Wertigkeit der Feinnadelpunktionszytologie bei Neoplasien der Glandula parotis

BACKGROUND: In many parts of Germany fine-needle aspiration biopsy (FNAB) is still not part of the routine preoperative diagnostic evaluation of salivary gland neoplasms. Most opponents consider the study unnecessary and recommend that all salivary gland neoplasms should be excised. OBJECTIVE: Because of this an evaluated the ability of FNAB to provide an accurate diagnosis of parotid gland neoplasms. PATIENTS AND METHOD: Between January 1992 and October 1995, 336 patients referred for operative therapy of salivary gland neoplasms underwent retrospective analysis of preoperative FNAB compared with the excised tumor histology. RESULTS: Results showed that the FNAB had a sensitivity of 93.1%, a specificity of 99.2%, a positive predictive value of 93.1%, a negative predictive value of 99.2% and an accuracy of 98.6%. Complications were observed in less than 1%. DISCUSSION: Our findings demonstrated that the FNAB is a safe diagnostic tool that has a reliable sensitivity and high specificity for the assessment of salivary gland pathology. Since many malignant salivary gland neoplasms present with a virtual lack of symptoms indicating actual malignancy we believe that there is need for FNAB in routine preoperative diagnostic testing.     

The role of fine needle aspiration biopsy in deep lobe parotid tumors: Comparison of preoperative cytology and postoperative histopathologic results

PurposeMajor salivary gland tumors constitute almost 3% of head and neck tumors. Tumors located exclusively in the deep lobe are not common and 20% of parotid gland tumors originate from deep lobe under the branches of the facial nerve. Accuracy of fine needle aspiration biopsy (FNAB) procedure in salivary gland tumors have been studied extensively, however there isn't any data regarding usefulness of FNAB in tumors located exclusively in deep lobe of parotid gland. In this study we aimed to assess the use of FNAB in deep lobe parotid tumors.Materials and methodsWe retrospectively analyzed 51 patients with deep lobe parotid tumors who underwent surgery in our clinic between January 2013–December 2018. Characteristics of patients were recorded. Preoperative FNAB results and postoperative final histopathologic diagnosis were compared. Statistical analysis was performed using SPSS 24.0 was used for statistical analysis.ResultsThe number of patients that met the inclusion criteria was 51. The mean age of patients were 49.2(14–86). In 40 (78.4) of the patients, tumor was reported as benign and in 11 (21.6) patients FNAB diagnosis was suspicious for malignancy, malignant or non-diagnostic. In final histopathologic diagnosis, 42 of the tumors were benign and 9 were malignant. The most common benign tumor type was pleomorphic adenoma which constitutes 27 of the cases (52.9%). Regarding detection of malignant disease, the sensitivity of FNAB was 90.4%, specificity was 77.7%, positive predictive value was 95%, negative predictive value was 63.6%. There was a substantial agreement between FNAB and final histopathologic diagnosis(kappa = 0,628).ConclusionsFNAB is a safe and reliable tool to evaluate deep lobe parotid tumors. It is an important part of preoperative surgical planning and can help the surgeon in patient counseling. FNAB with ultrasound guidance is recommended for deep lobe tumors.     

Parotid tumours: correlation between fine needle aspiration biopsy and histological findings

ObjectivesTo evaluate the role of the fine needle aspiration biopsy (FNAB) in the study of parotid masses.MethodsRetrospective review of FNAB results compared with final histological diagnosis in 148 patients with a parotid mass from 1993 to 2003.ResultsFNAB was performed in 93.92% of parotid masses. Eleven of these were not conclusive. The FNAB diagnosis of malignant o suspicious lesion had 81.25% of sensibility, 96.87% of specificity and positive and negative predictive values of 89.65% and 93.94%, respectively. The FNAB specific histopathologic diagnosis in the benign parotid masses were 92%, and 57.69% in the malign masses.ConclusionsFNAB is a diagnostic tool with a high negative predictive value, very usotul in the study of suspicious malignant parotid masses and whenever surgery is not possible.     

