Cohen Erik G, Patel Snehal G, Lin Oscar, Boyle Jay O, Kraus Dennis H, Singh Bhuvanesh, Wong Richard J, Shah Jatin P, Shaha Ashok R
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Arch Otolaryngol Head Neck Surg. 2004 Jun;130(6):773-8. doi: 10.1001/archotol.130.6.773.
To report the role of selective use of preoperative fine-needle aspiration biopsy (FNAB) in patients with major salivary gland lesions at a tertiary care cancer center.
Retrospective review of FNAB results compared with final histologic diagnosis as the criterion standard.
An academic tertiary care cancer center.
A consecutive series of 258 patients who underwent FNAB of major salivary gland lesions between 1996 and 2000, of whom 169 had surgical resection.
Predictive value, sensitivity, specificity, and accuracy.
FNAB was performed in 169 (37%) of 463 salivary gland lesions undergoing surgical procedures. A total of 126 lesions were in the parotid gland and 44 in the submandibular gland. Seventy-nine lesions (46%) were malignant. There were 150 FNAB specimens (89%) that were satisfactory for evaluation. The FNAB diagnosis of malignant or suspicious lesion had positive and negative predictive values of 84% and 77%, respectively. Ten of 20 false-negative FNAB results were low-grade lymphoma on final histologic assessment. Fine-needle aspiration biopsy diagnosis of a benign neoplasm had positive and negative predictive values of 83% and 88%, respectively. A cytopathologic diagnosis of a nonneoplastic lesion was predictive in only 47% of cases. Fifteen (47%) of 32 lymphocyte-predominant FNAB specimens were lymphoma on final histologic assessment. Ten (20%) of 49 patients with history of a solid, non-head and neck malignancy had evidence of distant metastasis to the salivary gland by histologic and/or cytopathologic assessment.
An FNAB diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of final histologic diagnosis. The predictive value of a negative FNAB finding is low, and should not supersede clinical suspicion. Cytologic findings of a lymphocyte-predominant lesion should prompt further workup to rule out lymphoma.
报告在一家三级癌症中心对主要唾液腺病变患者选择性使用术前细针穿刺活检（FNAB）的作用。
以最终组织学诊断作为标准，对FNAB结果进行回顾性分析。
一家学术性三级癌症中心。
1996年至2000年间连续258例接受主要唾液腺病变FNAB的患者，其中169例接受了手术切除。
预测值、敏感性、特异性和准确性。
在463例接受手术的唾液腺病变中，169例（37%）进行了FNAB。其中腮腺病变126例，下颌下腺病变44例。79例（46%）病变为恶性。150份FNAB标本（89%）评估结果满意。FNAB诊断为恶性或可疑病变的阳性和阴性预测值分别为84%和77%。20例假阴性FNAB结果中，最终组织学评估有10例为低级别淋巴瘤。FNAB诊断为良性肿瘤的阳性和阴性预测值分别为83%和88%。细胞病理学诊断为非肿瘤性病变的预测准确率仅为47%。最终组织学评估显示，32份以淋巴细胞为主的FNAB标本中有15份（47%）为淋巴瘤。49例有实体性非头颈部恶性肿瘤病史的患者中，10例（20%）经组织学和/或细胞病理学评估有唾液腺远处转移证据。
FNAB诊断为恶性或肿瘤性主要唾液腺疾病通常可预测最终组织学诊断。FNAB阴性结果的预测价值较低，不应取代临床怀疑。以淋巴细胞为主的病变的细胞学检查结果应促使进一步检查以排除淋巴瘤。
