3 FINE NEEDLE ASPIRATION NEEDLE ¢  INTRODUCTION : Fine needle aspiration cytology (FNAC)...

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Transcript of 3 FINE NEEDLE ASPIRATION NEEDLE ¢  INTRODUCTION : Fine needle aspiration cytology (FNAC)...

  • Journal of Dental Sciences

    University

    University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 03

    University J Dent Scie 2017; No. 3, Vol. 1

    Research Article1 2 3 4 5 Amrita Raj ,Amit Pandey , Ankita Raj , Gauri Mishra , Abhinav Misra , Saket Nigam

    1. Reader, Department of Oral and Maxillofacial Pathology, Rama Dental College, Hospital & Research Centre, Kanpur. 2. Reader, Department of Periodontology and Oral Implantology, Rama Dental College, Hospital & Research Centre, Kanpur. 3. Reader, Department of Oral and Maxillofacial Surgery, Rama Dental College, Hospital & Research Centre, Kanpur. 4. Associate Professor, Department of Dentistry. Government Medical College Jalaun, Orai. 5. Associate Professor, Department of Dentistry. Government Medical College, Kannauj. 6. Associate Professor, Department of Radiodiagnosis, Rama Medical College, Mandhana, Kanpur.

    INTRODUCTION : Fine needle aspiration cytology

    (FNAC) is a well established diagnostic tool for the lesions of

    the head and neck region, especially for swellings in the

    thyroid gland, salivary gland, and lymph nodes. Preoperative

    aspiration cytology can be practiced on almost any anatomic

    region evident visually. [1] The goal of FNAC is to yield

    diagnosis by causing minimum tissue trauma and producing

    quick results. It can obviate the need for surgery in non-

    neoplastic conditions or inflammatory lesions and metastatic

    tumors. Its low cost, minimal morbidity, rapid turn around

    time and relatively high sensitivity and specificity makes it a

    useful method of evaluating suspicious masses in outpatient

    and hospital setting.

    FINE NEEDLE ASPIRATION CYTOLOGY IN OROFACIAL SWELLINGS- A USEFUL TOOL

    Keywords-

    Source of support : Nil

    Conflict of interest: None

    Fine needle aspiration

    cytology, FNAC,

    Oropharyngeal Lesions,

    Diagnostic Accuracy,

    Oro-facial Swellings.

    ABSTRACT: Fine needle aspiration cytology (FNAC) is a well established diagnostic tool for

    the lesions of the head and neck region, especially for swellings in the thyroid gland, salivary

    gland, and lymph nodes. Preoperative aspiration cytology can be practiced on almost any

    anatomic region evident visually. The goal of FNAC is to yield diagnosis by causing minimum

    tissue trauma and producing quick results. Fine needle aspiration cytology (FNAC) of oral and

    maxillofacial region has not been widely utilized for diagnosis due to diversity of lesion types,

    heterogeneity of cell populations and difficulties in reaching and aspirating these lesions.

    Aim: The purpose of the current study was to evaluate the diagnostic accuracy, sensitivity, and specificity of Fine needle aspiration cytology (FNAC) in tumors and tumor-like conditions in the oral and maxillofacial region.

    Materials and method: The study was conducted on 62 patients of both sexes and all age groups, with clinically diagnosed tumors and tumor-like conditions of oral and maxillofacial region, with the oro-facial swellings. A comparison between cytological and histological diagnosis was done wherever biopsy material was available.

    Results: In present study of 62 cases excluding 3 cases with unsatisfactory smear, The Diagnostic accuracy was 88.13%, Sensitivity 97.05%, Specificity 90.47%, Positive predictive value 94.28% and, Negative predictive value 95%.

    Conclusion: FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with oromaxillofacial lesions. The present study illustrates the role of FNAC in the diagnosis of a variety of benign as well as malignant lesions of the oral cavity and oropharynx. The deeply situated oral / oropharyngeal lesions are difficult to aspirate, still FNAC is highly accurate especially for the malignant lesions which can be of great help in early planning of the definitive course of management. However, specific cytological diagnosis may be difficult to make in the absence of characteristic architectural patterns.

  • FNAC of oral and maxillofacial region has not been widely utilized for diagnosis due to diversity of lesion types, heterogeneity of cell populations and difficulties in reaching and aspirating these lesions. [2] The purpose of the current study was to evaluate its diagnostic accuracy, sensitivity, and specificity in tumors and tumor-like conditions in the oral and maxillofacial region.

