Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Saraswati Dental College
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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : EC07 - EC12 Full Version

Diagnostic Accuracy of FNAC and Ultrasonography in Salivary Gland Lesions in Comparison with Histopathology

Published: October 1, 2022 | DOI:
Shaheen Khan, Nandakumar Gopinathan Nair

1. Assistant Professor, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. 2. Professor, Department of Pathology, Government Medical College, Thiruvananthapuram, Kerala, India.

Correspondence Address :
Dr. Shaheen Khan,
Assistant Professor, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune-411041, Maharashtra, India.


Introduction: Modern era demands for early and accurate diagnosis. Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) are two such diagnostic modalities which have gained importance in recent years due to their rapid, repeatable and precision properties.

Aim: To study the accuracy of FNAC and USG in diagnosing salivary gland lesions in comparison with histopathology and to study the expression of p63 and Cytokeratin 7 (CK7) Immunohistochemical (IHC) markers in malignant salivary gland tumours.

Materials and Methods: A cross-sectional study was conducted on 106 cases who presented with salivary gland lesions possessing USG reports and underwent FNAC and surgical specimens received in Cytopathology and Histopathology Department, Government Medical College, Thiruvananthapuram, Kerala, India, during one year period (February 2017 to January 2018). In each case FNAC was performed and slides were stained with papanicolaou and giemsa stain, surgical specimens were grossed, histopathological features studied under microscope and tumours classified according to World Health Organisation (WHO) classification of salivary gland tumours 2017. Diagnosis on USG and FNAC were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy, concordance and discordance was calculated by Statistical Package for the Social Sciences (SPSS) software version 24.0. p63 and CK7 IHC markers were done only in malignant salivary gland tumours.

Results: In the present study majority of lesions i.e. 82 (77.4%) cases were seen predominantly in parotid gland and pleomorphic adenoma was the most commonest lesion and neoplasm overall with 50 (47.2%) cases. Most common malignant neoplasm was mucoepidermoid carcinoma 4 (3.8%) cases. USG and FNAC had high diagnostic accuracy of 89.6% and 97.2% in comparison to histopathology in diagnosing salivary gland lesions.

Conclusion: High sensitivity and specificity of USG and FNAC makes them most acclaimed preoperative diagnostic modality for salivary gland lesions, but histopathology remains gold standard. Subtyping of malignant and cystic lesions were difficult in USG and cytology.


Fine needle aspiration cytology Mucoepidermoid carcinoma, Parotid gland, Pleomorphic adenoma, Sensitivity, Specificity

There are three paired major salivary glands namely parotid, submandibular and sublingual. Global annual incidence of salivary gland tumours was found to be 0.4-13.5 cases per 1,00,000 population (1). Among all head and neck neoplasms salivary gland lesions account for 2-6.5% (2). Fine Needle Aspiration Cytology (FNAC) is a safe, easy, minimally invasive and diagnostically accurate procedure (3). FNAC diagnosis of salivary gland lesions are as inflammatory, benign or malignant neoplasms which gives clinician an idea for planning conservative or operative treatment accordingly. Needle or incision biopsy is not recommended as “it leads to fistula formation” (4). Ultrasonography (USG) is a non invasive and accurate test that can be repeated if necessary (5). As majority of the salivary gland lesions involve major salivary glands, hence USG is considered optimal. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) may be required only in cases of malignant neoplasms to assess deeper invasion and lymph node involvement (5). In lesions with superficial cystic and a deeper solid component USG guided FNAC is better than simple FNAC. Some tumours demonstrate unique cellular differentiation. Immunohistochemical (IHC) markers are helpful in their identification (6). Expression of IHC markers p63 and CK7 were studied in malignant salivary gland tumours which can aid in diagnosing malignant salivary gland tumours with hybrid or different morphology than usual. Needle biopsy or incision biopsy is not recommended as disruption of capsule can lead to seeding of tumour cells and subsequent recurrence in salivary gland tumours. Thus, warrants non invasive and rapid diagnostic modalities like FNAC and USG, which are relatively cheaper and when used in combination aid in better diagnostic yield than individual tests.

