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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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