Fine needle aspiration biopsy

Fine needle aspiration biopsy (FNA) can provide clinicians with rapid, nonsurgical diagnoses. It can be performed at the time of initial consultation. Correlation of the clinical impression, cytologic diagnosis and radiographic imaging studies can then guide along different treatment pathways. FNA can be used both as a diagnostic test and as a screening tool to triage patients into different treatment groups i.e. surgical vs. medical management vs. to follow without intervention {2109}. FNA biopsy is useful in establishing whether a given lesion is inflammatory or neoplastic, is a lymphoma or an epithelial malignancy, or represents a metastasis or a primary tumour {424, 1585,2892}. Unnecessary surgery can be avoided in approximately one third of cases {668} especially in: (1) patients whose salivary gland lesion is part of a more generalized disease process, (2) inflammatory lesions where a clinical suspicion of malignancy is low, (3)

patients in poor health who are not good operative candidates, (4) patients with metastasis to a salivary gland or adjacent lymph node, (5) some examples of lymphoproliferative disease {763} or (6) in a primary soft tissue or skin appendage lesion arising in the area of a major salivary gland. A number of series have examined the diagnostic accuracy of salivary FNA {26, 495,2474,2887} with false positive and false negative rates ranging from 1-14%. The rate of correctly establishing a diagnosis as benign or malignant ranges from 81-98% in most recent reports. However, a specific diagnosis can only be made in approximately 60-75% of cases {668}. False negative diagnoses due to inadequate sampling appear to be the most frequent error.

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