Hence, objectives were to study the spectrum of salivary gland lesions in relation to radiology, cytology, histopathology and correlating the diagnosis in USG and cytology with histopathology. Study identifies any changing trends in presentation of salivary gland lesions with respect to demographic variables of age, sex, and anatomical location.

Material and Methods

A cross-sectional study was conducted in the Department of Cytopathology and Histopathology, Government Medical College, Thiruvananthapuram, Kerala, India, for one year period (February 2017 to January 2018). Ethical Committee clearance was obtained before commencement of the study (IEC.No. 02/14/2017/MCT).

Inclusion criteria

1. Adequate cellularity in FNAC.
2. Possessing USG reports of the salivary swelling.
3. Surgical specimens sent to our Histopathology Department.

Exclusion criteria

1. Scanty cellularity in FNAC smears.
2. No USG reports of the salivary swelling.
3. Surgical specimens which were not sent to the Histopathology Department.

The USG guided FNAC was not done in present study. In present study cytological, histological and diagnostic test evaluation studies were conducted on 106 cases which satisfied all the criterias. Seven cases were excluded from the study due to scanty cellularity in FNAC smears. Remaining 15 cases whose surgical specimens were not sent to the Pathology Department were also excluded from the study.

Sample size calculation: The FNAC was performed on all 128 cases who presented with salivary gland lesions during the study period. Sample size was calculated using formula.

n=sample size
?α and ?β= upper α and β percentiles of standard normal distribution
α and β=type I and type II error
P1 and P2=proportion of FNAC and proportion of USG
For sensitivity-P1-0.94 (94.54%) (2), P2-0.80 (80%) (5),

For specificity-P1-0.80 (80.95%) (2), P2-0.76 (76.9%) (5),

?α/2-1.96 & ?β-0.84 (fixed)

Substituting the values
Sample size for sensitivity=89 rounded off to 90

Sample size for specificity=1683 rounded off to 1700

Approximate FNAC done in salivary gland lesions in our Department is 140-150/year. It is not feasible to get 1700 cases/year, so all cases during study period were included for specificity calculation.

Study Procedure

The FNAC was performed without anaesthesia using a 20-23G needle and 10 cc syringe after obtaining informed written consent from patients who had prior USG reports of the swelling. In each case dry and wet smears were prepared from the aspirated material and were stained with May Grunwald Giemsa (MGG) and papanicolaou stain respectively. Cytological features were studied in detail and diagnosis were made according to presence of epithelial, myoepithelial cells, background material and other cells.

Histopathology specimens were fixed in 10% buffered formalin, grossed, processed in an automated processor. Paraffin embedded blocks were cut at 3-4 μm thickness and Haematoxylin and Eosin (H&E) stained. Diagnosis on USG and cytology were correlated with histopathological diagnosis. Neoplasms were classified based on WHO classification of salivary gland tumours 2017 (7). The pitfalls in cytological diagnosis were evaluated on slide review related to adequacy, obscuring/background material, staining, etc.

The paraffin blocks of malignant salivary tumours were selected and cut at 3 μm thickness and stained with p63 and CK7 IHC markers and their expression in above tumours were studied in detail and documented. More than 10% of tumour cells showing brown nuclear immunostaining with p63 were considered positive and less than 10% cells were considered negative. More than 10% of tumour cells showing brown membranous immunostaining with CK7 were considered positive and less than 10% cells were considered negative. In both IHCs more than 25% immunostained cells were considered strong positive and less than 25% cells as weak positive.

Statistical Analysis

Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy, concordance and discordance of both USG and FNAC in comparison to histopathology was calculated by Statistical Package for the Social Sciences (SPSS) software version 24.0.


In present study, most frequent age group was between 51-60 years 29 (27.4%) cases followed by 41-50 years 27 (25.5%) cases. Lowest number of cases were seen in age group below 20 years and above 70 years (Table/Fig 1).

