Cytoarchitectural Elucidation Of Salivary Gland Lesions: Diagnostic Complexities And Interpretive Paradigms

Abstract

Context

Salivary gland lesions encompass a multifaceted spectrum of low grade and invasive entities, often presenting diagnostic challenges due to overlapping clinical and radiological features. Minimally invasive cytological technique serves as a minimally invasive, pragmatic financial standpoint for initial evaluation, offering valuable insights into lesion characterization.

Aim:To assess the analytical accuracy of cytomorphological evaluation in glandular lesions of oral cavity and correlate cytological findings with histopathological outcomes where available.

Study Protocol:  A retrospective record based analysis was conducted on cases who had presented with salivary gland swellings over last 1 year (2023-2024) at our centre. FNAC smears were examined for cellularity, architectural patterns, nuclear features, and background elements. Cases with subsequent histopathological examination were included for correlation. Diagnostic accuracy, sensitivity, specificity, and concordance rates were calculated.

Results: This cytomorphological study of 120 salivary gland lesions highlights pleomorphic adenoma as the predominant neoplasm, with a notable age distribution skewed toward individuals over 60 years (30%) and those aged 31–45 years (29.2%). Fine-needle aspiration cytology (FNAC) demonstrated robust diagnostic performance, yielding an overall accuracy of 89.2%. For malignant lesions, FNAC showed sensitivity of 85.7%, specificity of 89.9%, PPV of 64.3%, and NPV of 96.7%. In non-malignant cases, sensitivity index was 89.9%, selectivity index 85.7%, PPV 96.7%, and NPV 35.7%. These findings reinforce FNAC’s reliability as a robust tool.

Conclusion: Cytomorphological evaluation remains a reliable frontline diagnostic modality for salivary gland lesions, particularly in distinguishing benign from malignant processes. When integrated with clinical and radiological data, FNAC enhances diagnostic precision and guides appropriate management. Histopathological correlation reinforces its role in definitive diagnosis and underscores areas for refinement in cytological interpretation.