FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS DISEASES DIONYSIOS E. KYRMIZAKIS, MD, DDS, PhD GENERAL HOSPITAL VEROIA, GREECE

SALIVARY GLANDS DISEASES INFECTIONS INFECTIONS INFLAMATIONS INFLAMATIONS CYSTIC MASSES CYSTIC MASSES LYMPH NODES MASSES LYMPH NODES MASSES NEOPLASMS NEOPLASMS TRAUMATIC LESIONS TRAUMATIC LESIONS

F INE N EEDLE A SPIRATION B IOPSY or C YTOLOGY FNAB Ή FNAC

TWO MEN FNAB TECHNIQUE

WHO IS PERFORMING THE FNAB? THE SURGEON THE SURGEON THE CYTOPATHOLOGIST THE CYTOPATHOLOGIST THE RADIOLOGIST THE RADIOLOGIST

FNAB IS VERY USEFUL IN DIFFERENCIAL DIAGNOSIS OF THYROID NODULES-MASSES LYMPH NODES ENLARGEMENT OTHER NECK MASSES

IS FNAB NECESSARY FOR D.D. OF SALIVARY GLANDS DISEASES?

OPTIONS VARIES YES FNAB IS NECESSARY YES FNAB IS NECESSARY FNAB IS SIMPLY USEFUL FNAB IS SIMPLY USEFUL FNAB IS NOT NEEDED AT ALL FNAB IS NOT NEEDED AT ALL

HERAKLION VENIZELEION HOSPITAL EXPERIENCE FIRST YEAR (MANY NON DIAGNOSTIC SPECIMENS) FIRST YEAR (MANY NON DIAGNOSTIC SPECIMENS) SECOND AND THIRD YEAR A HUGE IMPROVEMENT OF THE NUMBERS OF DIAGNOSTIC SPECIMENS SECOND AND THIRD YEAR A HUGE IMPROVEMENT OF THE NUMBERS OF DIAGNOSTIC SPECIMENS

UTRECHT ORL (KNO) DEPARTMENT EXPERIENCE THIS IS A TERTIARY UNIVERCITY CENTER THIS IS A TERTIARY UNIVERCITY CENTER THEY HAVE THE OPINION THAT FNAC IS ALWAYS NEEDED THEY HAVE THE OPINION THAT FNAC IS ALWAYS NEEDED SOME TIMES UNDER ECHO SOME TIMES UNDER ECHO ACCURACY ALMOST 100% ACCURACY ALMOST 100%

PERSONAL EXPERIENCE THE LAST SEVEN YEARS ( ) A ACINIC CELL CA 1 CASE-[Right diagnosis with FNA] ACINIC CELL CA 1 CASE-[Right diagnosis with FNA] ADENOID CYSTIC CA 1-[Right (R)] ADENOID CYSTIC CA 1-[Right (R)] MUCOEPIDERMOID CA 1- [R] MUCOEPIDERMOID CA 1- [R] S.C. CA (METASTATIC) 3-[2 R-1 False (F)] S.C. CA (METASTATIC) 3-[2 R-1 False (F)] LYMPHOMA 3-[2 R-1 F] LYMPHOMA 3-[2 R-1 F] LIPOMA 1- [R] LIPOMA 1- [R] WARTHIN TUMOURS 8 [7R-1F] WARTHIN TUMOURS 8 [7R-1F] PLEOMORPHIC ADENOMA 12 parotid+2 extraparotid PLEOMORPHIC ADENOMA 12 parotid+2 extraparotid [13 R-1F] [13 R-1F] MONOMORHIC ADENOMA 1-[R] MONOMORHIC ADENOMA 1-[R]

PERSONAL EXPERIENCE THE LAST SEVEN YEARS B RECCURENT PLEOMORPHIC ADENOMA 3 RECCURENT PLEOMORPHIC ADENOMA 3 [3R] [3R] LYMPHOEPITHELIAL CYSTS 3 (2 HIV)-[3R] LYMPHOEPITHELIAL CYSTS 3 (2 HIV)-[3R] TBC 2-[1R-1F] TBC 2-[1R-1F] BASAL CELL ADENOMA 1-[R] BASAL CELL ADENOMA 1-[R]

FNAB CAN HELP IN D.D. OF NEOPLASTIC FROM NON NEOPLASTIC LESIONS D.D. OF NEOPLASTIC FROM NON NEOPLASTIC LESIONS D.D. OF LYMPHOMA FROM OTHER NEOPLASMS D.D. OF LYMPHOMA FROM OTHER NEOPLASMS D.D. OF BENIGN FROM MALIGNANT NEOPLASMS D.D. OF BENIGN FROM MALIGNANT NEOPLASMS TO COLLECT MATERIAL FOR CULTURE TO COLLECT MATERIAL FOR CULTURE FOR D.D. CYSTIC AND METASTATIC LESIONS (RENAL CELL CA, MELANOMA) FOR D.D. CYSTIC AND METASTATIC LESIONS (RENAL CELL CA, MELANOMA)

Pleomorphic adenoma

LYMPHOEPITHELIAL CYSTS

Giant Pleomorphic Adenoma of Parotis Jiannis K. Hajiioannou M.D.,Yannis Vlastos M.D., Vasillios Lachanas M.D., Dionysios Kyrmizakis M.D., D.D.S.