Diagnostic value of needle biopsy and frozen section histological examination in the surgery of primary parotid tumors

The necessity of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of parotid gland lesions is still controversial. We examined the accuracy of cytology and histology in a review of 128 parotid gland tumors who underwent surgery with FNAB, n = 102 and/or frozen section examination (FS), n = 94. The diagnostic sensibility and specificity for malignant or benign lesions was respectively 81.5% and 97.5% for FNAB and 75% and 100% for FS as compared with definite histology (110 tumors were benign and 18 malignant). Insufficient material for FNAB evaluation was found in 12 patients mainly with small tumors (p = 0.043) or with tumors located in the deep process of the parotid gland (p = 0.029). Surgery was inappropriate (superficial lobe resection for malignant tumor) because of 4 false negative FS diagnoses. FNAB offers valuable information in the diagnosis of nonsurgical lesions and permits to avoid FS if FNAB identify a benign lesion. FS remains mandatory if FNAB evaluation is not possible or suggests a neoplastic tumor.     

Transmucosal fine-needle aspiration diagnosis of intraoral and intrapharyngeal lesions.

OBJECTIVES: The effectiveness of fine-needle aspiration biopsy (FNAB) for the diagnosis of neck, thyroid, and salivary gland masses is well documented. Very few reports explore the potential of an intraoral FNAB approach for the diagnosis of submucosal lesions. We describe our technique and present case examples of pertinent differential diagnostic entities. We recommend an expanded role for FNAB of the oral cavity and oropharynx. STUDY DESIGN: Retrospective review. METHODS: A uniform technique was employed for transmucosal FNAB of 76 patients with intraoral masses. In applicable cases, cytology results were compared with traditional biopsy methods and permanent histopathologic specimens for accuracy. RESULTS: Our experience demonstrates the high sensitivity (93%) and specificity (86%) of intraoral FNAB when compared with biopsy by conventional means. FNAB provides distinct advantages for the cytologic diagnosis of submucosal lesions, which may be difficult to reach and adequately sample through conventional biopsy. FNAB of the tonsil and tonsillar fossa provides a safe and effective means of diagnosing both lymphoma and squamous cell cancer. Transmucosal FNAB via the mouth led to rapid diagnosis of a number of benign and malignant lesions. Applying this uniform FNAB technique, we had no significant complications. CONCLUSION: We recommend transmucosal FNAB as an effective means for highly accurate diagnosis of submucosal lesions of the oral cavity and oropharynx. CLINICAL RELEVANCE: Traditional biopsy techniques in the oral cavity may require anesthesia and may have diagnostic difficulties, particularly for submucosal lesions. Transmucosal FNAB overcomes these shortcomings by providing a minimally invasive means to rapid diagnosis of intraoral lesions.     

Clinical significance of fine-needle aspiration biopsy in major salivary gland tumors

We compared preoperative evaluations of 93 fine-needle aspiration biopsies (FNAB) of major salivary gland tumors done over a 5 year period with pathologic diagnoses of surgically resected specimens. The overall accuracy was 88.5%. Eight of 15 aspirates from malignant tumors were correctly diagnosed by FNAB, for a sensitivity of 53.3%, while 69 of 72 aspirates from benign tumors were correctly diagnosed by FNAB, for a specificity of 95.8%. Five malignant tumors diagnosed as benign by FNAB were squamous cell carcinoma, carcinoma in pleiomorphic adenoma, malignant lymphoma, low-grade mucoepidermoid carcinoma, and acinic cell carcinoma. The false negatives in the first 2 cases appeared to be due to inaccurate placement of the aspiration site. The other 3 cases showed lack of atypia, leading to a benign diagnosis. Malignant lymphoma is difficult to diagnose as malignant, even in properly aspirated specimens, so we recommend open biopsy when malignant lymphoma is suspected from physical and radiological examinations. A case confirmed pathologically as benign myoepithelioma was diagnosed as adenoid cystic carcinoma preoperatively, based on the finding of a cribriform pattern containing mucin. It should be borne in mind that myoepithelioma and adenoid cystic carcinoma are difficult to distinguish by FNAB. Although FNAB is useful in diagnosing major salivary gland tumors, its low sensitivity (high percentage of false negatives) is undesirable. It may thus be helpful in intraoperative decision-making when combined with frozen sectioning.     