Overall male predominance 68 (64.2%) was seen including neoplasms (Table/Fig 2). Lesions were mostly unilateral 96 (90.6%) cases with parotid gland being commonest site 82 (77.4%) cases and submandibular gland 24 (22.6%) cases as next common site (Table/Fig 3)

In this study, USG of non neoplastic lesions like chronic sialadenitis showed atrophic gland with multiple oval hypoechoic areas. Benign neoplasms in USG were approximate 25 mm size, well defined margins, lobulated contour, without increased internal vascularity or calcification. Few lesions were hypoechoic and few were anechoic. In USG malignant neoplasms were approximate 35 mm size, ill defined margins, heterogenous hypoechoic with increase in internal vascularity and acoustic enhancement. In USG, most common neoplastic lesion detected was pleomorphic adenoma and non neoplastic lesion was chronic sialadenitis. USG detected 10 malignant salivary gland neoplasm in this study but further subclassification into specific type of malignant neoplasms and cystic lesions was possible only in histopathology (Table/Fig 4).

In FNAC most common benign neoplasm diagnosed was pleomorphic adenoma and among malignant neoplasms commonest was mucoepidermoid carcinoma (Table/Fig 5). The morphology of the cells and background matrix was well appreciated in MGG stained smears (Table/Fig 6).

In histopathology 27 non neoplastic lesions and 79 neoplastic lesions were diagnosed. Among non neoplastic lesions chronic sialadenitis was most common. Commonest among 69 benign neoplasms was pleomorphic adenoma (47%) and Missed Oesophageal Cancer (MEC) (3.8%) among 10 malignant neoplasms. Grossly all benign neoplasms were 2-6 cm size, well circumscribed, solid/cystic, grey-white to tan (Table/Fig 7). Malignant neoplasms grossly were 3-6 cm size, ill circumscribed, irregular borders, solid/cystic, grey-white. Histological features considered for diagnosis were the presence or absence of epithelial and myoepithelial cells, inflammatory cells, stroma, hyaline globules, proliferated acini, squamous cells and mucin. The neoplastic lesions were classified based on WHO classification of salivary gland tumours 2017 (7).

The diagnosis on both USG and FNAC showed a good correlation with histopathology with concordance of 88 (83%) cases and 96 (90.5%) cases, except in few cystic lesions with discordance of 18 (17%) cases and 10 (9.4%) cases respectively (Table/Fig 8),(Table/Fig 9). Discordant cystic lesions on USG were diagnosed on histopathology as pleomorphic adenoma, warthin’s tumour, parotid abscess, epidermal cyst and lymphoepithelial cyst. Discordant lesions on FNAC were diagnosed as sialadenosis, pleomorphic adenoma, adenoid cystic carcinoma, mucoepidermoid carcinoma and sialadenitis.

Subtyping of few malignant (basaloid) lesions and most of the cystic lesions were done only by histopathology. One of the cystic lesion which was reported as neoplastic on USG and warthin’s tumour on cytology, turned out to be mucoepidermoid carcinoma on histopathology (Table/Fig 10). Another cystic lesion which was reported as Pleomorphic Adenoma (PA) on cytology showed plasmacytoid cells with few cells surrounding hyaline material was diagnosed as adenoid cystic carcinoma on histopathology (Table/Fig 11).

Diagnostic accuracy of USG and FNAC in comparison to histopathology was 89.6% and 97.2% respectively (Table/Fig 12). Both USG and FNAC had high sensitivity, specificity, PPV, NPV in diagnosing salivary gland lesions.

In this study, IHC (CK7 and p63) performed on 10 malignant salivary gland neoplasms demonstrated strong membranous CK7 positivity in epithelial cells 9/10 cases and strong nuclear positivity in myoepithelial cells in 7/10 cases (Table/Fig 13). Acinic cell carcinoma and adenocarcinoma NOS demonstrated positivity only for CK7 and were negative for p63. Squamous cell carcinoma showed negativity for both p63 and CK7. The (Table/Fig 14),(Table/Fig 15) shows histopathological and immunohistochemical images.


