Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA.
Laryngoscope. 2013 Dec;123(12):3056-60. doi: 10.1002/lary.24247. Epub 2013 Jun 21.
OBJECTIVES/HYPOTHESIS: Pleomorphic adenoma (PA) is the most common, benign tumor of the major salivary glands. Surgical resection is the treatment of choice. Initial preoperative workup of major salivary gland neoplasms often includes fine needle aspiration biopsy (FNAB) and magnetic resonance imaging (MRI) of the head and neck. Our objective was to assess the positive predictive value of FNAB and MRI in the evaluation of PA arising from within the major salivary glands.
Retrospective chart review.
All patients with a FNAB diagnosis of PA of the major salivary glands and who underwent surgical excision at our institution from 2001 to 2011 were identified. FNAB slides from these cases were reviewed by a cytopathologist for findings suggestive of PA: fibrillary stroma, mesenchymal elements, plasmacytoid myoepithelial cells, epithelial cells forming ducts or tubules, and the absence of nuclear atypia. For those patients with a preoperative MRI, the MRI studies were reviewed by a neuroradiologist for findings suggestive of PA, including homogenous T2 hyperintensity, well-circumscribed borders, and solid contrast enhancement. Positive predictive value (PPV) of these specific FNAB and MRI findings were calculated using chi-squared testing.
One hundred forty-six patients met inclusion criteria, and 68 had preoperative MRI. PPV of a FNAB diagnosis of PA was 97.8%. Characteristic features of PA on FNAB (fibrillary stroma, mesenchymal elements, plasmacytoid myoepithelial cells, epithelial cells forming ducts or tubules, and the absence of nuclear atypia) and MRI (homogenous T2 hyperintensity, well-circumscribed borders, and solid contrast enhancement) all demonstrated PPVs of 95% or greater in patients with FNA diagnosis of PA.
PPV of a FNAB diagnosis of PA in the major salivary glands is high. Among patients with a FNAB diagnosis of PA, specific MRI characteristics also have a high PPV. The diagnostic accuracy of these studies in combination allows for the confident preoperative diagnosis of PA.
目的/假设：多形性腺瘤（PA）是最常见的良性大涎腺肿瘤。手术切除是首选治疗方法。大涎腺肿瘤的初步术前检查通常包括细针抽吸活检（FNAB）和头颈部磁共振成像（MRI）。我们的目的是评估 FNAB 和 MRI 在评估大涎腺内发生的 PA 的阳性预测值。
回顾性图表审查。
确定了 2001 年至 2011 年在我院行 FNAB 诊断为大涎腺 PA 并接受手术切除的所有患者。对这些病例的 FNAB 切片由细胞病理学家进行审查，以寻找提示 PA 的发现：纤维状基质、间质成分、浆细胞样肌上皮细胞、形成导管或小管的上皮细胞，以及缺乏核异型性。对于那些有术前 MRI 的患者，由神经放射科医生对 MRI 研究进行审查，以寻找提示 PA 的发现，包括 T2 高信号均匀、边界清楚和实性对比增强。使用卡方检验计算这些特定 FNAB 和 MRI 发现的阳性预测值（PPV）。
146 名患者符合纳入标准，其中 68 名患者有术前 MRI。FNAB 诊断 PA 的 PPV 为 97.8%。FNAB 上 PA 的特征性表现（纤维状基质、间质成分、浆细胞样肌上皮细胞、形成导管或小管的上皮细胞，以及缺乏核异型性）和 MRI（T2 高信号均匀、边界清楚和实性对比增强）在 FNAB 诊断为 PA 的患者中均具有 95%或更高的 PPV。
大涎腺 FNAB 诊断 PA 的 PPV 较高。在 FNAB 诊断为 PA 的患者中，特定的 MRI 特征也具有较高的 PPV。这些研究的联合诊断准确性可在术前明确诊断 PA。
