Роль малоінвазивних цитологічних досліджень у діагностиці та лікуванні уражень слинних залоз

Abstract

Тонкоголкове аспіраційне цитологічне дослідження –це метод цитодіагностики, заснований на морфологічних дослідженнях окремих і невеликих групклітин, що аспіровано за допомогою тонкої голки. Діаг-ностична точність тонкоголкового аспіраційного цитологічного дослідження в оцінці набряків слинних залоз ви-вчалася у різних дослідженнях, але дані є дещо суперечливими та представлені у недостатній кількості для клі-нічного аналізу, що й обумовило обраний напрямок дослідження.

Salivary gland disorders include inflammatory, bacterial, viral, and tumor diseases. Such a wide discrepancy among diseases of the salivary glands determines the need to use minimally invasive, but at the same time accurate and specific methods of examination of such patients. Fine-needle aspiration cytological research is a cytodiagnostic method based on morphological studies of individual and small groups of cells aspirated with a fine needle. The diagnostic accuracy of fine-needle aspiration cytological research in evaluating salivary gland swelling has been studied in various studies, but the data are somewhat contradictory and insufficient for clinical analysis, which determined the chosen direction of research. The purpose of the study: assessment of the diagnostic accuracy of fine-needle aspiration cytological examination in inflammatory and tumor lesions of the salivary glands. 192 patients who had parotid and submandibular swellings took part in the study. In 52 cases, a diagnosis of a tumor process was established, of which 25 were benign, and in 19 - an unequivocal diagnosis of malignancy. Chronic sialoadenitis was the most common non-neoplastic lesion (38%), followed by acute and chronic sialoadenitis (34%) and chronic granulomatous inflammation (28%). We have recorded pleomorphic adenoma as the most common benign neoplasm, and lymphoma as the most common malignant lesion (37.8%), acinic cell carcinoma was diagnosed in 29.2% and adenoid cystic carcinoma in 17.8% of cases. The overall accuracy of fine-needle aspiration cytological research in our study was 85.2% with 74.1% sensitivity and 79.9% specificity. The rates of sensitivity and specificity we recorded after adjustment for verification bias were 65.2% (35.2-92.5) and 89.4% (81.1-96.5). We recorded two cases of false negative diagnosis: mucoepidermoid carcinoma and acinic cell carcinoma at the initial stage of diagnosis were diagnosed as pleomorphic adenoma, which is a biphasic neoplasm. We found a correlational relationship between fine-needle aspiration cytological examination and histological examination after an extended biopsy. In 12.8% of cases, pleomorphic adenoma with inadequate aspiration can be a false diagnosis. Currently, there is no trend towards a decrease in the number of patients with salivary gland diseases of various etiologies. Many such patients require surgical treatment, which requires a certain qualification of the doctor, since the radical treatment of benign and malignant neoplasms is characterized by a significant difference and is mainly carried out by different specialists. Based on the above, the accuracy of diagnostic tools is a critical indicator that has a significant impact on the results of further treatment. Thus, the use of fineneedle aspiration cytological research to establish a clinical diagnosis in salivary gland diseases of various etiologies is justified. The accuracy of such research is quite high and in the vast majority of clinical cases corresponds to the results of postoperative histological examination and is characterized by high specificity, which is confirmed by literature data. At the same time, the inaccuracy of this research method occurred only in isolated cases. We found a correlational relationship between fine-needle aspiration cytological examination and histological examination after an extended biopsy. In 12.8% of cases, pleomorphic adenoma with inadequate aspiration can be a false diagnosis. In this case, the aspiration biopsy should be repeated or an immunohistochemical study should be performed, depending on the availability of the cell block material of the neoplasm.