In present study, out of 106 cases, 27 were non neoplastic and 79 were neoplastic lesions. Majority of salivary gland lesions were seen in the age group 51-60 years similar to study conducted by Rohilla M et al., Panwar K et al., (8),(9) and opposed to study done by Khandekar MM et al., (2) and Omhare A et al., (10). Age range for non neoplastic salivary gland lesions was from 21-75 years and of neoplastic lesions was from 20-80 years similar to study done by Omhare A et al., and Shetty A and Geethamani V (10),(11). Neoplasms were more common in age group 41-60 years. In present study, there were 68 males and 38 females. Overall male predominance was seen with male to female ratio of 1.79:1 similar to other studies but opposed to study by Panwar K et al., which showed female preponderance (5),(8),(9),(10),(12). Parotid gland was most common gland involved (82 cases) followed by submandibular gland (24 cases) similar to Rohilla M et al., (8). In present study, no lesions were seen in minor salivary glands or sublingual gland. Lesions in parotid were predominantly unilateral (96 cases) similar to study done by Gadodia A et al., (13).

In present study, USG could identify most of the salivary gland lesions both neoplastic and non neoplastic which was comparable to studies done by Rudack C et al., Pratap V and Jain SK (14),(15). In USG, most common neoplastic lesion detected was pleomorphic adenoma similar to Thoeny HC study and among non neoplastic lesion commonest was chronic sialadenitis (16). Subtyping of malignant neoplasms and cystic lesions could not be done similar to studies done by Petrovan C et al., and Yadav A et al., (5),(17). 100% correlation of USG diagnosis with histopathology was seen in all cases of pleomorphic adenoma (44 cases) and warthin’s tumour (12 cases). Chronic sialadenitis (16/18 cases), sialadenosis, lipoma and abscess were correctly diagnosed on USG. Cystic lesions on USG were diagnosed by histopathology as pleomorphic adenoma, warthin’s tumour, parotid abscess, epidermal cyst and lymphoepithelial cyst similar to Petrovan C et al., study (5). Diagnostic accuracy of USG in comparison to histopathology in diagnosing salivary gland lesions in this study was found to be as high as 89.6% with high sensitivity (85.7%), specificity (100%), PPV (100%) and NPV (72.5%) similar to other studies (5),(18),(19). USG was 100% accurate in diagnosing malignant salivary neoplasms.

Most frequent lesion diagnosed on FNAC was pleomorphic adenoma followed by warthin’s tumour. All the findings were in concordance with several other previous studies (2),(3),(5),(8),(9),(10),(11). Among malignant neoplasms most frequent diagnosis was mucoepidermoid carcinoma similar to previous studies (8),(9),(20). Cytological features which were taken into consideration for diagnosis were the presence or absence of epithelial and myoepithelial cells, inflammatory cells, stroma, hyaline globules, proliferated acini, squamous cells and mucin (21).

