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In management of

FNA and FS. In management of. Salivary Gland Lesions. Bastaninejad , Shahin MD, Assistant Prof of ORL, TUMS Amir’Alam Hospital. Case #1. 74 yrs old man Left Parotid Mass Clinically and Radiologically resembles to Warthin tumor Suffering from IHD and CHF What is the plan? FNA and F/U.

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In management of

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  1. FNAandFS In management of Salivary Gland Lesions Bastaninejad, Shahin MD, Assistant Prof of ORL, TUMS Amir’Alam Hospital

  2. Case #1 • 74 yrs old man • Left Parotid Mass • Clinically and Radiologically resembles to Warthin tumor • Suffering from IHD and CHF • What is the plan? • FNA and F/U

  3. Case #2 • 44 yrs old Woman • Known case of HCC from 1yr ago • Rt. Parotid mass developed over 4mo • No sign or symptom of inflammation • What is your plan? • FNA, further intervention depends on FNA result, and the primary tumor status

  4. Case #3 • 60 yrs old man • Complains from Rt. Parotid swelling and pain in 3 weeks • No collections in CT-Scan • Little response to IV antibiotics after 48 hour • What is the plan? • FNA + US

  5. Case #4 • A 20 yrs old girl suffering from Lt. parotid tail mass • CT-Scan  homogeneous mass in that region • What is the plan? • FNA + FS

  6. Case #5 • A 40 yrs old woman • Rt. Parotid mass for 6mo • Clinically and radiologically suspicious to be malignant • What is the plan? • FNA  Preop. counseling • FS  do appropriate surgical procedure

  7. Case #6 • A 30 yrs old woman • Parotid mass for 2 yrs • 3*3, multilobulated, mobile mass in the lower part of the Lt. parotid gland • What is the plan? • FNA  if you are scheduling the patient for a Limited superficial parotidectomy

  8. To do or not to do!?

  9. FNA and FS FNA FS Sensitivity and Specificity near or a little bit more than FNA (specially it is more specific than FNA) ability to assess margins and lymph nodes at the time of surgery FS is better able to type the malignancy • Sensitivity  85-90% • Specificity  92 to 100% • Higher for benign lesions • Lower for Malignant lesions • An FNA cytological diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of the final histologic diagnosis

  10. FNA and FS • In reality they are complementary: Sensitivity and Specificity, for FNA and FS combined, were more than 90% and 100%, respectively • There are some pitfalls for FNA: • Lymphoma • Ex-Pleomorphic Carcinoma • Low grade MEC

  11. When do we perform FNA? • When there is diagnostic doubt as to whether we are dealing with a salivary or non-salivary lesion • Whether the lesion is neoplastic or inflammatory • When malignancy in a salivary lesion is suspected on clinical grounds • When we wish to avoid surgery

  12. FNA, Continue… • Pre-operative counseling with a patient with a suspicious mass • Limited approaches to the lesion

  13. When do we perform FS? • FS is recommended when cytology and/or clinical findings are suggestive of malignancy • In instances of discordance between FNAC findings on the one hand and clinical and radiologic findings on the other • Instances in which FS is going to offer information that could alter the extent of the surgical procedure (elective neck dissection or no, lateral, or total parotidectomy).

  14. FS, Continue… • …Indicated for the assessment of resection margins, lymph nodes and recognition of tumor involvement of critical anatomic structures

  15. Thank you!

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