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FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES

FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES. DIONYSIOS E. KYRMIZAKIS, MD, DDS, PhD GENERAL HOSPITAL VEROIA, GREECE. SALIVARY GLANDS DISEASES. INFECTIONS INFLAMATIONS CYSTIC MASSES LYMPH NODES MASSES NEOPLASMS TRAUMATIC LESIONS.

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FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES

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  1. FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES DIONYSIOS E. KYRMIZAKIS, MD, DDS, PhD GENERAL HOSPITAL VEROIA, GREECE

  2. SALIVARY GLANDS DISEASES INFECTIONS INFLAMATIONS CYSTIC MASSES LYMPH NODES MASSES NEOPLASMS TRAUMATIC LESIONS

  3. FINE NEEDLE ASPIRATION BIOPSY or CYTOLOGYFNABΉFNAC

  4. TWO MEN FNAB TECHNIQUE

  5. WHO IS PERFORMING THE FNAB? • THE SURGEON • THE CYTOPATHOLOGIST • THE RADIOLOGIST

  6. FNAB IS VERY USEFUL INDIFFERENCIAL DIAGNOSIS OF THYROID NODULES-MASSES LYMPH NODES ENLARGEMENT OTHER NECK MASSES

  7. IS FNAB NECESSARY FOR D.D. OF SALIVARY GLANDS DISEASES?

  8. OPTIONS VARIES • YES FNAB IS NECESSARY • FNAB IS SIMPLY USEFUL • FNAB IS NOT NEEDED AT ALL

  9. HERAKLION VENIZELEIONHOSPITAL EXPERIENCE • FIRST YEAR (MANY NON DIAGNOSTIC SPECIMENS) • SECOND AND THIRD YEAR A HUGE IMPROVEMENT OF THE NUMBERS OF DIAGNOSTIC SPECIMENS

  10. UTRECHT ORL (KNO) DEPARTMENT EXPERIENCE • THIS IS A TERTIARY UNIVERCITY CENTER • THEY HAVE THE OPINION THAT FNAC IS ALWAYS NEEDED • SOME TIMES UNDER ECHO • ACCURACY ALMOST 100%

  11. PERSONAL EXPERIENCE THE LAST SEVEN YEARS (2004-2011) A • ACINIC CELL CA 1 CASE-[Right diagnosis with FNA] • ADENOID CYSTIC CA 1-[Right (R)] • MUCOEPIDERMOID CA 1- [R] • S.C. CA (METASTATIC) 3-[2 R-1 False (F)] • LYMPHOMA 3-[2 R-1 F] • LIPOMA 1- [R] • WARTHIN TUMOURS 8 [7R-1F] • PLEOMORPHIC ADENOMA 12 parotid+2 extraparotid [13 R-1F] • MONOMORHIC ADENOMA 1-[R]

  12. PERSONAL EXPERIENCE THE LAST SEVEN YEARS B • RECCURENT PLEOMORPHIC ADENOMA 3 [3R] • LYMPHOEPITHELIAL CYSTS 3 (2 HIV)-[3R] • TBC 2-[1R-1F] • BASAL CELL ADENOMA 1-[R]

  13. FNAB CAN HELP IN • D.D. OF NEOPLASTIC FROM NON NEOPLASTIC LESIONS • D.D. OF LYMPHOMA FROM OTHER NEOPLASMS • D.D. OF BENIGN FROM MALIGNANT NEOPLASMS • TO COLLECT MATERIAL FOR CULTURE • FOR D.D. CYSTIC AND METASTATIC LESIONS (RENAL CELL CA, MELANOMA)

  14. Pleomorphic adenoma

  15. LYMPHOEPITHELIAL CYSTS

  16. Giant Pleomorphic Adenoma of Parotis Jiannis K. Hajiioannou M.D. ,Yannis Vlastos M.D. , Vasillios Lachanas M.D., Dionysios Kyrmizakis M.D., D.D.S.

  17. COMPLICATIONS • PAIN (RARELY) • INJURY OF NERVES (FACIAL, LINGUAL, HYPOGLOSSAL) OR OTHER STRUCTURES -VERY RARELY • HEMATOMA • BLEEDING (IN CASE OF COUMARIN OR ASPIRIN USE) • TUMOUR SEEDING (ALMOST NEVER) • INFECTION • SYNCOPE (The procedure should be performed while the patient is lying down)

  18. FNAB IS VERY USEFUL BUT MANY CONDITIONS MUST BE EXISTED • A GOOD PERFORMER MUST BE AVAILABLE • AN EXCELLENT CYTOPATHOLOGIST • HIGH LEVEL OF COLLABORATION • TECHNOLOGY-SOPHISTICATED EQUIPMENT (FLOW CYTOMETRY, IMMUNOHISTOCHEMISTRY, LIQUID PHASE CYTOLOGY ETC) MUST BE AVAILABLE • MANY STAINS (PAP, GIEMSA-ROMANOWSKY etc)

  19. CONCLUSIONS 1 • FNAB IS VERY USEFUL AND COST EFFECTIVE METHOD • A LOT OF MONEY AND ANXIETY CAN BE SAVED • MANY PATIENTS CAN AVOID SURGERY (TBC, LYMPHOMA,WARTHIN, LYMPHOEPITHELIAL CYSTS)

  20. CONCLUSIONS 2 BUT IF YOU DON’T HAVE RELIABLE, LOYAL AND DETERMINANT CYTOPATHOLOGIST THE RESULTS CAN BE VERY POOR

  21. CONCLUSIONS 3From thesis of J. A. de Ru –UTRECHT 2005<Parotid gland tumors-diagnostics, surgical aspects, follow up, and suggestions> FNAC SHOULD BE PERFORMED IN ALL PATIENTS WITH A PAROTID TUMOUR BY PERSONS WITH EXPERIENCE IN THE TECHNIQUE OF ASPIRATION AND INTERPRETATION OF SMEARS

  22. Jonas T. Johnson, MD, FACS emedicine-FNA of neck masses (updated April 2012) • When the diagnosis is uncertain, an FNA can almost always help. • The results of FNA may contribute to establishing the diagnosis but should not be accepted as absolute when clinical or other information contradicts the FNA findings. • The accuracy of FNA is increased by providing the cytopathologist accurate clinical information. It may be further enhanced by having the pathologist chairside during the procedure. • Further enhancement of results is achieved with the use of ultrasonographic guidance to assure accurate placement of the needle during aspiration.

  23. References 1.Kesse KW, Manjaly G, Violaris N, Howlett DC. Ultrasound-guided biopsy in the evaluation of focal lesions and diffuse swelling of the parotid gland. Br J Oral Maxillofac Surg2002;40:384–9. 2. Verma K, Kapila K. Role of fine needle aspiration cytology in the diagnosis of pleomorphic adenoma. Cytopathology2002;13:121–7. 3. Balakrishnan K, Castling B, McMahan J, Imrie J, Feeley KM, Parker AJ, et al. Fine needle aspiration cytology in the management of parotid mass: a two centre retrospective study. Surgeon2005;2:67–72. 4. Parwarni AV, Ali-Sayed Z. Diagnostic accuracy and pitfalls in the fine needle aspiration interpretation of Warthin's tumour. Cancer2003;99:166–71. 5. de Ru JA, van Leeuwen MS, van Benthem PP, Velthuis BK, Sie-Go DM, Hordijk GJ. Do MRI and ultrasound add anything to the preoperative work up of parotid gland tumors? J Oral Maxillofac Surg. 2007 May;65(5):945-52

  24. THANK YOU FOR YOUR ATTENSION

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