In present study, comparison of FNAC with histopathology, diagnosis of lipoma, sialadenosis and mucoepidermoid carcinoma showed 100% correlation. In histopathology 2/4 cases of MEC diagnosed were low grade, other two were intermediate and high grade. 1/17 cases of chronic sialadenitis was reported as sialadenosis. This discordance may be due to the bilaterality of the lesion and few bare nuclei in the background which was mistaken for lymphocytes. 1/50 cases of pleomorphic adenoma and 1/17 cases of chronic sialadenitis were diagnosed as inflammatory lesion on FNAC. In both cases FNAC slides were reviewed. PAP stained slides in 1st case showed few acini, scattered very few plasmacytoid cells and lymphocytes in a background of thin blood and giemsa stained slides were scanty. In 2nd case PAP stained slides showed acinar cell clusters, against bloody background and MGG slides showed only lymphocytes. Hence, in both these cases correct diagnosis was missed. 1/45 cases of pleomorphic adenoma on FNAC was diagnosed adenoid cystic carcinoma in histopathology. Slide review showed hyaline material surrounded by few cells which was mistaken as matrix of pleomorphic adenoma on PAP stained slides, correlates well with studies conducted by Khandekar MM et al., and Kotwal M et al., (2),(22). On giemsa slides few plasmacytoid cells were noted but no fibrillary matrix was seen. Hyaline globules can be seen in both neoplasms, thus histopathology was mandatory for confirmation. 1/17 case of warthin’s tumour on cytology was reported as mucoepidermoid carcinoma on histopathology. Slide review showed few muciphages which could have been mistaken as macrophages and squamous cells in a dirty background was viewed as metaplastic change in warthin’s tumour. Giemsa stained slides showed better morphological details and background/basement membrane material than PAP stained slides in majority cases in present study and proved to be very useful cytological aid in diagnosis, except for few cases with scanty material. Scanty or obscuring background material and lack of the characteristic matrix were the pitfalls in cytology in this study. Combination of the stains yielded better results in this study.

Diagnostic accuracy of FNAC in diagnosing salivary gland lesions in present study was as high as 97.2% along with high sensitivity (97.4%), specificity (96.6%), PPV (98.7%), and NPV (93.3%) similar to several other studies (2),(3),(8),(9),(10),(11). Sensitivity was higher in present study compared to Rohilla M et al., study (8). FNAC was found to be 100% accurate in diagnosing malignant salivary neoplasm such as mucoepidermoid carcinoma. Basaloid and cystic neoplasm subtyping in FNAC was difficult which was similar to other studies (10),(11),(22).

In present study, IHC performed on all 10 cases of malignant salivary gland tumours demonstrated CK7 positivity in 9/10 cases, and 3/10 cases were negative for p63. Adenoid cystic carcinoma, 4/4 cases of mucoepidermoid carcinoma, epithelial myoepithelial carcinoma and carcinoma ex pleomorphic adenoma demonstrated diffuse membranous positivity for CK7 by epithelial cells and intense nuclear p63 positivity by myoepithelial cells surrounding the tubular structures. MEC showed p63 positivity in intermediate cells (23),(24),(25),(26). Adenocarcinoma NOS and acinic cell carcinoma demonstrated strong membranous positivity for CK7 by epithelial cells and myoepithelial cells were negative for p63 (6),(26),(27),(28). Squamous cell carcinoma was both CK7 and p63 negative. All findings on IHC were comparable with the studies done by Nikitakis NG et al., Nagao T et al., (29),(30). Diagnosis in histopathology is based on morphology, if it is not clear then novel IHC/molecular markers specific to tumours such as C-kit in adenoid cystic carcinoma, PLAG1 in pleomorphic adenoma, MAML2 and CRTC1 fusion was seen in mucoepidermoid carcinoma, ETV6-NTRK3 gene fusion in MASC etc can be employed (31).


Immunohistochemical on cell blocks could not be done in malignant salivary gland tumours due to financial constraints of the patients and lack of availability of newer IHC markers.


High diagnostic accuracy of both USG and FNAC in diagnosing salivary gland lesions confirms that these preoperative tests are simple and rapid diagnostic tools, but histopathology still remains the gold standard. Subtyping of malignant and cystic lesions were difficult in USG and cytology. Inherent defects in sampling, obscuring background material and lack of the characteristic matrix were the pitfalls in cytology. Combination of both PAP and giemsa stain for salivary gland lesions yield better results. Immunohistochemistry/ molecular markers should be reserved for malignant tumours which are morphologically different from usual in histopathology. However, IHC on cell blocks can be attempted for subtyping of malignant tumours with unclear cytology though it doesn’t alter the final treatment plan.


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DOI and Others

DOI: 10.7860/JCDR/2022/57726.17109

Date of Submission: May 24, 2022
Date of Peer Review: Jun 16, 2022
Date of Acceptance: Sep 03, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: May 26, 2022
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