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FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES

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fnab in the diagnosis of salivary glands diseases dionysios e. kyrmizakis, md, dds, phd general hospital veroia, greece fine needle aspiration biopsy or cytology fnab ... – PowerPoint PPT presentation

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Title: FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES


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

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

4
FINE NEEDLE ASPIRATION BIOPSY or CYTOLOGYFNAB ?
FNAC
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TWO MEN FNAB TECHNIQUE

7
WHO IS PERFORMING THE FNAB?
  • THE SURGEON
  • THE CYTOPATHOLOGIST
  • THE RADIOLOGIST

8
FNAB IS VERY USEFUL INDIFFERENCIAL DIAGNOSIS OF
  • THYROID NODULES-MASSES
  • LYMPH NODES ENLARGEMENT
  • OTHER NECK MASSES

9
IS FNAB NECESSARY FOR D.D. OF SALIVARY GLANDS
DISEASES?
10
OPTIONS VARIES
  • YES FNAB IS NECESSARY
  • FNAB IS SIMPLY USEFUL
  • FNAB IS NOT NEEDED AT ALL

11
HERAKLION VENIZELEIONHOSPITAL EXPERIENCE
  • FIRST YEAR (MANY NON DIAGNOSTIC SPECIMENS)
  • SECOND AND THIRD YEAR A HUGE IMPROVEMENT OF THE
    NUMBERS OF DIAGNOSTIC SPECIMENS

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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

14
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 parotid2 extraparotid
  • 13 R-1F
  • MONOMORHIC ADENOMA 1-R

15
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

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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)

18
Pleomorphic adenoma
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LYMPHOEPITHELIAL CYSTS
21
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.
22
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)

23
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)

24

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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)

26
CONCLUSIONS 2
  • BUT IF YOU DONT HAVE RELIABLE, LOYAL AND
    DETERMINANT CYTOPATHOLOGIST THE RESULTS CAN BE
    VERY POOR

27
CONCLUSIONS 3From thesis of J. A. de Ru UTRECHT
2005ltParotid gland tumors-diagnostics, surgical
aspects, follow up, and suggestionsgt
  • FNAC SHOULD BE PERFORMED IN ALL PATIENTS WITH A
    PAROTID TUMOUR
  • BY PERSONS WITH EXPERIENCE IN THE TECHNIQUE OF
    ASPIRATION AND INTERPRETATION OF SMEARS

28
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.

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?a?as?e?? 2,?e?eµß???? 2011, 0800-0900
F?01 (?????sa ?)?e????????? ??????? ?????? (e?de??e??-te??????) ??pa?de?t?? ?as???? ?a?????d?? F?02 (?????sa ?)? FNAB st?? ?a??µ??a O?? p?a?t?????pa?de?t?? ?????s??? ?. ???µ?????? ???d???? S?d???p????? F?03 (?????sa G)??e???e?? st?? t?µpa??µet??a??pa?de?t?? ??e??????? Fe?e??d??
31
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32
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 Surg 2002403849.
  • 2. Verma K, Kapila K. Role of fine needle
    aspiration cytology in the diagnosis of
    pleomorphic adenoma. Cytopathology 2002131217.
  • 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. Surgeon
    200526772.
  • 4. Parwarni AV, Ali-Sayed Z. Diagnostic accuracy
    and pitfalls in the fine needle aspiration
    interpretation of Warthin's tumour. Cancer
    20039916671.
  • 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
    May65(5)945-52

33
THANK YOU FOR YOUR ATTENSION
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