    MATERIAL AND METHODS

    The study was conducted on 62 patients of both sexes of all

    age groups, with clinically diagnosed tumors and tumor-like

    conditions of oral and maxillofacial region, with the oro-

    facial swellings. The patients were selected from the indoor

    and outdoor department of Rama Dental College, Hospital

    and Research Center, Kanpur, Rama Medical College,

    Kanpur, J.K.Cancer Institute, Kanpur.

    The FNAC was performed using 21–25 G needle and a 20-ml

    syringe with or without local anesthetic, as and when

    required. The lesional site was swabbed, using povidine-

    iodine solution and ethyl alcohol (spirit). The needle was

    inserted into the lesion and aspirate from different portions of

    the mass lesion was collected by altering the direction of the

    needle inside the mass and by giving multiple passes. The

    aspirated material so obtained was smeared onto glass slide

    [75x25mm]. Air-dried smears were stained with May-

    Grünwald Geimsa (MGG) stain and smears fixed in 95%

    ethanol were stained with hematoxylin and eosin (H& E) /

    Papanicolaou (PAP) stains. Special stains like Ziehl-Neelsen

    and periodic acid-Schiff (PAS) were performed in accordance

    with the type of lesion and requirement. Cytopathological

    diagnosis was made and correlated with histopathological

    diagnosis wherever biopsy was possible. Complete

    requisition form was filled, mentioning the clinical details.

    Procedure-related minor complications in the form of

    prolonged bleeding were noted in a few of the patients;

    however, no major complications were seen.

    RESULTS AND OBSERVATIONS

    Fine needle aspiration was performed on 62 patients (Table 1, Graph 1), out of which, a definite positive diagnosis of malignant or benign lesion was given in 57 cases (91.93%). Histopathological correlation was possible in 44 cases. Out of these 57 cases, 37(59.67%) were proved to be malignant and 20(32.25%) were benign on biopsy. On cytology, two cases were signed out as suspicious for malignancy and three cases were unsatisfactory because of inadequate material for which tissue was not available.

    TABLE 1: Showing categorization of total orofacial

    University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 04

    University J Dent Scie 2017; No. 3, Vol. 1

    Category Reported Cases

    n (%)

    Benign 20 (32.25)

    Malignant 37 (59.67)

    Suspicious 02 (3.3)

    Inadequate 03 (4.83)

    Total 62 (100)

    aspirations performed.

    GRAPH 1: Showing categorization of total orofacial

    aspirations performed

    On considering various sites (Table 2), a total of 54 cases

    were reported from within oral cavity, of which 16 were

    benign and 33 turned out to be malignant. Two out of three

    cases from lymph node area were benign. Three cases were

    reported from salivary glands of which 1 was malignant and

    from the tonsillar area, 2 cases were reported both being

    carcinomas.

    TABLE 2: Showing Cyto-diagnosis of various lesions

    /sites

    On comparing the cytodiagnosis with histopathology (Table 3), Squamous cell carcinoma was reported on cytodiagnosis

    in twenty eight patients which was histopathologically

    confirmed in twenty seven cases, whereas in one case only

    benign necrotic tissue was seen. Giant cell lesion was reported

    in three patients which were confirmed by histopathology as

    giant cell granulomas. Adenoid cystic carcinoma of minor

    salivary glands was reported in three patients which was

    histopathologically confirmed in two patients whereas one

    turned out to be adenoma. Eight cases were reported as

    odontogenic lesions of which three were reported as

    ameloblastoma, three as OKC, one as radicular cyst and one

    as benign inflammatory tissue on histopathology. Five cases

    were reported as benign inflammatory tissues of which one

    was histopathologically confirmed as malignant carcinoma.

    Sr No Site of FNAC

    Total no. of cases

    Benign Malignant Suspicious Inadequate

    1 Oral cavity 54 16 33 02 03 2 Lymph node 03 02 01 00 00

    3 Salivary gland

    03 02 01 00 00

    4 Tonsillar region

    02 00 02 00 00

    5 Total n (%) 62 20 (32.25)

    37 (59.67) 02 (3.3) 02 (4.83)

  • University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 05

    University J Dent Scie 2017; No. 3, Vol. 1

    One case was reported as melanoma which was confirmed

    histopathologically as malignant melan