Diagnostic Accuracy of Fine Needle Aspiration Cytology in Salivary Gland Lesions: A Comparative Study with Histopathology as the Reference Standard at Bahawal Victoria Hospital, Bahawalpur, Pakistan: Fine Needle Aspiration Cytology for Diagnosing Salivary Gland Lesions

Asmah Afzal; Uzma Shaheen; Fatima Khalid; Firdous Iqbal; Azra Akhtar

doi:10.54393/pjhs.v6i1.2208

Authors

Asmah Afzal Department of Pathology, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
Uzma Shaheen Department of Pathology, Dera Ghazi Khan Medical College, Dera Ghazi Khan, Pakistan
Fatima Khalid Department of Pathology, Al-Aleem Medical College, Lahore, Pakistan
Firdous Iqbal University of Health Sciences, Lahore, Pakistan
Azra Akhtar Buch International Hospital, Multan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i1.2208

Keywords:

Fine Needle Aspiration Cytology, Salivary Gland Neoplasm, Histopathology, Cytology

Abstract

Fine-needle aspiration cytology (FNAC) is one of the most widely used diagnostic tools for evaluating salivary gland lesions. However, its diagnostic accuracy is uncertain due to certain factors. Objective: To analyze the diagnostic accuracy of FNAC in salivary gland lesions compared to histopathological examination in a clinical setting. Methods: This cross-sectional study was conducted from October 2021 to June 2022 at Bahawal Victoria Hospital, Bahawalpur, Pakistan. A total of 75 patients, aged 18 to 75 years, were included in the study who were previously clinically diagnosed with salivary gland lesions. Every patient included in the study underwent the FNAC, and the outcomes were compared to the histopathological analysis of the excised biopsies. The results are analyzed in terms of sensitivity, specificity, NPV, PPV, and diagnostic accuracy. Results: Among the 75 patients, the mean age was 42.5 ± 14.3 years, with a male-to-female ratio of 1:1.08. FNAC results showed 7 non-neoplastic lesions (9.3%), 61 benign (81.3%), and 7 malignant neoplasms (9.3%). A histopathological analysis identified 63 benign, 5 malignant, and 7 non-neoplastic neoplasms. FNAC showed a 96.0% overall diagnostic accuracy, with sensitivity, specificity, Positive predictive value (PPV), and Negative Predictive Value (NPV) of 97.0%, 88.9%,98.5%, and 80.0% respectively. Two false-negative instances (2.7%) and one false-positive case (1.3%) were found in the study. Conclusion: FNAC is an extremely sensitive and accurate diagnostic tool especially when it is required to distinguish between benign and malignant neoplasms. However, its low specificity increases the risk of false-negative results where histopathological confirmation becomes an integral part of the diagnosis especially the cases where clinical suspicions are high.

References

Chrabańska M, Kiczmer P, Drozdzowska B. Salivary Gland Lesions: Diagnostic Reliability and Challenges of Fine Needle Aspiration Cytology. International Journal of Clinical and Experimental Pathology. 2021; 14(1): 54.

AlGhamdi GZ, Alzahrani AK, Saati H, Algarni HM, Alshehri KA, Baroom M, et al. Correlation between Fine Needle Aspiration Cytology (FNAC) and Permanent Histopathology Results in Salivary Gland Masses. Cureus. 2021 Mar; 13(3). doi: 10.7759/cureus.13976.

Akinmoladun VI, Gbolahan OO, Aladelusi TO, Ogun GO, Ajani MA. Diagnostic Accuracy of Fine-Needle Aspiration Cytology in Head and Neck Lesions from a Tertiary Health Facility in Southwestern Nigeria. Nigerian Medical Journal. 2020 Nov; 61(6): 303-306. doi: 10.4103/nmj.NMJ_65_20.

Mohammad MA, Mayer M, Klußmann JP, Engels M, Wolber P, Nachtsheim L, et al. Descriptive Analysis of Fine Needle Aspiration Cytology of the Major Salivary Glands in the Head and Neck Region. Laryngo-Rhino-Otologie. 2024 May; 103(2). doi: 10.1055/S-0044-1785145.

Shetty A and Geethamani V. Role of Fine-Needle Aspiration Cytology in the Diagnosis of Major Salivary Gland Tumors: A Study with Histological and Clinical Correlation. Journal of Oral and Maxillofacial Pathology. 2016; 20(2): 224–229. doi: 10.4103/0973-029X.185899.

Gupta N, Saini S, Gupta N, Gupta V. A Hospital Based Prospective Study to Evaluate the Sensitivity and Specificity of FNAC Diagnosis in Salivary Gland Neoplasms at Tertiary Care Center. International Journal of Academic Medicine and Pharmacy. 2024; 6(2): 206-209. doi: 10.47009/Jamp.2024.6.2.43.

