Clinical Values of Fine Needle Aspiration Biopsy in Salivary Gland Diseases

Kim, Jong Yang; Pae, Ki Hoon; Choi, Seung Ho; Kim, Sang Yoon; Nam, Soon Yuhl

Abstract

BACKGROUND AND OBJECTIVES: Fine-needle aspiration biopsy (FNAB) has been used as a diagnostic instrument in patients with salivary gland lesions. This article is aimed at defining the exact role of FNAB in the diagnostic workup of patients. MATERIALS AND METHOD: A retrospective study design was used to evaluate the accuracy of FNAB for salivary gland diseases. From January 1997 to June 2004, FNABs, confirmed histologically after surgery, were carried out on 419 patients with salivary gland diseases. Cytopathologic and histologic findings were categorized as malignant, suspicious, benign neoplastic, or nonneoplastic. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of FNAB were calculated using histologic diagnosis of the surgical specimen as the criterion standard.
RESULTS
FNAB was performed in all of 419 salivary gland lesions undergoing surgical procedures. A total of 321 lesions were in the parotid gland and 98 in the submandibular gland. There were 417 FNAB specimens (99%) that were satisfactory for evaluation. The FNAB diagnosis of malignant or suspicious lesions had positive and negative predictive values of 77% and 91%, respectively. Fine-needle aspiration biopsy diagnosis of a benign neoplasm had positive and negative predictive values of 93% and 77%, respectively. A cytopathologic diagnosis of a nonneoplastic lesion was predictive in only 59% of the cases.
CONCLUSION
Although an FNAB diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of the final histologic diagnosis, the predictive value of a negative FNAB finding is low. A negative FNAB finding should not supersede clinical judgment in the management of a clinically suspected malignant or neoplastic lesion of the major salivary glands.