Clinical impact of sonographically guided biopsy of salivary gland masses and surrounding lymph nodes.Abstract Although fine-needle aspiration biopsy aspiration biopsy n. See needle biopsy. Aspiration biopsy The removal of cells in fluid or tissue from a mass or cyst using a needle for microscopic examination and diagnosis. of salivary gland salivary gland Any of the organs that secrete saliva. Three pairs of major glands secrete saliva into the mouth through distinct ducts: the parotid glands (the largest), between the ear and the back of the lower jaw; the submaxillary glands, along the side of the lower jaw; masses has been reported in the otolaryngology literature, the use of sonography sonography: see ultrasound to guide the biopsy of nonpalpable masses and masses seen on other cross-sectional imaging studies has not been described. Our goal was to evaluate sonographically guided biopsy of masses and lymph nodes Lymph nodes Small, bean-shaped masses of tissue scattered along the lymphatic system that act as filters and immune monitors, removing fluids, bacteria, or cancer cells that travel through the lymph system. related to the salivary glands salivary glands (săl`əvâr'ē), in humans, three pairs of glands that secrete the alkaline digestive fluid, saliva, into the mouth. . We analyzed the records of 18 patients who had under-gone fine-needle aspiration biopsy of a salivary gland mass or lymph node lymph node Small, rounded mass of lymphoid tissue contained in connective tissue. They occur all along lymphatic vessels, with clusters in certain areas (e.g., neck, groin, armpits). with a 25-, 22-, or 20-gauge needle. A definitive cytologic cytological, cytologic pertaining to cytology. cytological examination examination of material for purposes of cytology. Carried out on cerebrospinal fluid, joint fluid, aspirates of body cavities and cystic lesions. diagnosis was made for 13 of the 18 patients (72%); cytology cytology (sītŏl`əjē), in biology, the study of the structure of all normal and abnormal components of cells and the changes, movements, and transformations of such components. was suggestive but not definitive in three patients (17%) and insufficient in two (11%). Definitive diagnoses were made in three cases of reactive lymph node, in two cases each of lymph node metastasis metastasis /me·tas·ta·sis/ (me-tas´tah-sis) pl. metas´tases 1. transfer of disease from one organ or part of the body to another not directly connected with it, due either to transfer of pathogenic microorganisms or to and Warthin 's tumor, and in one case each of pleomorphic adenoma pleomorphic adenoma (plē´ōmôr´-fik ad´  nō´m , adenoid-cystic carcinoma,
schwannomaneurofibroma, parotid parotid /pa·rot·id/ (pah-rot´id) near the ear. pa·rot·id adj. 1. Situated near the ear. 2. Of or relating to a parotid gland. n. A parotid gland. metastasis, parotid lymphoma, and Sjogren's 's-related lymphoid-epithelial lesion. Sonographically guided biopsy allows for confident needle placement in masses seen on computed tomography Computed tomography (CT scan) X rays are aimed at slices of the body (by rotating equipment) and results are assembled with a computer to give a three-dimensional picture of a structure. and magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. . Sonography can usually distinguish a perisalivary lymph node from true intrasalivary masses, and it can help the surgeon avoid the pitfall of a nondiagnostic aspiration of the cystic component of masses. We conclude that sonographically guided biopsy of salivary gland masses can provide a tissue diagnosis that can have a direct impact on clinical decision making. Introduction The performance of fine-needle aspiration biopsy (FNAB FNAB Fine Needle Aspiration Biopsy FNAB Fédération National de l'Agriculture Biologique ) of palpable neck masses, including salivary gland tumors Salivary Gland Tumors Definition A salivary gland tumor is an uncontrolled growth of cells that originates in one of the many saliva-producing glands in the mouth. , without imaging guidance has been described in the literature. [1-9] As technology continues to improve, sonographic guidance is becoming common for FNAB of small, nonpalpable lesions, particularly in metastases Metastasis (plural, metastases) A tumor growth or deposit that has spread via lymph or blood to an area of the body remote from the primary tumor. Mentioned in: Malignant Melanoma from head and neck malignancies or thyroid nodules. [10-22] When masses in the submandibular submandibular /sub·man·dib·u·lar/ (sub?man-dib´u-ler) below the mandible. submandibular (sub´mandib´y region are palpated, it is not always possible to differentiate a mass related to the salivary gland from a regional lymph node. Sonography