| Abstract: | Fine needle aspiration cytology (FNAc) plays a vital investigative tool in the diagnostic and management pathway of the benign and malignant salivary pathologies. The current practice guidelines dictate acquirement of the nature of the salivary gland disease prior to embarking on definitive surgery. FNAc is a rapid, relatively easy, non-invasive diagnostic tool with minimal complications that achieves this goal. The diagnostic adequacy and the accuracy of FNAc sampling depends on a variety of factors including the operator aptness, lesional characteristics and patient factors. Hence the reported sensitivity of salivary cytology is variable and broad. However, the reported specificity is >90%. The diagnostic accuracy of benign salivary gland lesions is very high globally, but the figures for malignant lesions are comparatively low. This may be attributed to the inherent complexity of the salivary malignant pathologies, mostly related to their heterogeneous histological make-up. Certainly, the rarer entities would provide further diagnostic challenges. This article aims to provide a thorough but concise account of the challenges in routine salivary cytology in obtaining a near precise diagnosis and explores how the understanding of salivary histology can play an important role in increasing the diagnostic accuracy of the routine salivary FNAc reporting. |