Consamus EN, Smith D, Oviedo SP, Mody DR, Takei H. Diagnostic Accuracy of Fine-Needle Aspiration Cytology of Salivary Gland Lesions: A 6-Year Retrospective Review. Journal Of the American Society of Cytopathology. 2015; 4(2): 63–73. doi: 10.1016/J.Jasc.2014.11.003.

Ali MI, Huq MM, Haque M, Tarafder KH. Comparative Study of Neck Swelling by Clinical, Cytological and Histopathological Examination. Bangladesh Journal of Otorhinolaryngology. 2020 Jul; 26(1): 24-30. doi: 10.3329/Bjo.V26i1.47949.

Vijayakumar G, Narayanan AV, Srikiran TK, Aravind S, Vijay PS. Importance of Radio-Histo-Cytopathological Correlation, A Retrospective Study of Cyto-Histological and Radiological Correlation of Salivary Gland Lesions Using Milan System for Reporting Salivary Gland Cytopathology. Journal of Cancer Research and Therapeutics. 2024 Jul; 20(5): 1394-1399. doi: 10.4103/Jcrt.Jcrt_2687_22.

Gudmundsson JK, Ajan A, Abtahi J. The Accuracy of Fine-Needle Aspiration Cytology for Diagnosis of Parotid Gland Masses: A Clinicopathological Study of 114 Patients. Journal of Applied Oral Science. 2016; 24(6): 561-567. doi: 10.1590/1678-775720160214.

Hafeez S, Mahmood A, Khan RU, Malkani N. Trends in Cancer Prevalence in Punjab, Pakistan: A Systematic Study from 2010 to 2016. Journal of Bioresource Management. 2020; 7(2): 8. doi: 10.35691/JBM.0202.0133.

Ghaderi H, Kruger E, Ahmadvand S, Mohammadi Y, Khademi B, Ghaderi A. Epidemiological Profile of Salivary Gland Tumors in Southern Iranian Population: A Retrospective Study of 405 Cases. Journal of Cancer Epidemiology. 2023; 2023(1). doi: 10.1155/2023/8844535.

Da Silva LP, Serpa MS, Viveiros SK, Sena DA, De Carvalho Pinho RF, De Abreu Guimarães LD, et al. Salivary Gland Tumors in a Brazilian Population: A 20-Year Retrospective and Multicentric Study of 2292 Cases. Journal of Cranio-Maxillofacial Surgery. 2018 Dec; 46(12): 2227-2233. doi: 10.1016/J.Jcms.2018.09.028.

Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample Size Calculation in Medical Studies. Gastroenterology And Hepatology from Bed to Bench. 2013; 6(1): 14.

Naz S, Hashmi AA, Khurshid A, Faridi N, Edhi MM, Kamal A, et al. Diagnostic Role of Fine Needle Aspiration Cytology (FNAC) In the Evaluation of Salivary Gland Swelling: An Institutional Experience. BMC Research Notes. 2015 Dec; 8: 1-5. doi: 10.1186/S13104-015-1048-5.

Mourouzis C, Schoinohoriti O, Mastagkas D, Rallis G. Fine-Needle Aspiration Cytology in the Diagnosis of Salivary Gland Tumors before the Milan System: A Ten-Year Experience from a Tertiary Care Center in Greece. Cureus. 2023 Jul; 15(7). doi: 10.7759/Cureus.42737.

Pitiyage G. Salivary Neoplasia Cytopathology: A Logical Diagnostic Approach to Cytological Interpretation Using Histopathology Knowledge. Diagnostic Histopathology. 2023 Apr; 29(4): 188-196. doi: 10.1016/J.Mpdhp.2023.01.002.

Kumar A, Khan J, Kaur G, Khalilullah M, Saha AK, Kumar A. Ultrasonography-Guided Fine Needle Aspiration Cytology Versus Histopathology: Diagnostic Consistency in Salivary Gland Neoplasms. Cureus. 2024 Sep; 16(9). doi: 10.7759/Cureus.69552.

Kumar R, Mandal MM, Panchal AJ, Kapadia PB. Fine-Needle Aspiration Cytology: A Reliable Tool in the Diagnosis of Salivary Gland Lesions. Indian Journal of Otolaryngology and Head & Neck Surgery. 2022 Dec; 74(3): 5511-5514. doi: 10.1007/S12070-021-02845-W.

Karki D, Adhikari P, Dahal M. Cytohistopathological Evaluation of Salivary Gland Lesions in Tertiary Care Center of Eastern Nepal. Asian Journal of Medical Sciences. 2024 Jun; 15(6): 107-112. doi: 10.3126/ajms.v15i6.63308.

Farhan F, Ilyas M, Muneer S, Niazi Z, Zahra A, Farooq M. Diagnostic Accuracy of Fine Needle Aspiration Cytology (FNAC) in Salivary Gland Tumors. Annals Of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University. 2024 Jun; 20(3): 346-350. doi: 10.48036/Apims.V20i3.1054.