Utpaul Kumar Sarkar, Mohd. Rafiul Alam, Mohammad Abubakar Siddique, Md. Abul Kashem, Md. Hasan Ali, Sheikh Mohammad Tanjil-Ul- Alam, Shourav Kumar Sarker, and Tamal Kumar Das
Background: Salivary gland swellings are relatively rare but present serious diagnostic challenges due to their heterogeneous nature and variable malignancy. A very important differentiation between benign and malignant lesions has to be made since it would have implications for management strategies and surgical decisions. FNA cytology has emerged as an imperative, non-traumatic diagnostic modality allowing such differentiation, and hence, it minimizes unnecessary surgical morbidity and improves patient outcomes. The study aims to establish the diagnostic accuracy of FNAC in salivary gland swellings and its clinical implication in management decisions. In this context, cytological findings are correlated with subsequent histopathological diagnoses to underline the importance of FNAC in preoperative workup in cases presenting with salivary gland lesions.
Method: A total of 50 patients with palpable salivary gland swellings were prospectively studied at the Department of Otolaryngology & Head-Neck Surgery at Sir Salimullah Medical College Mitford Hospital in Dhaka from November 2022 to November 2023. All patients underwent FNAC, and the cytological diagnoses were compared with histopathology diagnoses for the determination of diagnostic accuracy of the FNAC. Descriptive statistics were done by estimating sensitivity, specificity, PPV, and NPV. The sizes of the lesions were also analyzed for their association with benign or malignant characteristics.
Results were as follows: sensitivity 76.9%, specificity 94.6%, PPV 80%, and NPV 92.1%. Of the cases, benign nature was seen in 40% and malignant lesions in 30%. Out of the 40 benign cases, 38 were correctly diagnosed by FNAC, which reflects its high degree of accuracy. There was also a size difference, considering that the malignant lesions had an average size of 4.5 cm as compared to benign lesions, which measured 2.5 cm, thus indicating that the size of the lesion could also be used as an predictive factor for malignancy.
Conclusion: These findings point to the central role of FNAC in diagnosis and management related to salivary gland swellings. Accurate differentiation by FNAC between benign and malignant lesions eliminates morbidity from unnecessary surgery and hence increases patient outcomes. Incorporation of FNAC into routine clinical practice is in step with a patient-centered and evidence-based approach to medicine that ensures optimum care for patients presenting with disorders of the salivary glands.
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