Cystic major salivary gland lesions: Utilizing fine needle aspiration to optimize the clinical management of a broad and diverse differential diagnosis

Derek B. Allison, Austin M. McCuiston, Satomi Kawamoto, David W. Eisele, Justin A. Bishop, Zahra Maleki

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Introduction: The use of fine-needle aspiration (FNA) cytology for the preoperative evaluation of salivary gland lesions is an accepted but, currently, nonstandardized practice. More specifically, cystic major salivary gland lesions are relatively rare and can be very challenging to diagnose on FNA due to low cellularity and an incredibly broad differential diagnosis. The purpose of this study was to investigate the diagnostic utility of preoperative FNA cytology for cystic major salivary gland lesions. Methods and Materials: The electronic pathology archives of The Johns Hopkins Hospital were searched to identify FNA specimens of cystic major salivary gland lesions over a 15 year period (January 1, 2000 to December 21, 2015). The age, race, sex, biopsy site, use of ultrasound guidance, cytopathologic diagnosis, and presence or absence of clinical follow-up were recorded for each patient. Cases were divided into those with and without follow-up. Diagnostic performance between FNA and follow-up data were recorded. Results: A total of 145 cases met the inclusion criteria, while 123 (84.8%) patients had follow-up data available. Of these patients, 67.5% underwent FNA as the only pathologic diagnostic modality. Sensitivity, specificity, positive predictive value, and negative predictive value for the detection of cystic neoplasms were 41.6%, 99.0%, 90.9%, and 87.6%, respectively. For cases containing mucin, 100.0% sensitivity and specificity were achieved. Conclusion: FNA of cystic salivary gland lesions is a useful clinical decision-making tool that can reduce the number of patients ultimately requiring surgical excision. Although specificity is high, a relatively low overall sensitivity makes clinical and radiologic correlation imperative.

Original languageEnglish (US)
Pages (from-to)800-807
Number of pages8
JournalDiagnostic Cytopathology
Volume45
Issue number9
DOIs
StatePublished - Sep 1 2017

Keywords

  • cystic salivary gland lesions
  • cytology
  • fine-needle aspiration
  • head and neck pathology
  • major salivary gland lesions

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

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