland carcinoma: A review of an old marker as a possible new target

The role of the androgen receptor (AR) as an immunomarker for diagnosis of salivary gland duct carcinoma (SDC) is well known. Other non‐squamous cell head and neck cancers (NSCC‐HN), including a small subset of salivary gland cancers (SGCs), can also express AR. With the increase in effective and powerful new generation of anti‐androgen agents and drugs administered orally, more targetable AR‐driven NSCC‐HN, such as subsets of SGCs, should be investigated for possible expression of AR. In this review, we focus on SGC subtypes, which could express AR and describe the main androgen deprivation therapy (ADT) strategies.     

The prognostic implications of comorbidity and risk factors for (post)operative complications,days spent in the intensive care unit (ICU), and length of hospitalization in patients with oral squamous cell carcinoma: A prospective study

BackgroundThis study aimed to investigate the prognostic implications of comorbidity/risk factors in a cohort of patients with OSCC.MethodsThe prospective study included patients with biopsy-proven primary OSCC. The impact of potential predictors on (post)operative complications, days spent in the ICU, and length of hospitalization was analyzed using both univariate and multivariate analysis.ResultsUsing a microvascular free flap (p = 0.009) and tobacco abuse (p = 0.005) had statistically significant impacts on postoperative complications in univariate, but not in multivariate, analysis. The duration of anesthesia (p < 0.001), type of neck dissection (p = 0.014), reconstruction type (p < 0.001), and red blood cell transfusion during operation (p = 0.007) had statistically significant impacts on spending ≥ 3 days in ICU in univariate analysis, with reconstruction type (p = 0.022) and red blood cell transfusion during operation (p = 0.034) having similar impacts in multivariate analysis. The duration of anesthesia (p < 0.001), pT (p = 0.009), type of neck dissection (p = 0.046), reconstruction type (p < 0.001), and microvascular free flap (p < 0.001) had a statistically significant impacts on length of hospitalization in univariate analysis, with reconstruction type (p < 0.001) also having a significant impact in multivariate analysis.ConclusionNone of the investigated variables showed a significant effect on the prediction of (post)operative complications according to the Clavien-Dindo classification. The type of reconstruction proved to be a valid predictor for the time spent in ICU as well as for the overall length of hospitalization. Red blood cell transfusion during operation further predicted the time spent in ICU after operation. Both variables should be taken into account when performing a comprehensive planning of the patients’ hospitalization.     

Dental disease before radiotherapy in patients with head and neck cancer: Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients

Background

No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in patients with head and neck cancer (HNC). An ongoing multicenter, prospective cohort study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), is addressing this knowledge gap. The authors evaluated the level of dental disease before RT in the OraRad cohort, factors associated with dental disease, and dental treatment recommendations made before RT.

Clinical outcomes and cost-effectiveness of superficial parotidectomy versus extracapsular dissection of the parotid gland: a single-centre retrospective study of 161 patients

Improvements in preoperative diagnostics and intraoperative techniques have made the surgical excision of benign parotid gland tumours less invasive. Extracapsular dissection (ECD) has become more popular in comparison to superficial parotidectomy (SP), the gold standard. Although clinical outcomes have been reported, reports on cost-effectiveness are limited. The aim of this retrospective study was to analyse the surgical outcomes and cost-effectiveness of ECD versus SP in benign parotid tumour surgery. A retrospective cohort of 161 patients treated between 2012 and 2020 was collected. Data concerning demographics, clinical outcomes, and cost-efficiency were recorded. Analysis of the 161 unilateral parotidectomy cases (59 SP, 102 ECD) showed a significantly longer operation time, anaesthesia time, and length of stay for SP patients (all P < 0.001). Regarding postoperative complications, transient facial nerve weakness (P < 0.001) and haematoma formation (P = 0.016) were more prevalent in the SP patients. The frequency of positive margins was lower for SP (P = 0.037). No case of recurrence was identified with either technique. ECD showed excellent clinical outcomes as well as a reduction in complications when compared to SP. ECD is a viable alternative for superficial benign parotid gland tumours after thorough preoperative clinical, pathological, and radiological examination. The reduction in operation, anaesthesia, and hospitalization times with ECD is likely to result in a gain in cost-effectiveness.