can usually make this distinction, although this can be difficult in the jugulodigastric region. [23] our institution, sonographic guidance has also been used to biopsy masses-of the salivary glands, including the parotid gland parotid gland n. Either of a pair of major salivary glands situated below and in front of each ear and opening into the parotid duct; the largest of the major salivary glands. . Neoplasms pose a particular challenge to the cytopathologist because of the wide spectrum of tumors, including (in order of increasing potential for malignancy) pleomorphic adenomas, adenolymphomas (Warthin's tumor War·thin's tumor n. See adenolymphoma. Warthin's tumor A benign tumor of the parotid gland. Mentioned in: Salivary Gland Scan Warthin's tumor ), acinic cell carcinomas, adenoid-cystic carcinomas, and mucoepidermoid carcinomas. [24,25] We reviewed our experience with sonographically guided FNAB of masses related to the salivary glands. We hypothesized that a definitive tissue diagnosis, benign or malignant, can be made based on cytopathology from sonographically guided FNAB. To our knowledge, there has been no other reported series dealing specifically with sonographically guided biopsy of salivary gland masses. Materials and methods A computer search spanning an 11-year period from March 1987 to March 1998 revealed that 18 patients had been referred to our institution for a sonographically guided biopsy of a parotid or submandibular mass. The indications for biopsy included nonpalpable masses seen on earlier cross-sectional imaging and palpable masses in which imaging localization Customizing software and documentation for a particular country. It includes the translation of menus and messages into the native spoken language as well as changes in the user interface to accommodate different alphabets and culture. See internationalization and l10n. was felt to be critical for biopsy. All lesions had been seen on previous magnetic resonance imaging (MRI 1. (application) MRI - Magnetic Resonance Imaging. 2. MRI - Measurement Requirements and Interface. ), computed tomography (CT), or sonography. The ten men and eight women ranged in age from 32 to 81 years (mean: 60). Parotid and submandibular masses were identified as focal masses surrounded by more echogenic salivary gland tissue (figures 1, 2). Lymph nodes were identified by their location around the salivary gland and by their shape, either ellipsoid or rounded, with or without a central echogenic hilus hilus /hi·lus/ (hi´lus) pl. hi´li [L.] hilum. hilus (hī´lus), n (figures 3, 4). Based on their sonographic appearance, we identified 11 intraparotid masses, five perisubmandibular lymph nodes, and two periparotid lymph nodes. The masses and lymph nodes ranged in size from 5 x 4 x 3 mm to 38 x 20 x 25 mm. Eleven were palpable. The masses were biopsied under continuous sonographic guidance with a 25-, 22-, or 20-gauge needle; two parotid masses were also biopsied with a 20-gauge automated core device (Temno, Bauer Medical; Clearwater, Fla.). Sonographically guided biopsies were performed with the free-hand technique under sterile conditions, with passes directed to the solid portion of the mass during real-time monitoring. Linear high-frequency probes with multifrequency capabilities (10-5 MHz (MegaHertZ) One million cycles per second. It is used to measure the transmission speed of electronic devices, including channels, buses and the computer's internal clock. A one-megahertz clock (1 MHz) means some number of bits (16, 32, 64, etc. or 7-4 MHz) were used (Advanced Technology Laboratories; Bothel, Wash.). Either a cytotechnologist cy·to·tech·nol·o·gist n. A technician trained in medical examination and identification of cellular abnormalities. cytotechnologist a medical laboratory technologist specializing in cytology. or a cytopathology fellow was present at the time of biopsy to stain the aspirated material and to determine if there was adequate cellularity in the specimen. The smears of the aspirated material were stained by rapid Papanicolaou technique, and the remaining material was submitted for cell block. For each mass, one to six biopsy passes (mean: 2.8) were necessary. Excisional surgery was performed on eight patients following the FNAB, and cytology in these cases was compared with surgical pathology surgical pathology n. A field in anatomical pathology concerned with examination of surgical specimens of tissues removed from living patients for the purpose of diagnosis of disease and guidance in the care of patients. ; one patient refused surgery. For the remaining nine patients, clinical or imaging followup was obtained. Results Six patients (cases 1-6) had adenomatous adenomatous /ad·e·nom·a·tous/ (ad?e-nom´ah-tus) 1. pertaining to an adenoma. 