In management ofIn management of

Bastaninejad, ShahinBastaninejad, Shahin MD, Assistant Prof of ORL, TUMS MD, Assistant Prof of ORL, TUMS

Amir’Alam HospitalAmir’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

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

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

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

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

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

FNA and FSFNAFNA

• 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

FSFS

• 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

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

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

FNA, Continue…

• Pre-operative counseling with a patient

with a suspicious mass

• Limited approaches to the lesion

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).

FS, Continue…

• …Indicated for the assessment of

resection margins, lymph nodes and

recognition of tumor involvement of critical

anatomic structures