Accuracy of fine-needle aspiration biopsy for Warthin's tumours

BACKGROUND: Although the overall accuracy of fine-needle aspiration biopsy (FNAB) for salivary gland neoplasms has been well established, definitive results for Warthin's tumour (WT) are lacking. For most salivary gland tumours, surgery is recommended because of progressive enlargement and the risk of malignant transformation. This behaviour is unusual with WT, and surgery is usually advocated for pathologic confirmation. A highly accurate diagnosis of WT by FNAB may justify conservative management for the asymptomatic patient. However, if the reliability of this diagnostic procedure is questionable, there should be little hesitation in recommending parotidectomy. METHODS: A retrospective study design was used to evaluate the accuracy of FNAB for parotid WTs. All consecutive parotid FNABs and parotidectomy specimens from 1992 to 2000 were reviewed, and cases suggestive of WT were identified. The fine-needle cytology and histopathology results were then correlated. The true-positive, false-positive, and false-negative rates were tabulated to determine the sensitivity and positive predictive value (PPV) of FNAB for WT. RESULTS: A total of 41 patients were included in the study. Of these, 33 patients had FNABs suggestive or diagnostic of WT that were confirmed following parotidectomy (true positives = 33). In 4 patients, the FNAB incorrectly suggested WT, with the surgical histopathology confirming different diagnoses (false positives = 4) (3 acinic cell carcinomas and 1 pleomorphic adenoma). Four patients had surgically confirmed WTs with FNABs suggestive of other diagnoses (false negatives = 4) (1 cystic squamous cell carcinoma, 1 simple cyst, 1 "inflammatory process," and 1 "negative for malignant cells"). The sensitivity and PPV were 89.2% and 89.2%, respectively. CONCLUSION: Although the sensitivity and PPV in this study are high, the false-positive rate is clinically significant given the type of lesions missed. Three acinic cell carcinomas and one pleomorphic adenoma were misdiagnosed as WT on FNAB. One must be cautious in recommending conservative management for parotid tumours even when a WT is suggested by FNAB.     

The value of fine-needle aspiration cytology in salivary gland lesions, 1994-2004

OBJECTIVE: Fine-needle aspiration cytology (FNAC) of the salivary gland is a commonly accepted, sensitive and specific technique in the diagnosis of both neoplastic and nonneoplastic lesions of the salivary gland. The aim of this study was to investigate the efficacy of FNAC of salivary gland lesions and to decide whether the radiologist could perform it or not. METHODS: We aspirated 162 salivary gland lesions of 56 patients undergoing biopsy and excision. A cytopathologist and a surgical pathologist made histopathological and cytological examinations in a blinded fashion. RESULTS: In the present study, among the FNAC performed in 162 patients with salivary gland masses, 15 (9%) were inadequate, and the remaining 147 were diagnostic. Of the 162 cases, 56 (35%) were also checked histologically. With FNAC there were 89 (55%) nonneoplastic and 58 (36%) neoplastic lesions. With FNAC 45 of the neoplastic lesions were benign and 13 malignant tumors. When cytohistopathological correlation was performed, the overall accuracy in diagnosing benign and malignant lesions was 91 and 78%, respectively, except for 2 malignant lymphoma cases. The sensitivity and specificity for benign and malignant lesions were 72 and 100%, respectively. The diagnostic sensitivity for all neoplastic and nonneoplastic lesions was 84% and the specificity 92%. There was 1 false-positive result, in which a nonneoplastic lesion was misdiagnosed as a Warthin's tumor. Fifteen (26%) cases were false-negative, 12 of which were undefined. CONCLUSION: FNAC is a useful and reliable tool in the diagnosis of salivary gland masses when performed by a radiologist or a clinician. There are no contraindications, and complications are minimal.     

