FNAB IN THE DIAGNOSIS FNAB IN THE DIAGNOSIS OF SALIVARY GLANDS OF SALIVARY GLANDS

DISEASESDISEASES

DIONYSIOS E. KYRMIZAKIS, MD, DDS, PhDDIONYSIOS E. KYRMIZAKIS, MD, DDS, PhD

GENERAL HOSPITAL VEROIA, GREECEGENERAL HOSPITAL VEROIA, GREECE

SALIVARY GLANDS DISEASESSALIVARY GLANDS DISEASES

INFECTIONSINFECTIONS INFLAMATIONSINFLAMATIONSCYSTIC MASSESCYSTIC MASSESLYMPH NODES MASSESLYMPH NODES MASSESNEOPLASMSNEOPLASMSTRAUMATIC LESIONSTRAUMATIC LESIONS

FFINE INE NNEEDLE EEDLE AASPIRATION SPIRATION BBIOPSY or IOPSY or CCYTOLOGYYTOLOGY

FNABFNAB ΉΉ FNACFNAC

TWO MEN FNAB TECHNIQUE

WHO IS PERFORMING THE WHO IS PERFORMING THE FNAB?FNAB?

THE SURGEONTHE SURGEON

THE CYTOPATHOLOGISTTHE CYTOPATHOLOGIST

THE RADIOLOGISTTHE RADIOLOGIST

FNAB IS VERY USEFUL INFNAB IS VERY USEFUL INDIFFERENCIAL DIAGNOSIS OFDIFFERENCIAL DIAGNOSIS OF

THYROID NODULES-MASSESTHYROID NODULES-MASSES

LYMPH NODES ENLARGEMENTLYMPH NODES ENLARGEMENT

OTHER NECK MASSESOTHER NECK MASSES

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

DISEASES?DISEASES?

OPTIONS VARIESOPTIONS VARIES

YES FNAB IS NECESSARYYES FNAB IS NECESSARY

FNAB IS SIMPLY USEFULFNAB IS SIMPLY USEFUL

FNAB IS NOT NEEDED AT ALLFNAB IS NOT NEEDED AT ALL

HERAKLION VENIZELEIONHERAKLION VENIZELEIONHOSPITAL EXPERIENCE HOSPITAL EXPERIENCE

FIRST YEAR (MANY NON DIAGNOSTIC FIRST YEAR (MANY NON DIAGNOSTIC SPECIMENS)SPECIMENS)

SECOND AND THIRD YEAR A HUGE SECOND AND THIRD YEAR A HUGE IMPROVEMENT OF THE NUMBERS OF IMPROVEMENT OF THE NUMBERS OF DIAGNOSTIC SPECIMENSDIAGNOSTIC SPECIMENS

UTRECHT ORL (KNO) UTRECHT ORL (KNO) DEPARTMENT EXPERIENCEDEPARTMENT EXPERIENCE

THIS IS A TERTIARY UNIVERCITY THIS IS A TERTIARY UNIVERCITY CENTERCENTER

THEY HAVE THE OPINION THAT FNAC THEY HAVE THE OPINION THAT FNAC IS ALWAYS NEEDEDIS ALWAYS NEEDED

SOME TIMES UNDER ECHOSOME TIMES UNDER ECHOACCURACY ALMOST 100%ACCURACY ALMOST 100%

PERSONAL EXPERIENCE THE LAST PERSONAL EXPERIENCE THE LAST SEVEN YEARS (2004-2011) SEVEN YEARS (2004-2011) AA

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 extraparotidPLEOMORPHIC ADENOMA 12 parotid+2 extraparotid [13 R-1F][13 R-1F] MONOMORHIC ADENOMA 1-[R]MONOMORHIC ADENOMA 1-[R]

PERSONAL EXPERIENCE THE LAST PERSONAL EXPERIENCE THE LAST SEVEN YEARS SEVEN YEARS BB

RECCURENT PLEOMORPHIC ADENOMA 3RECCURENT 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 INFNAB CAN HELP IN

D.D. OF NEOPLASTIC FROM NON D.D. OF NEOPLASTIC FROM NON NEOPLASTIC LESIONSNEOPLASTIC LESIONS

D.D. OF LYMPHOMA FROM OTHER D.D. OF LYMPHOMA FROM OTHER NEOPLASMSNEOPLASMS

D.D. OF BENIGN FROM MALIGNANT D.D. OF BENIGN FROM MALIGNANT NEOPLASMSNEOPLASMS

TO COLLECT MATERIAL FOR CULTURETO COLLECT MATERIAL FOR CULTURE FOR D.D. CYSTIC AND METASTATIC FOR D.D. CYSTIC AND METASTATIC

LESIONS (RENAL CELL CA, MELANOMA)LESIONS (RENAL CELL CA, MELANOMA)

PlPleomorphic adenomaeomorphic adenoma

LYMPHOEPITHELIAL CYSTSLYMPHOEPITHELIAL CYSTS

Giant Pleomorphic Adenoma of ParotisGiant Pleomorphic Adenoma of Parotis

Jiannis K. Hajiioannou M.D. ,Yannis Vlastos M.D. , Vasillios Lachanas M.D., Jiannis K. Hajiioannou M.D. ,Yannis Vlastos M.D. , Vasillios Lachanas M.D., Dionysios Kyrmizakis M.D., D.D.S.Dionysios Kyrmizakis M.D., D.D.S.