2. pertaining to nodular hyperplasia of a gland. ad·e·nom·a·tous adj. 1. parotid masses, two (cases 7, 8) had nonadenomatous parotid masses, and ten (cases 9-18) had intra- or perisalivary gland lymph nodes (table). Overall, cytology was definitive for a specific diagnosis in 13 of the 18 patients (72%): three cases of reactive lymph node, two cases each of lymph node metastasis and parotid Warthin's tumor, and in one case each of parotid pleomorphic adenoma, parotid adenoid-cystic carcinoma, parotid schwannoma-neurofibroma, parotid metastasis, parotid lymphoma, and Sjogren's-related reactive pleomorphic pleomorphic adjective Referring to a variable appearance or morphology lymphoid-epithelial lesion. In three patients, cytology was suggestive of suggestive of Decision making adjective Referring to a pattern by LM or imaging, that the interpreter associates with a particular–usually malignant lesion. See Aunt Millie approach, Defensive medicine. , but not definitive for, a specific diagnosis; cytology suggested an adenoma adenoma: see neoplasm. in one parotid mass, and it showed rare atypical cells in two patients with melanoma who had otherwise benign lymphoid lymphoid /lym·phoid/ (lim´foid) resembling or pertaining to lymph or tissue of the lymphoid system. lym·phoid adj. Of or relating to lymph or the lymphatic tissue where lymphocytes are formed. cells. In the remaining two patients, cytology was nondiagnostic. There were no complications related to any of the biopsies. Excisional surgical biopsy was performed on six patients with definitive or suggestive cytology, and histology agreed with cytology in five: one case each of adenoid-cystic carcinoma, Warthin's tumor, parotid lymphoma, benign lymph node, and reactive lymph node. In the sixth patient, cytology of a parotid mass was consistent with an adenoma, but excisional biopsy excisional biopsy A surgical procedure intended to completely remove–ie, excise a lesion submitted for pathological evaluation; in EBs, the nature of the lesion–ie benign vs malignant is often unknown at the time of operation, and thus the margin of later revealed that it was an acinic cell carcinoma. Excisional biopsy was also performed on two patients with parotid masses whose cytology was nondiagnostic (benign acinar cells). At surgery, one mass was proven to be a pleomorphic adenoma, and the other was proven to be a cavernous hemangioma cavernous hemangioma n. A vascular tumor composed of large dilated blood vessels and containing large blood-filled spaces, due to dilation and thickening of the walls of the capillary loops. Also called cavernous angioma. . One other patient whose cytology was definitive for a pleomorphic adenoma was recommended for surgery, but the patient refused. Clinical or imaging followup was available in the nine cases in which excisional biopsy was not performed, and the clinical course was compatible with the cytologic diagnosis in all nine. A subset of five patients had melanoma. Cytology revealed metastatic Metastatic The term used to describe a secondary cancer, or one that has spread from one area of the body to another. Mentioned in: Coagulation Disorders metastatic pertaining to or of the nature of a metastasis. melanoma in two, and atypical or benign lymphocytes in the other three; of the latter three, surgery confirmed a benign lymph node in one, and clinical followup was compatible with benign disease in the other two. Statistical analysis of the data showed that FNAB was able to establish a definitive tissue diagnosis, benign or malignant, with 83% accuracy. Discussion Primary salivary gland tumors are relatively rare, occurring in between 1 and 2 per 100,000 population; they represent less than 3% of all head and neck tumors. [26,27] Intraglandular metastases to the parotid gland are less common than primary neoplasms because most metastases of the aerodigestive tract aerodigestive tract Surgical anatomy A term that encompasses the oral cavity, sinonasal tract, larynx, pyriform sinus, pharynx, and esophagus spread via the deep cervical or internal jugular jugular /jug·u·lar/ (jug´u-lar) 1. cervical. 