Salivary gland tumors. Fine-needle aspiration vs frozen-section diagnosis

We examined the relative accuracy of fine-needle aspiration biopsy (FNAB) and frozen section (FS) in the diagnosis of salivary gland tumors; FNAB completely and accurately diagnosed 35 (88%) of 40 cases, including ten (100%) of ten nonneoplastic lesions, 20 (87%) of 23 benign, and five (71%) of seven malignant tumors. No complications were encountered with this procedure. These results compare favorably with previously published reports. Twenty-one of 40 tumors diagnosed by FNAB and FS at surgery. Sixteen (76%) of 21 of these were correctly diagnosed by FNAB, and 15 (71%) of 21 by FS. Cystic lesions gave the most diagnostic difficulties both on FNAB and FS. Worldwide, FNAB has been demonstrated to be a cost-effective, accurate, and safe procedure. Furthermore, the use of FNAB allows for better preoperative management and overall treatment planning.     

A study of salivary gland aspiration cytology reporting: guideline validity

We retrospectively reviewed 44 cases of major salivary gland lesions surgically resected following preoperative fine-needle aspiration cytology (FNAC). Our objective was to determine the validity of the salivary gland FNAC reporting proposed in 2004 by the Japanese Society of Clinical Cytology. Of the 44 lesions, 33 were in the parotid gland and 11 in the submandibular gland. Of these, 8 lesions were malignant. Two from benign lesions could not be satisfactorily evaluated, and 4 from benign lesions and 1 from a malignant lesion were indeterminate. Results were 3 true positive, 30 true negative, and 4 false negative, with no false positive results. Calculated sensitivity was 42.9% (4/7), specificity 100% (30/ 30), and accuracy 89.2% (34/37). We concluded that using the new reporting decreases ambiguity in clinicians' interpretation of cytology reports, thus benefitting subjects.     

Fine needle aspiration biopsy: role in diagnosis of pediatric head and neck masses

OBJECTIVE: To assess the feasibility and role of fine needle aspiration biopsy (FNAB) as a diagnostic tool in children with neck masses. DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital. PATIENTS: Consecutive series of 71 children with a head and neck mass who underwent FNAB as the primary diagnostic modality. INTERVENTIONS: FNAB was performed and interpreted by a pediatric cytopathologist. Rapid on-site analysis was performed to allow immediate assessment of specimen adequacy and to attain a preliminary diagnosis, after which routine cytologic staining was performed. Flow cytometry was performed on cytological specimens when malignancy was suspected, and open biopsy was performed when the cytologic diagnosis was in question. MAIN OUTCOME MEASURES: Technical feasibility of FNAB in children, complications, cytopathological diagnoses, accuracy of rapid on-site analysis, need for subsequent diagnostic evaluations, clinical outcomes and follow-up. RESULTS: Mean age was 8.4 years (S.D. 5.3 years), with mean follow-up of 4.1 months (S.D. 9.6 months). FNAB was performed under general anesthesia in 54 cases (76%). There were no technical complications. On-site rapid interpretation was completed in 55 cases, 18/55 confirmed adequacy of specimen only, 37/55 yielded a preliminary diagnosis, and in 34/37 cases, was same as final cytopathologic result. Overall, FNAB biopsy demonstrated 64 benign lesions, 3 malignant diagnoses, 2 follicular thyroid neoplasms, and 2 non-diagnostic specimens. FNAB was the only pathological test performed in 54 (76%) cases. The most common diagnosis was reactive lymphoid hyperplasia (n=39), followed by benign granulomatous disease (n=8). Flow cytometry was performed on 7 specimens (non-diagnostic in 5, negative for malignancy in 2). Of the 15 cases with surgical specimens, 3 revealed a pathologic diagnosis different from initial FNAB. There were no cases in which FNAB missed a malignancy, and there were 2 cases where FNAB suggested malignancy, with benign disease subsequently found on open biopsy. CONCLUSIONS: Fine needle aspiration biopsy is developing into a feasible option in diagnosing pediatric neck masses, with its main advantage being its minimally-invasive nature and avoidance of an open surgical procedure for benign persistent lymphadenitis. On-site rapid interpretation can be used successfully to confirm specimen adequacy and to give an accurate preliminary diagnosis for concerned parents. Issues to consider include the need for a specialized pediatric cytopathologist familiar with pediatric differential diagnoses, the need for general anesthesia in many cases, and the possibility of inaccurate diagnosis requiring an open procedure.     

