FNA for Parotid Tumours
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Transcript of FNA for Parotid Tumours
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JOURNAL CLUBJOURNAL CLUB
11/03/0211/03/02Raffi QasabianRaffi Qasabian
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CLINICAL QUESTIONCLINICAL QUESTION
"Could FNAC safely be used to prevent"Could FNAC safely be used to prevent
patients undergoing surgery for nonpatients undergoing surgery for non--
neoplastic conditions?"neoplastic conditions?"
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RATIONALERATIONALE
Complications of Parotid Surgery:Complications of Parotid Surgery:
Damage VIIDamage VII
Frey's SyndromeFrey's Syndrome
Numbness of earNumbness of ear
Salivary FistulaSalivary Fistula
XerostomiaXerostomia
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RATIONALERATIONALE
Influence decision to operateInfluence decision to operate
Planning of most appropriatePlanning of most appropriate
operative procedureoperative procedure
BetterBetter--informed preinformed pre--operativeoperative
counsellingcounselling
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SEARCH STRATEGYSEARCH STRATEGY
Ovid Medline search 1966Ovid Medline search 1966--20012001
1.1. exp. PAROTID NEOPLASMS/pa,suexp. PAROTID NEOPLASMS/pa,su
[Pathology, Surgery][Pathology, Surgery] 31373137
2.2. Biopsy, Needle/Biopsy, Needle/ 25483254833.3. 1 and 21 and 2 233233
4.4. Limit 3 to (human & englishLimit 3 to (human & english
language)language) 197197
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STUDYSTUDY
Que Hee CG, Perry CF. FineQue Hee CG, Perry CF. Fine--needleneedle
aspiration cytology of parotid tumours:aspiration cytology of parotid tumours:
is it useful?is it useful?ANZ J. Surg.ANZ J. Surg. 2001;2001;7171, 345, 345--
348348
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INCLUSIONSINCLUSIONS
169 patients169 patients
19951995--19991999
FNAC then surgery for parotidFNAC then surgery for parotidtumourstumours
Patients with nonPatients with non--diagnostic FNACdiagnostic FNAC
were not excludedwere not excluded
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STUDY DESIGN & METHODSSTUDY DESIGN & METHODS
RetrospectiveRetrospective
FNAC by multiple surgeonsFNAC by multiple surgeons
Surgery by multiple surgeons/traineesSurgery by multiple surgeons/trainees Multiple pathologists/trainees inMultiple pathologists/trainees in
multiple centresmultiple centres
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STUDY DESIGN AND METHODSSTUDY DESIGN AND METHODS
FNAC results compared withFNAC results compared with
histopathological diagnosis fromhistopathological diagnosis from
surgical specimensurgical specimen
Sensitivity and specificity calculatedSensitivity and specificity calculated
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EXCLUSIONSEXCLUSIONS
Patients who had more than onePatients who had more than one
FNAC preFNAC pre--opop -- number not givennumber not given
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STUDY DEMOGRAPHICSSTUDY DEMOGRAPHICS
169 patients169 patients
Age range 19Age range 19--91 years91 years Mean age 55 yearsMean age 55 years
84 men, 85 women84 men, 85 women
113 superficial, 21 total, six113 superficial, 21 total, sixlumpectomies, one biopsy and 28lumpectomies, one biopsy and 28
unknown proceduresunknown procedures
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RESULTSRESULTS
DiagnosisDiagnosis NumberNumber Sens (%)Sens (%) Spec (%)Spec (%)
BenignBenign 108/122108/122 8888 6161
MalignantMalignant 27/4727/47 5757 100100
Pleo AdenPleo Aden 67/7867/78 7878 9595
Warthin'sWarthin's 9/249/24 3333 9999
SCCSCC 11/2111/21 5252 9999
Mucoep caMucoep ca 1/71/7 1414 9999
AdenocaAdenoca 1/51/5 2020 100100
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RESULTSRESULTS
28 FNAC contained "non28 FNAC contained "non--specificspecificbenign tissue" (11 malignant)benign tissue" (11 malignant)
17 FNAC categorised as non17 FNAC categorised as non--
diagnostic or inadequate (threediagnostic or inadequate (threemalignant)malignant)
6 patients had non6 patients had non--neoplasticneoplastic
conditions on histopathologyconditions on histopathology
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RESULTSRESULTS
2 of 3 lymphomas diagnosed on2 of 3 lymphomas diagnosed on
FNAC (1 was nonFNAC (1 was non--diagnostic)diagnostic)
Accuracy of identifying malignantAccuracy of identifying malignant
tumourtumour -- 43%43%
Accuracy of identifying benignAccuracy of identifying benign
tumourtumour -- 62%62%
Overall accuracyOverall accuracy -- 56%56%
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RESULTSRESULTS
FNAC able to exclude malignancyFNAC able to exclude malignancy
wellwell
FNAC not able to reliably diagnoseFNAC not able to reliably diagnose
malignancy preoperativelymalignancy preoperatively
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ANALYSISANALYSIS +VE+VE
NonNon--diagnostic FNAC were notdiagnostic FNAC were not
excluded from the statistical analysisexcluded from the statistical analysis
Statistical analysis simple andStatistical analysis simple and
effectiveeffective
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ANALYSISANALYSIS -- VEVE
RetrospectiveRetrospective
Unclear whether blindedUnclear whether blinded
ConfoundingConfounding -- reference standardsreference standards
not able to be stipulated due to largenot able to be stipulated due to large
amount of individual variation inamount of individual variation in
obtaining dataobtaining data
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CONCLUSIONCONCLUSION
This study probably underestimatesThis study probably underestimates
the usefulness of FNAC in parotidthe usefulness of FNAC in parotid
tumour surgerytumour surgery -- ie. underestimatesie. underestimates
its ability to determine differenceits ability to determine difference
between nonbetween non--neoplastic andneoplastic andneoplastic conditionsneoplastic conditions