COMPLICATIONS PAIN (RARELY) PAIN (RARELY) INJURY OF NERVES (FACIAL, LINGUAL, HYPOGLOSSAL) OR OTHER STRUCTURES - VERY RARELY INJURY OF NERVES (FACIAL, LINGUAL, HYPOGLOSSAL) OR OTHER STRUCTURES - VERY RARELY HEMATOMA HEMATOMA BLEEDING (IN CASE OF COUMARIN OR ASPIRIN USE) BLEEDING (IN CASE OF COUMARIN OR ASPIRIN USE) TUMOUR SEEDING (ALMOST NEVER) TUMOUR SEEDING (ALMOST NEVER) INFECTION INFECTION SYNCOPE (The procedure should be performed while the patient is lying down) SYNCOPE (The procedure should be performed while the patient is lying down)

FNAB IS VERY USEFUL BUT MANY CONDITIONS MUST BE EXISTED A GOOD PERFORMER MUST BE AVAILABLE A GOOD PERFORMER MUST BE AVAILABLE AN EXCELLENT CYTOPATHOLOGIST AN EXCELLENT CYTOPATHOLOGIST HIGH LEVEL OF COLLABORATION HIGH LEVEL OF COLLABORATION TECHNOLOGY-SOPHISTICATED EQUIPMENT (FLOW CYTOMETRY, IMMUNOHISTOCHEMISTRY, LIQUID PHASE CYTOLOGY ETC) MUST BE AVAILABLE TECHNOLOGY-SOPHISTICATED EQUIPMENT (FLOW CYTOMETRY, IMMUNOHISTOCHEMISTRY, LIQUID PHASE CYTOLOGY ETC) MUST BE AVAILABLE MANY STAINS (PAP, GIEMSA-ROMANOWSKY etc) MANY STAINS (PAP, GIEMSA-ROMANOWSKY etc)

CONCLUSIONS 1 FNAB IS VERY USEFUL AND COST EFFECTIVE METHOD FNAB IS VERY USEFUL AND COST EFFECTIVE METHOD A LOT OF MONEY AND ANXIETY CAN BE SAVED A LOT OF MONEY AND ANXIETY CAN BE SAVED MANY PATIENTS CAN AVOID SURGERY MANY PATIENTS CAN AVOID SURGERY (TBC, LYMPHOMA,WARTHIN, LYMPHOEPITHELIAL CYSTS) (TBC, LYMPHOMA,WARTHIN, LYMPHOEPITHELIAL CYSTS)

CONCLUSIONS 2 BUT IF YOU DON’T HAVE RELIABLE, LOYAL AND DETERMINANT CYTOPATHOLOGIST THE RESULTS CAN BE VERY POOR

CONCLUSIONS 3 From thesis of J. A. de Ru –UTRECHT 2005 CONCLUSIONS 3 From thesis of J. A. de Ru –UTRECHT 2005 FNAC SHOULD BE PERFORMED IN ALL PATIENTS WITH A PAROTID TUMOUR BY PERSONS WITH EXPERIENCE IN THE TECHNIQUE OF ASPIRATION AND INTERPRETATION OF SMEARS

Jonas T. Johnson, MD, FACS emedicine-FNA of neck masses (updated April 2012) When the diagnosis is uncertain, an FNA can almost always help. When the diagnosis is uncertain, an FNA can almost always help. The results of FNA may contribute to establishing the diagnosis but should not be accepted as absolute when clinical or other information contradicts the FNA findings. The results of FNA may contribute to establishing the diagnosis but should not be accepted as absolute when clinical or other information contradicts the FNA findings. The accuracy of FNA is increased by providing the cytopathologist accurate clinical information. It may be further enhanced by having the pathologist chairside during the procedure. The accuracy of FNA is increased by providing the cytopathologist accurate clinical information. It may be further enhanced by having the pathologist chairside during the procedure. Further enhancement of results is achieved with the use of ultrasonographic guidance to assure accurate placement of the needle during aspiration. Further enhancement of results is achieved with the use of ultrasonographic guidance to assure accurate placement of the needle during aspiration.

Παρασκευή 2, Δεκεμβρίου 2011, 08:00-09:00 ΦΜ01 (Αίθουσα Α) Χειρουργική ρινικών κογχών (ενδείξεις-τεχνικές) Εκπαιδευτής: Βασίλης Δανιηλίδης ΦΜ02 (Αίθουσα Β) Η FNAB στην καθημέρα ΩΡΛ πρακτική Εκπαιδευτές: Διονύσιος Ε. Κυρμιζάκης Ιορδάνης Σιδηρόπουλος ΦΜ03 (Αίθουσα Γ) Εξελίξεις στην τυμπανομετρία Εκπαιδευτής: Ελευθέριος Φερεκύδης

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