2. pertaining to a jugular vein. 3. a jugular vein. jug·u·lar adj. chain. [28] The management of both benign and malignant salivary gland masses requires surgical excision. Surgery is more extensive for high-grade tumors and for tumors with local extension and regional lymphadenopathy lymphadenopathy /lym·phad·e·nop·a·thy/ (-op´ah-the) disease of the lymph nodes. angioimmunoblastic lymphadenopathy , angioimmunoblastic lymphadenopathy with dysproteinemia . [24-26] In the case of lymph nodes, their detection in the head and neck region can be a sign of neoplasms at the base of the tongue, pharynx pharynx (fâr`ĭngks), area of the gastrointestinal and respiratory tracts which lies between the mouth and the esophagus. In humans, the pharynx is a cone-shaped tube about 4 1-2 in. (11.43 cm) long. , or larynx, particularly in patients who have a history of cigarette smoking. Because many head and neck abnormalities seen on MRI and CT are not palpable not palpable Physical exam adjective Referring to that which cannot be touched or felt, usually in the context of bedside examination of the breast or internal organs , sonographically guided biopsy of salivary gland masses is logical. Sonographic guidance is critical to assuring that the mass being biopsied correlates with other imaging findings. Sonographically guided biopsy allows for the confident identification of the needle tip within the mass. Even when submandibular and parotid masses are palpable, it might not be possible to clinically distinguish an enlarged regional lymph node from a true salivary gland mass. Imaging-guided FNAB has proven to be useful in a variety of head and neck applications, particularly in cases of metastatic lymph nodes and thyroid nodules. [10-22] According to the literature, the sensitivity of sonographically guided FNAB of head and neck lymph node metastases ranges from 76 to 98%, and its specificity ranges from 93 to 100%. [12,16,17,20] A recent prospective series concluded that the distinction between malignant and benign lymph nodes based on real-time sonography is unreliable; these authors reported a sensitivity of 77% and a specificity of 100% for sonographically guided FNAB. [20] Most parotid masses are hypoechoic but, again, their echotexture alone cannot be relied on for a specific histologic diagnosis. Using the criterion of sharp or ill-defined borders to distinguish benign from malignant masses, one series found that 28% of malignant parotid tumors (including metastases and lymphomas) had benign sonographic features. [23] These authors also felt that in the jugulodigastric regi on, it can be difficult, even with sonography, to determine the exact origin of a mass because sonography cannot demonstrate the entire salivary gland capsule. Because our institution is a referral center for melanoma, a large proportion of our patients (5/18[28%]) had this disease. Metastases from melanoma to the parotid gland usually occur when the melanoma is located in the temporal skin. The cytologic diagnosis is extremely helpful in this subset of patients because a positive diagnosis will be treated medically and a benign aspirate as·pi·rate v. To take in or remove by aspiration. n. A substance removed by aspiration. Aspirate The removal by suction of a fluid from a body cavity using a needle. will be followed clinically. In either case, surgical biopsy is usually not necessary. The early literature on cytology reported that the cytologic evaluation of aspirated material from salivary gland tumors was most challenging because of the wide variety of tumor types and the heterogeneity of cell populations in individual tumors. [2] However, as cytologic experience has grown, the accuracy of cytologic diagnoses has increased and now ranges from 60 to 98%. [7] The limitations of FNAB are related primarily to sampling errors. The surgeon can never be certain whether a report of benign cytology is in fact the result of the benign nature of the mass or a failure to sample its most malignant component. In one case in our series, cytology was misleading in a parotid mass that was read as an adenoma but which proved to be an acinic cell carcinoma at surgery. After the cytologic material in this case was reanalyzed, we felt, even in retrospect, that it showed scanty cellularity and was compatible with adenoma. We consider this to be a false-negative result caused by a sampling error. Regardless, t he management of this case was the same: surgical excision. One possible approach to reducing the number of false negatives might be to obtain core biopsies. In our series, sonographically guided FNAB established either a definitive or suggestive diagnosis in 16 of 18 masses (89%). Although this absolute rate is similar to those seen in larger clinical series, [7] we probably biopsied smaller masses. We cannot be certain of this, however, because lesional measurements were not reported in earlier clinical series based on palpation palpation /pal·pa·tion/ (pal-pa´shun) the act of feeling with the hand; the application of the fingers with light pressure to the surface of the body for the purpose of determining the condition of the parts beneath in physical diagnosis. . The cases of two patients with clinical presentations of Sjogren's syndrome Sjö·gren's syndrome n. A syndrome occurring in menopausal women, characterized