in management of bastaninejad, shahin md, assistant prof of orl, tums amir’alam hospital
DESCRIPTION
Case #1 74 yrs old man Left Parotid Mass Clinically and Radiologically resembles to Warthin tumor Suffering from IHD and CHF What is the plan? FNA and F/UTRANSCRIPT
In management ofIn management of
Bastaninejad, ShahinBastaninejad, Shahin MD, Assistant Prof of ORL, TUMS MD, Assistant Prof of ORL, TUMS
Amir’Alam HospitalAmir’Alam Hospital
Case #1
• 74 yrs old man• Left Parotid Mass• Clinically and Radiologically resembles to
Warthin tumor• Suffering from IHD and CHF
• What is the plan?• FNA and F/U
Case #2
• 44 yrs old Woman• Known case of HCC from 1yr ago• Rt. Parotid mass developed over 4mo• No sign or symptom of inflammation
• What is your plan?• FNA, further intervention depends on FNA
result, and the primary tumor status
Case #3• 60 yrs old man• Complains from Rt. Parotid swelling and
pain in 3 weeks• No collections in CT-Scan• Little response to IV antibiotics after 48 hour
• What is the plan?• FNA + US
Case #4
• A 20 yrs old girl suffering from Lt. parotid tail mass
• CT-Scan homogeneous mass in that region
• What is the plan?• FNA + FS
Case #5
• A 40 yrs old woman• Rt. Parotid mass for 6mo• Clinically and radiologically suspicious to
be malignant
• What is the plan?• FNA Preop. counseling• FS do appropriate surgical procedure
Case #6
• A 30 yrs old woman• Parotid mass for 2 yrs• 3*3, multilobulated, mobile mass in the
lower part of the Lt. parotid gland
• What is the plan?• FNA if you are scheduling the patient
for a Limited superficial parotidectomy
FNA and FSFNAFNA
• Sensitivity 85-90% • Specificity 92 to 100%
– Higher for benign lesions– Lower for Malignant lesions
• An FNA cytological diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of the final histologic diagnosis
FSFS
• Sensitivity and Specificity near or a little bit more than FNA (specially it is more specific than FNA)
• ability to assess margins and lymph nodes at the time of surgery
• FS is better able to type the malignancy
FNA and FS
• In reality they are complementary: Sensitivity and Specificity, for FNA and FS combined, were more than 90% and 100%, respectively
• There are some pitfalls for FNA:– Lymphoma– Ex-Pleomorphic Carcinoma– Low grade MEC
When do we perform FNA?
• When there is diagnostic doubt as to whether we are dealing with a salivary or non-salivary lesion
• Whether the lesion is neoplastic or inflammatory
• When malignancy in a salivary lesion is suspected on clinical grounds
• When we wish to avoid surgery
FNA, Continue…
• Pre-operative counseling with a patient
with a suspicious mass
• Limited approaches to the lesion
When do we perform FS?• FS is recommended when cytology and/or
clinical findings are suggestive of malignancy• In instances of discordance between FNAC
findings on the one hand and clinical and radiologic findings on the other
• Instances in which FS is going to offer information that could alter the extent of the surgical procedure (elective neck dissection or no, lateral, or total parotidectomy).
FS, Continue…
• …Indicated for the assessment of
resection margins, lymph nodes and
recognition of tumor involvement of critical
anatomic structures