Value of of fine-needle aspiration cytology and MRI in parotid gland masses

INTRODUCTION: The objective of our study was to discuss the valve of fine-needle aspiration cytology (FNAC) and magnetic resonance imaging (MRI) in the diagnosis and treatment of parotid gland masses. MATERIALS AND METHODS: Forty patients were included in the prospective study. They had undergone clinical examination, FNAC and MRI before parotidectomy. The results of these examinations were compared with the corresponding histopathological diagnosis. RESULTS: When it is positive, FNAC is a good examination of malignant tumours (sensitivity 67%, specificity 79%, positive predictive value 86%, negative predictive value 100%). The MRI allows a good assessment of the tumoural mass and its anatomical relationships (sensitivity 55%, specificity 86%, positive predictive value 89%, negative predictive value 75%). If the T2 sequence shows reduced density (p < 0.05) or in case of bad limitation (p = 0.004), a malignant character is strongly suspected. CONCLUSION: In cases of parotid gland mass, where surgical intervention is necessary, there is no need of special investigations: however FNAC and MRI allow us to anticipate what operation will be required.     

Evaluation of clinician‐operated sonography and fine‐needle aspiration in the assessment of salivary gland tumours

Objectives: To evaluate the combination of ultrasound (US) + fine‐needle aspiration (FNA) in the assessment of salivary gland tumours in the hands of the otolaryngologist. Design: A retrospective review of case notes was performed. Setting: Two university teaching hospitals in Switzerland. Participants: One hundred and three patients with a total of 106 focal masses of the salivary glands were included. Clinician‐operated US + FNA were the first line of investigation for these lesions. All patients underwent surgical excision of the lesion, which allowed for confirmation of diagnosis by histopathology in 104 lesions and by laboratory testing in two lesions. Main outcome measures: Primary – diagnostic accuracy in identifying true salivary gland neoplasms and detecting malignancy. Secondary – predicting an approximate and specific diagnosis in these tumours. Results: The combination of US + FNA achieved a diagnostic accuracy of 99% in identifying and differentiating true salivary gland neoplasms from tumour‐like lesions. In detecting malignancy, this combination permitted an accuracy of 98%. An approximate diagnosis was possible in 89%, and a specific diagnosis in 69% of our patients. Conclusions: Due to economic factors and a high diagnostic accuracy, the combination of US + FNA represents the investigation method of choice for most salivary gland tumours. We suggest that the otolaryngologist be employed in carrying out these procedures, as is already the rule in other medical specialties, while computed tomography and magnetic resonance imaging should be reserved to those few lesions, which cannot be delineated completely by sonography.     

Fine needle aspiration biopsy of intra-osseous lesions of the mandible and maxilla

This study was done with an aim to assess the reliability and diagnostic accuracy of fine needle aspiration biopsy of intraosseous jaw lesions. Of the 42 cases, adequate material for cytologic evaluation was obtained in 35 cases. Malignant cells were found in 9 of 35 cases. FNAB diagnosis was confirmed by histopathology in all 9 of these specimens (100% accuracy). The FNAB diagnosis of benign lesions was confirmed in 19 of 26 cases (73% accuracy). The most common benign lesions were odontogenic cysts, followed by fibro-osseous and giant cell lesions. Incorrect diagnosis was related to lack of architectural context of the FNAB material, inadequate quantity of the aspirate and sampling of a non-representative part of a large lesion. Thus FNAB is a useful, simple, fairly reliable and outpatient procedure for diagnosis of intra-osseous jaw lesions, especially to distinguish between malignant and benign jaw lesions.     

Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions

PurposeTo assess the clinical value of ultrasound (US) and fine needle aspiration (FNA) of salivary gland lesions prior to surgery, for preoperative decision-making and long-term follow-up/outcome.Materials & methodsWe retrospectively analyzed the medical charts of 98 consecutive patients with major salivary gland lesions who were treated in a single medical from 2008 to 2017. Preoperative US and FNA was performed in all patients. Cytology results were compared with histopathological diagnoses. The correlation between preoperative US findings, cytology and histopathological diagnoses was assessed.ResultsTwenty-three specimens were histopathologically malignant, and 75 were diagnosed as benign. Three false-positive results diagnosed as malignant in cytology had a final histology of sialadenitis, pleomorphic adenoma and Warthin's tumor, respectively. In six cases, cytology yielded false-negative results. The overall accuracy of FNA in distinguishing benign from malignant lesions was 91%. Sensitivity was 70% and specificity 93%. There was no significant correlation between US features and final pathology, but larger size had some correlation with malignancy (p = 0.306). No complications were observed during or after performing FNA.ConclusionFNA from salivary gland lesions is safe and in many cases can help in preoperative decision making or surgical planning. Hence, the results of FNA cytology should have an integral role in clinical decision-making and management of major salivary gland lesions. False-negative results do occur and therefore should be used only as an adjunctive measure.     

Fine-needle aspiration cytology in the management of salivary gland tumors: an Australian experience

We conducted a retrospective study of 104 cases of salivary gland tumors that were initially assessed by fine-needle aspiration biopsy (FNAB). Based on subsequent histopathologic analysis of excised specimens, we found that preoperative FNAB was highly sensitive and specific for both benign and malignant tumors-including the most common, pleomorphic adenomas and squamous cell carcinomas, respectively. Despite its possible drawbacks, we conclude that preoperative FNAB is a useful tool in the management of salivary gland tumors.     

The radiologic work-up in thyroid surgery: fine-needle biopsy versus scintigraphy and ultrasound

To compare the effectiveness and predictive value of radiologic studies with fine-needle aspiration biopsy (FNAB) in correctly diagnosing thyroid lesions, we reviewed the medical records of 441 patients who had been treated surgically for thyroid disease from 1987 through 1999. We compared the results of thyroid scintigraphy, ultrasound, and FNAB with findings on final surgical pathology. The data were analyzed according to the chi-squared (chi 2) test. Of 189 thyroid scintigraphy scans that showed a hypofunctional (cold) nodule, 52 (27.5%) were found to be cancerous, and of 35 hyperfunctional (hot) nodules, two (5.7%) were malignant (sensitivity = 91%; specificity = 19%; accuracy = 38%; chi 2 = 7.67; p = 0.006). Of 66 ultrasounds that detected a solid or a mixed solid-cystic mass, 16(24.2%) were cancerous, while none of the eight sonograms that showed a purely cystic lesion was malignant (sensitivity = 100%; specificity = 14%; accuracy = 32%; chi 2 = 2.47; p = 0.116 [not statistically significant]). Of the 119 patients whose FNABs were diagnostic, 55 biopsies revealed follicular cells. Of the remaining 64 biopsies, cancer was correctly predicted in 35 of 44 patients (79.5%) and benign disease was correctly diagnosed in 18 of 20 patients (90.0%) (sensitivity = 95%; specificity = 67%; accuracy = 83%; chi 2 = 27.3; p = 0.00). We conclude that in the evaluation of thyroid lesions, FNAB is superior to imaging studies, which yield a relatively high rate of false-positive results.     