by keratoconjunctivitis sicca, dryness of mucous membranes, telangiectasias or purpuric spots on the face, and bilateral parotid enlargement; it is often associated with were interesting. Cytology in one patient who had bilateral parotid masses revealed a lymphoma. Cytology of the other revealed reactive pleomorphic lymphoid and epithelial cells, a common finding in this disease, and excluded lymphoma. An important limitation of our study is the small number of patients. Because salivary gland tumors are not common, the experience of any single institution will be limited. Another limitation is that because our study was retrospective, fine-needle and core biopsy techniques were not standardized. From a practical standpoint, a definitive FNAB cytology gives the otolaryngologist important information, which can be helpful in surgical planning. Beginning with the premise that all intraparotid lesions must be surgically removed, a definitive FNAB could be used to plan more complete surgery, possibly even including the facial (VIIth) nerve. It should be noted, however, that some surgeons will wait until permanent sections of the excised tumor are definite before they sacrifice the cranial nerve. If sonography shows intra- or perisalivary lymph nodes that are benign on FNAB cytology, close clinical followup seems to be acceptable, but only when the benign result concurs with the clinical history, physical examination, and other appropriate studies. There remains a subset of masses, such as pleomorphic adenomas and hemangiomas, that will be indeterminate on FNAB. Therefore, an important precept An order, writ, warrant, or process. An order or direction, emanating from authority, to an officer or body of officers, commanding that officer or those officers to do some act within the scope of their powers. Rule imposing a standard of conduct or action. of management is that when cytologic findings do not agree with the clinical impression, excisional biopsy is warranted. Sonographically guided biopsy has three advantages over FNAB that is not guided by imaging: 1) it allows for confident biopsy of masses seen on other cross-sectional imaging studies, 2) it is usually able to distinguish perisalivary lymph nodes from true intrasalivary gland masses, and 3) it avoids the pitfall of nondiagnostic aspiration of the cystic component of masses. In conclusion, not all palpable abnormalities in the region of the salivary glands represent primary salivary sal·i·var·y adj. 1. Of, relating to, or producing saliva. 2. Of or relating to a salivary gland. salivary pertaining to the saliva. neoplasms, and FNAB can help distinguish lymph nodes from primary tumors. Sonographically guided FNAB cytology can help the otolaryngologist in making management decisions. It allows for less radical surgery for low-grade tumors, and it avoids surgery for metastatic disease from known primaries, such as melanoma. From the Division of Diagnostic Ultrasound (Dr. Feld, Dr. Nazarian, Dr. Needleman, Dr. Lev-Toaff, and Dr. Segal) and the Division of Head and Neck Radiology (Dr. Rao), Department of Radiology; the Division of Cytopathology, Department of Pathology (Dr. Bibbo); and the Department of Otolaryngology-Head and Neck Surgery (Dr. Lowry), Jefferson Medical College, Thomas Jefferson University It began as Jefferson Medical College in 1824. On July 1, 1969 the institution officially became Thomas Jefferson University. The university is made up of three colleges:
Reprint requests: Rick Feld, MD, Division of Diagnostic Ultrasound, Thomas Jefferson University Hospital, 132 S. 10th St., Philadelphia, PA 19107. Phone: (215) 955-8658; fax: (215) 955-8549; e-mail: RiekFeld@mail.tju.edu References (1.) Mavec P, Eneroth CM, Franzen S, et al. Aspiration biopsy of salivary gland tumours: Correlation of cytologic reports from 652 aspiration biopsies with clinical and histologic findings. Acta Otolaryngol (Stockh) 1964;58:471-84. (2.) Eneroth CM, Franzen S, Zajicek J. Aspiration biopsy of salivary gland tumors: A critical review of 910 biopsies. Acta Cytol 1967;11:470-2. (3.) Eneroth CM, Franzen S, Zajicek J. Cytologic diagnosis on aspirate from 1000 salivary-gland tumours. Acta Otolaryngol Suppl 1967;224:168-72. (4.) Persson PS, Zettergren L. Cytologic diagnosis of salivary gland tumors by aspiration biopsy. Acta Cytol 1973;17:351-4. (5.) Lindberg LG, Akerman M. Aspiration cytology of salivary gland tumors: Diagnostic experience from six years of routine laboratory work. Laryngoscope 1976;86:584-94. (6.) Sismanis A, Merriam JM, Kline TS, et al. Diagnosis of salivary gland tumors by fine needle aspiration biopsy Fine needle aspiration biopsy A procedure using a thin needle to remove fluid and cells from a lump in the breast. Mentioned