COMPLICATIONSCOMPLICATIONS

PAIN PAIN (RARELY)(RARELY) INJURY OF NERVES (FACIAL, LINGUAL, INJURY OF NERVES (FACIAL, LINGUAL,

HYPOGLOSSAL) OR OTHER STRUCTURES -HYPOGLOSSAL) OR OTHER STRUCTURES -VERY RARELYVERY RARELY

HEMATOMAHEMATOMA BLEEDING (IN CASE OF COUMARIN OR BLEEDING (IN CASE OF COUMARIN OR

ASPIRIN USE)ASPIRIN USE) TUMOUR SEEDING TUMOUR SEEDING (ALMOST NEVER)(ALMOST NEVER) INFECTIONINFECTION SYNCOPE (The procedure should be performed SYNCOPE (The procedure should be performed

while the patient is lying down)while the patient is lying down)

FNAB IS VERY USEFUL BUT MANY FNAB IS VERY USEFUL BUT MANY CONDITIONS MUST BE EXISTEDCONDITIONS MUST BE EXISTED

A GOOD PERFORMER MUST BE AVAILABLEA GOOD PERFORMER MUST BE AVAILABLE AN EXCELLENT CYTOPATHOLOGIST AN EXCELLENT CYTOPATHOLOGIST HIGH LEVEL OF COLLABORATIONHIGH LEVEL OF COLLABORATION TECHNOLOGY-SOPHISTICATED EQUIPMENT TECHNOLOGY-SOPHISTICATED EQUIPMENT

(FLOW CYTOMETRY, (FLOW CYTOMETRY, IMMUNOHISTOCHEMISTRY, LIQUID PHASE IMMUNOHISTOCHEMISTRY, LIQUID PHASE CYTOLOGY ETC) MUST BE AVAILABLECYTOLOGY ETC) MUST BE AVAILABLE

MANY STAINS (PAP, GIEMSA-ROMANOWSKY MANY STAINS (PAP, GIEMSA-ROMANOWSKY etc)etc)

CONCLUSIONS 1CONCLUSIONS 1

FNAB IS VERY USEFUL AND COST FNAB IS VERY USEFUL AND COST EFFECTIVE METHODEFFECTIVE METHOD

A LOT OF MONEY AND ANXIETY CAN A LOT OF MONEY AND ANXIETY CAN BE SAVEDBE SAVED

MANY PATIENTS CAN AVOID MANY PATIENTS CAN AVOID SURGERYSURGERY

(TBC, LYMPHOMA,WARTHIN, (TBC, LYMPHOMA,WARTHIN, LYMPHOEPITHELIAL CYSTS)LYMPHOEPITHELIAL CYSTS)

CONCLUSIONS 2CONCLUSIONS 2

BUT IF YOU DON’T HAVE RELIABLE, BUT IF YOU DON’T HAVE RELIABLE, LOYAL AND DETERMINANT LOYAL AND DETERMINANT

CYTOPATHOLOGIST THE RESULTS CYTOPATHOLOGIST THE RESULTS CAN BE VERY POORCAN BE VERY POOR

CONCLUSIONS 3CONCLUSIONS 3From thesis of J. A. de Ru –UTRECHT 2005From thesis of J. A. de Ru –UTRECHT 2005<Parotid gland tumors-diagnostics, surgical <Parotid gland tumors-diagnostics, surgical

aspects, follow up, and suggestions>aspects, follow up, and suggestions>

FNAC SHOULD BE PERFORMED IN ALL FNAC SHOULD BE PERFORMED IN ALL PATIENTS WITH A PAROTID TUMOURPATIENTS WITH A PAROTID TUMOUR

BY PERSONS WITH EXPERIENCE IN THE BY PERSONS WITH EXPERIENCE IN THE TECHNIQUE OF ASPIRATION AND TECHNIQUE OF ASPIRATION AND

INTERPRETATION OF SMEARSINTERPRETATION OF SMEARS

Jonas TJonas T.. Johnson, MD, FACS Johnson, MD, FACS emedicine-FNA of neck masses emedicine-FNA of neck masses (updated April 2012)(updated April 2012)

When the diagnosis is uncertain, an FNA can almost When the diagnosis is uncertain, an FNA can almost always help.always help.

The results of FNA may contribute to establishing the The results of FNA may contribute to establishing the diagnosis but should not be accepted as absolute diagnosis but should not be accepted as absolute when clinical or other information contradicts the FNA when clinical or other information contradicts the FNA findings. findings.

The accuracy The accuracy oof FNA is increased by providing the f FNA is increased by providing the cytopathologist accurate clinical information. It may be cytopathologist accurate clinical information. It may be further enhanced by having the pathologist chairside further enhanced by having the pathologist chairside during the procedure. during the procedure.

Further enhancement of results is achieved with the Further enhancement of results is achieved with the use of ultrasonographic guidance to assure accurate use of ultrasonographic guidance to assure accurate placement of the needle during aspiration. 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 πρακτικήΕκπαιδευτές: Διονύσιος Ε. Κυρμιζάκης Ιορδάνης Σιδηρόπουλος

ΦΜ03 (Αίθουσα Γ)Εξελίξεις στην τυμπανομετρίαΕκπαιδευτής: Ελευθέριος Φερεκύδης

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