Fine-needle aspiration cytology in the diagnosis of salivary gland lesions. The role of the Milan system for reporting cytopathology

BackgroundFine needle aspiration cytology (FNAC) is an established technique in the management of salivary gland lesions. The Milan System for reporting salivary gland cytopathology (MSRSGC) intents to standardize diagnostic categories. Current studies are trying to evaluate the diagnostic approach of this system.MethodsFNAC of salivary gland lesions were retrieved over an 11-year period. 185 FNAC specimens from 182 patients were reviewed blindly and classified according to the criteria established by the MSRSGC. 136 (74.7%) patients had follow-up of their processes.ResultsThe total number of diagnostic categories and risk of malignancy (ROM) in 185 specimens were the following: non-diagnostic 39 (21.1%; ROM 12%), non-neoplastic 35 (18.9%; ROM 0%), atypia of undetermined significance (AUS) 17 (9.2%; ROM 46.1%), benign neoplasm 75 (40.5%; ROM 4.9%), salivary gland neoplasm of uncertain malignant potential 4 (2.2%; ROM 100%), suspicious for malignancy 7 (3.8%; ROM 100%), malignant 8 (4.3%; ROM 100%). No false positives were observed in groups IVb, V, and VI in this series. The overall sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy were 88%, 91.8%, 96.3%, 76.7%, and 91% respectively.ConclusionThe ROM reported in our study was in keeping with ROM published by the MSRSGC. This system provides standardized information for risk stratification. The category AUS encompassed cases causing uncertainty representing a challenge in management. Defining criteria for AUS category need to be refined. The system facilitates communication between pathologists and clinicians favoring improvement in patient care.     

The predictive value of dominant nodules and the management of indeterminate group in multinodular goiter

The objectives of this study were to determine the predictive value of dominant nodules (DNs) in multinodular goiters (MNGs), and to stratify the risk of malignancy within the indeterminate category. The study design was retrospective study of patients with MNG. A total of 140 patients were reviewed. Fine needle aspiration biopsy (FNAB) findings for all DNs were categorized into four groups: (1) benign, (2) positive or suspicious for malignancy, (3) indeterminate, and (4) non-diagnostic. All FNAB specimens of the indeterminate group were also evaluated for the presence of Hurthle cell metaplasia and were categorized according to the presence of cytological atypia. Cytohistological comparison was then performed. Mean number and diameter of the DNs were 1.45 and 25.6 mm, respectively. Based on final histopathology, 22.14% of the patients had thyroid malignancy and 74.2% of thyroid carcinomas were located in DNs. The number of DNs was significantly larger in malignant thyroid glands than in benign ones. In total, 22.6% of the indeterminate FNABs were malignant. FNABs of the indeterminate group that included atypical cells had a statistically significant higher incidence of malignancy. The presence of Hurthle cells was not statistically different in malignant and benign nodules upon final histological diagnosis. In conclusion, FNAB of only DNs in MNG could determine thyroid malignancy in 75% of patients. The DN number might be required for the predictive value of malignancy. A subclassification of the indeterminate group, based on the presence or absence of cytological atypia, is necessary to better assess the risk of malignancy.     

Chronic myoepithelial sialadenitis - symptomatology, clinical signs, differential diagnostics

In the differential diagnosis of mass lesions of the salivary glands, myoepithelial sialadenitis (MESA), i. e. benign lymphoepithelial lesion, carries particular importance because of its association with Sjoegren's syndrome and development of malignant lymphoma. In the present study, epidemiology and clinical findings were analysed in relation to presence of MESA, Sjoegren's syndrome and lymphoma development. MATERIAL AND METHOD: 67 patients, histopathologically classified by the salivary gland registry, were analysed retrospectively in regard to their clinical presentation, especially in regard to the chronical process of inflammation as present in MESA. RESULTS: MESA primarily affects women in the 5th and 6th decade and regularly the parotid gland; in 44.8 % of the cases, there is multiple organ presentation. Xerostomy (38.5 %) is usually present (in 88,9 % of all cases) before or at clinical onset of gland inflammation, whereas xerophthalmy (28.4 %) did not show such a correlation. In general, rheumatic diseases (23.9 %) precede the gland-symptoms in 77.8 % of the patients. In 31.3 % of the cases a Sjoegren's syndrome was present. 26.9 % of the patients developed a malignant Non Hodgkin's Lymphoma (88.9 % of the MALT-type). CONCLUSION: The most important clinical relevance of MESA lies in the higher probability to develop malignant lymphoma; this requires adequate staging-procedures and proper histopathological examination of sialogenic and nodal masses, especially over the course of the disease.