in: Breast Biopsy fine needle aspiration biopsy . Head Neck Surg 1981;3:482-9. (7.) Qizilbash AH, Sianos J, Young JE, Archibald SD. Fine needle aspiration biopsy cytology of major salivary glands. Acta Cytol 1985;29:503-12. (8.) Nettle nettle, common name for the Urticaceae, a family of fibrous herbs, small shrubs, and trees found chiefly in the tropics and subtropics. Several genera of nettles are covered with small stinging hairs that on contact emit an irritant (formic acid) which produces a WJ, Orell SR. Fine needle aspiration fine needle aspiration Diagnostics A method of in which a thin or “skinny”–18- to 23-gauge needle is used to suck in cells or tissue bits for diagnoses; the sites selected for FNAs are often guided by radiologists with fluoroscopy, CT, MRI in the diagnosis of salivary gland lesions. Aust N Z J Surg 1989;59:47-51. (9.) Jayaram N, Ashim D, Rajwanshi A, et al, The value of fine-needle aspiration biopsy in the cytodiagnosis of salivary gland lesions. Diagn Cytopathol 1989;5:349-54. (10.) Feldman PS, Kaplan MJ, Johas ME, Cantrell RW. Fine-needle aspiration in squamous cell carcinoma squamous cell carcinoma n. A carcinoma that arises from squamous epithelium and is the most common form of skin cancer. Also called cancroid, epidermoid carcinoma. of the head and neck. Arch Otolaryngol 1983;109:735-42. (11.) Baatenburg de Jong RI, Rongen RJ, De long PC, et al. Screening for lymph nodes in the neck with ultrasound. Clin Otolaryngol 1988;13:5-9. (12.) Baatenburg de Jong RJ, Rongen RJ, Lameris JS, et al. Metastatic neck disease: Palpation vs ultrasound examination. Arch Otolaryngol Head Neck Surg 1989;l 15:689-90. (13.) Robbins KT, vanSonnenbcrg E, Casola G, Varney RR. Imageguided needle biopsy of inaccessible head and neck lesions. Arch Otolaryngol Head Neck Surg 1990;l16:957-61. (14.) van Overhagen H, Lameris JS, Zonderland HM, et al. Ultrasound and ultrasound-guided fine needle aspiration biopsy of supraclavicular lymph nodes supraclavicular lymph nodes (soo´pr  klavik´ūlur),n the deep cervical nodes located along the clavicle. in patients with esophageal carcinoma. Cancer 1991;67:585-7. (15.) van den Brekel MW, Stel HV, Castelijns JA, et al. Lymph node staging in patients with clinically negative neck examinations by ultrasound and ultrasound-guided aspiration cytology. Am J Surg 1991;162:362-6. (16.) van den Brekel MW, Castelijns JA, Stel HV, et al. Occult metastatic neck disease: Detection with US and US-guided fineneedle aspiration cytology. Radiology 1991;180:457-61. (17.) Baatenburg de Jong RJ, Rongen RJ, Verwoerd CD, et al. Ultrasound-guided fine-needle aspiration biopsy of neck nodes, Arch Otolaryngol Head Neck Surg 1991;117:402-4. (18.) Bearcroft PW, Berman LH, Grant J. The use of ultrasound-guided cutting-needle biopsy in the neck. Clin Radiol 1995;50:690-5. (19.) Kruyt RH, van Putten WL, Levendag PC, et al. Biopsy of nonpalpable cervical lymph nodes Cervical lymph nodes are lymph nodes found in the neck. Anterior cervical nodes The anterior cervical nodes are a group of nodes found on the anterior part of the neck. : Selection criteria for ultrasound-guided biopsy in patients with head and neck squamous cell carcinoma. Ultrasound Med Biol 1996;22:413-9. (20.) Takes RP, Knegt P, Manni JJ, et al. Regional metastasis in head and neck squamous cell carcinoma: Revised value of US with USguided FNAB. Radiology 1996; 198:819-23. (21.) Atula TS, Grenman R, Varpula MJ, et al. Palpation, ultrasound, and ultrasound-guided fine-needle aspiration cytology in the assessment of cervical lymph node status in head and neck cancer patients. Head Neck 1996;18:545-51. (22.) Boland GW, Lee MJ, Mueller PR, et al. Efficacy of sonographically guided biopsy of thyroid masses and cervical lymph nodes. AJR AJR American Journal of Roentgenology AJR American Journalism Review AJR Academy for Jewish Religion AJR Association of Jewish Refugees (UK organization) AJR Accelerated Junctional Rhythm Am J Roentgenol 1993;161:1053-6. (23.) Gritzmann N. Sonography of the salivary glands. AJR Am J Roentgenol 1989;153:161-6. (24.) Johns ME, Nachlas NE. Salivary gland tumors. In: Paparella MM, ed. Otolaryngology. 3rd ed. Philadelphia: W.B. Saunders, 1991:2099-127. (25.) Kaplan MJ, Johns ME. Malignant neoplasms. In: Otolaryngology--Head and Neck Surgery. 2nd ed. St. Louis: Mosby Year Book, 1993:1043-78. (26.) Suen JY, Snyderman NL. Benign neoplasms of the salivary glands. In: Cummings CW, ed. Otolaryngology--Head and Neck Surgery. 2nd ed. St. Louis: Mosby Year Book, 1996:823-914. (27.) Som PM. Lymph nodes. In: Head and Neck Imaging. 3rd ed. St. Louis: Mosby Year Book, 1996:772-93. (28.) Som PM, Brandwein M. Salivary glands. In: Head and Neck Imaging. 3rd ed. St. Louis: Mosby Year Book, 1996:823-914.
