Factors Liable for Misinterpretation of Salivary Gland Neoplasms on Fine Needle Aspiration Cytology

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Factors Liable for Misinterpretation of Salivary Gland Neoplasms on Fine Needle Aspiration Cytology

Hijab Shah*, Anwar Ul Haque**
*Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad
** Department of Pathology Department of Pathology, AJK Medical College, Faculty of Medical Sciences,
Muzaffarabad, Azad Kashmir, Pakistan

Fine needle aspiration cytology (FNAC) is now considered an effective technique for evaluation of salivary gland tumors. However making precise diagnosis, at times, is a challenging job due to diverse morphological alterations and overlapping features of different tumors.
Objective: 1) To determine different factors liable for misinterpretation of salivary gland tumors on fine needle aspiration cytology. 2) To determine overall diagnostic accuracy of fine needle aspiration cytology in salivary gland tumors using histopathology as gold standard.
Design: Cross-sectional study. Setting: Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. Duration of study: From 15th October 2009 to 15th October 2010.
Sample size: 51.
Results: The sensitivity and specificity of FNAC came out to be 84.6% and 97.3% respectively with an overall diagnostic accuracy of 98%. Out of 51 cases, 3 were wrongly diagnosed by FNAC. The major factors found responsible for this misinterpretation were; lack of standardization of cellular adequacy in salivary gland cytology smears, indeterminate exact criteria of definite atypia for malignancy and failure to correctly identify different cell types.
Conclusion: FNAC was found to be a useful diagnostic tool in the evaluation of salivary gland tumors because of its simplicity, cost effectiveness, excellent patient compliance and high diagnostic accuracy. The diagnostic pitfalls in salivary gland FNAC, may be avoided by determination of definite predictive atypical nuclear features and identifying non predictive, non relevant nuclear features. Repeat FNAC when required and careful interpretation of slides could avoid and minimize mistakes. Support from special stains may also be quite helpful.
Key words: Fine Needle Aspiration Cytology (FNAC), Salivary gland neoplasm, Diagnostic pitfalls


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