FNA for Parotid Tumours

8/2/2019 FNA for Parotid Tumours

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JOURNAL CLUBJOURNAL CLUB

11/03/0211/03/02Raffi QasabianRaffi Qasabian


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Journal ClubJournal Club

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

FNA for Parotid Tumours

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