1. In management of Bastaninejad, Shahin MD, Assistant Prof of ORL, TUMS Amir’Alam Hospital

3. Case #1 74 yrs old man Left Parotid Mass Clinically and Radiologically resembles to Warthin tumor Suffering from IHD and CHF What is the plan? FNA and F/U

5. Case #2 44 yrs old Woman Known case of HCC from 1yr ago Rt. Parotid mass developed over 4mo No sign or symptom of inflammation What is your plan? FNA, further intervention depends on FNA result, and the primary tumor status

7. Case #3 60 yrs old man Complains from Rt. Parotid swelling and pain in 3 weeks No collections in CT-Scan Little response to IV antibiotics after 48 hour What is the plan? FNA + US

9. Case #4 A 20 yrs old girl suffering from Lt. parotid tail mass CT-Scan  homogeneous mass in that region What is the plan? FNA + FS

11. Case #5 A 40 yrs old woman Rt. Parotid mass for 6mo Clinically and radiologically suspicious to be malignant What is the plan? FNA  Preop. counseling FS  do appropriate surgical procedure

13. Case #6 A 30 yrs old woman Parotid mass for 2 yrs 3*3, multilobulated, mobile mass in the lower part of the Lt. parotid gland What is the plan? FNA  if you are scheduling the patient for a Limited superficial parotidectomy

15. FNA and FS FNA Sensitivity  85-90% Specificity  92 to 100% –Higher for benign lesions –Lower for Malignant lesions An FNA cytological diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of the final histologic diagnosis FS Sensitivity and Specificity near or a little bit more than FNA (specially it is more specific than FNA) ability to assess margins and lymph nodes at the time of surgery FS is better able to type the malignancy

16. FNA and FS In reality they are complementary: Sensitivity and Specificity, for FNA and FS combined, were more than 90% and 100%, respectively There are some pitfalls for FNA: –Lymphoma –Ex-Pleomorphic Carcinoma –Low grade MEC

17. When do we perform FNA? When there is diagnostic doubt as to whether we are dealing with a salivary or non-salivary lesion Whether the lesion is neoplastic or inflammatory When malignancy in a salivary lesion is suspected on clinical grounds When we wish to avoid surgery

18. FNA, Continue… Pre-operative counseling with a patient with a suspicious mass Limited approaches to the lesion

19. When do we perform FS? FS is recommended when cytology and/or clinical findings are suggestive of malignancy In instances of discordance between FNAC findings on the one hand and clinical and radiologic findings on the other Instances in which FS is going to offer information that could alter the extent of the surgical procedure (elective neck dissection or no, lateral, or total parotidectomy).

20. FS, Continue… …Indicated for the assessment of resection margins, lymph nodes and recognition of tumor involvement of critical anatomic structures