Garrett Samuel L, Trott Kiley, Sebastiano Christopher, Wolf Michael J, Rao Neeta K, Curry Joseph M, Cognetti David M, Luginbuhl Adam J
1 Department of Otolaryngology-Head and Neck Surgery, BS, Thomas Jefferson University, Philadelphia, PA, USA.
2 Department of Pathology, Anatomy, & Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA.
Ann Otol Rhinol Laryngol. 2019 Aug;128(8):755-759. doi: 10.1177/0003489419842582. Epub 2019 Apr 16.
To determine the diagnostic accuracy of fine-needle aspiration (FNA) and imaging modalities for low-grade mucoepidermoid carcinoma (MEC) of the parotid gland.
Retrospective chart review of patients diagnosed with low-grade MEC of the parotid gland following surgical excision between January 2010 and June 2018. Imaging from patients with MEC were randomly mixed with imaging from patients with benign pathology and reviewed in a blinded fashion. Main outcome measure was sensitivity.
A total of 24 patients were confirmed to have had low-grade MEC on final pathology, with a total of 31 FNAs performed between them. Twelve of 31 FNAs were positive for low-grade MEC, with a sensitivity of 39%. A total of 27 imaging studies were reviewed, which included 16 patients with low-grade MEC and 11 patients with benign pathology. Of these 27 imaging studies, 10 were declared indeterminate. Of the remaining 17 imaging studies, 13 were reviewed as malignant (11 true positive and 2 false positive) and 4 as benign (4 true negative). Overall magnetic resonance imaging (MRI) sensitivity for low-grade MEC was 100% (9/9) with 95% CI (0.66-1.0) when considering indeterminate results as positive for malignancy.
This study reaffirms that for low-grade MEC, sensitivity of FNA is poor. MRI provides an important diagnostic tool in the evaluation of salivary gland neoplasms, due to its increased sensitivity for low-grade MEC when considering indeterminate results as positive. This provides confidence in the diagnosis of benign tumors and allows appropriate counseling of all options to the patient, including observation. Imaging and low threshold of excision should be considered despite an inflammatory or benign FNA.
确定细针穿刺抽吸（FNA）及成像方式对腮腺低级别黏液表皮样癌（MEC）的诊断准确性。
回顾性分析2010年1月至2018年6月间手术切除后诊断为腮腺低级别MEC的患者病历。将MEC患者的影像与良性病变患者的影像随机混合，以盲法进行评估。主要观察指标为敏感性。
最终病理确诊24例患者患有低级别MEC，共进行了31次FNA。31次FNA中有12次低级别MEC呈阳性，敏感性为39%。共评估了27项影像学检查，其中包括16例低级别MEC患者和11例良性病变患者。在这27项影像学检查中，10项结果为不确定。其余17项影像学检查中，13项被判定为恶性（11例假阳性和2例假阴性），4项为良性（4例真阴性）。将不确定结果视为恶性阳性时，总体磁共振成像（MRI）对低级别MEC的敏感性为100%（9/9），95%置信区间为（0.66 - 1.0）。
本研究再次证实，对于低级别MEC，FNA的敏感性较差。MRI在唾液腺肿瘤评估中提供了重要的诊断工具，因为将不确定结果视为阳性时，其对低级别MEC的敏感性更高。这为良性肿瘤的诊断提供了信心，并能为患者提供包括观察在内的所有合适选择的咨询。尽管FNA结果为炎症或良性，仍应考虑影像学检查及较低的切除阈值。