Summary of sonographically guided biopsy of salivary
gland masses and surrounding lymph nodes
Patient no./ Clinical Sonogram
age/sex history findings Cytology
1. 62/F Swelling Parotid mass Benign acinar cells
15 x 7 x 4 mm
2. 35/M Swelling Parotid mass Pleomorphic adenoma
8 x 7 x 7 mm
3. 63/M Swelling; Parotid mass Adenoid-cystic carcinoma
laryngeal cancer 37 x 26 x 25 mm
4. 64/F Smoking Jugulodigastric mass Warthin's tumor
19 x 11 x 19 mm
5. 56/M Contralateral Parotid mass Warthin's tumor
Warthin's tumor 8 x 7 x 6 mm
6. 54/M Pain Parotid mass Suggestive of adenoma
10 x 5 x 9 mm
7. 62/F Swelling Stenson's duct mass Benign nerve sheath tumor:
10 x 9 x 12 mm schwannoma neurofibroma
8. 64/F Swelling Parotid mass Benign acinar cells
22 x 15 x 21 mm
9. 68/F Sjorgren's Left parotid mass B cell lymphoma
syndrome 17 x 10 x 17 mm;
Right parotid mass
20 x 7 x 6 mm
10. 81/F Sjorgren's Parotid mass Reactive pleomorphic
syndrome 19 x 11 x 7 mm lymphoid epithelial cells
11. 72/M Melanoma Parotid mass Melanoma
38 x 20 x 25 mm
12. 46/M Melanoma Submandibular Melanoma
lymph node
15 x 12 x 15 mm
13. 72/M Melanoma Submandibular Lymphocytes; no
lymph node malignant cells
13 x 5 x 6 mm
14. 65/M Melanoma Parotid lymph node Atypical cells
10 x 8 x 6 mm
15. 77/M Melanoma Parotid lymph node Atypical cells
13 x 5 x 12 mm
16. 35/M Squamous cell Submandibular Squamous cell
carcinoma of lymph node carcinoma
the tongue 21 x 17 x 16 mm
17. 99/M Smoking; Submandibular Reactive lymph node
swelling lymph node
22 x 7 x 13 mm
18. 32/F Swelling Submandibular Reactive lymph node
lymph node
5 x 4 x 3 mm
Patient no./ Surgery or
age/sex clinical followup
1. 62/F Pleomorphic adenoma
2. 35/M Surgery recommended:
patient refused
3. 63/M Adenoid-cystic carcinoma
4. 64/F Warthin's tumor
5. 56/M 2 yr: stable on MRI
6. 54/M Acinic cell carcinoma
7. 62/F 1 yr: no symptoms
8. 64/F Cavernous hemangioma
9. 68/F B cell lymphoma
10. 81/F 1 yr: stable
11. 72/M 2 mo: followup CT showed
marked progressive disease
of mediastinum, lung, liver,
kidneys, bone and mesentery
12. 46/M Surgery performed; lymph
nodes harvested for vaccine;
11 mo: followup CT showed
no evidence of disease
13. 72/M Benign lymph node
14. 65/M 7 mo: no clinical disease
15. 77/M 8 mo: no clinical disease
disease
16. 35/M 11 mo: died of progressive
disease
17. 99/M Reactive lymph node
18. 32/F 20 mo: no clinical disease
|
|
||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion