The clinical usefulness of fine-needle aspiration cytology (FNAC) for the diagnosis of parotid gland lesions is controversial. Many accuracy studies have been published, but the literature has not been adequately summarized. We identified 64 studies on the diagnosis of malignancy (6,169 cases) and 7 studies on the diagnosis of neoplasia (795 cases). The diagnosis of neoplasia (area under the summary receiver operating characteristic [AUSROC] curve, 0.99; 95% confidence interval [CI], 0.97-1.00) had higher accuracy than the diagnosis of malignancy (AUSROC, 0.96; 95% CI, 0.94-0.97). Several sources of bias were identified that could affect study estimates. Studies on the diagnosis of malignancy showed significant heterogeneity (P < .001). The subgroups of American, French, and Turkish studies showed greater homogeneity, but the accuracy of these subgroups was not significantly different from that of the remaining subgroup. It is not possible to provide a general guideline on the clinical usefulness of FNAC for parotid gland lesions owing to the variability in study results. There is a need to improve the quality of reporting and to improve study designs to remove or assess the impact of bias.

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A Systematic Review and Meta-Analysis of the Diagnostic Accuracy of Fine-Needle Aspiration Cytology for Parotid Gland Lesions

PURPOSETo provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy.METHODSASCO convened an Expert Panel of medi...

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.21.00449

Management of Salivary Gland Malignancy: ASCO Guideline.

Objectives(1) To analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease. (2) To determine the anticipated posttest probability of malignancy and probability of nondiagnostic and indeterminate cytology with parotid FNA.Data SourcesIndependently corroborated computerized searches of PubMed, Embase, and Cochrane Central Register were performed. These were supplemented with manual searches and input from content experts.Review MethodsInclusion/exclusion criteria specified diagnosis of parotid mass, intervention with both FNA and surgical excision, and enumeration of both cytologic and surgical histopathologic results. The primary outcomes were sensitivity, specificity, and posttest probability of malignancy. Heterogeneity was evaluated with the I2 statistic. Meta-analysis was performed via a 2-level mixed logistic regression model. Bayesian nomograms were plotted via pooled likelihood ratios.ResultsThe systematic review yielded 70 criter...

Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration: A Systematic Review and Meta-analysis.

Objectives This study sought to assess the efficacy and safety of a drug-coated balloon (DCB) strategy versus drug-eluting stent (DES) in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). Background In primary percutaneous coronary intervention for STEMI, stenting has proved to be beneficial with regard to repeat revascularization, but not recurrent myocardial infarction or death, compared with balloon angioplasty alone. A strategy of DCB angioplasty without stenting might abolish the potential disadvantages of stent implantation while reducing the probability of restenosis observed in plain old balloon angioplasty. Methods In the prospective, randomized, single-center REVELATION trial, we compared DCB with DES in patients presenting with STEMI. Patients with a new, nonseverely calcified culprit lesion in a native coronary artery and a residual stenosis of  Results A total of 120 patients were included. At 9 months after enrolment, the mean fractional flow reserve value was 0.92 ± 0.05 in the DCB group (n = 35) and 0.91 ± 0.06 in the DES group (n = 38) (p = 0.27). One abrupt vessel closure requiring treatment occurred after treatment with DCB. Up to 9-months follow-up, 2 patients required nonurgent target lesion revascularization (1 in each group). Conclusions In the setting of STEMI, the DCB strategy was noninferior to DES in terms of fractional flow reserve assessed at 9 months. Furthermore, it seemed to be a safe and feasible strategy. (Revascularization With Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stenting in Acute Myocardial Infarction [REVELATION]; NCT02219802)

Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent in Acute Myocardial Infarction: The REVELATION Randomized Trial.

Drug-Coated Balloon for De Novo Coronary Artery Disease: JACC State-of-the-Art Review

Risk factors for wound infection after oral cancer surgery

Drug-Coated Balloon Versus Drug-Eluting Stent in Primary Percutaneous Coronary Intervention: A Feasibility Study.

Main objective of this study was to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) diagnosis of parotid masses to distinguish reliably between benign and malignant lesions. In the period of 5 years, 214 parotid glands were resected at the Rijeka University Hospital Center (Croatia), but 176 patients had cytopathological and histopathological diagnoses and therefore fulfilled the criteria for study. The results of the FNAC were analyzed and compared to the corresponding histopathological diagnosis obtained from the surgical specimen. Histological evaluation revealed 17malignant and 159 benign lesions. There were 13 true positive, 147 true negative, 3 false negative, and 13 false positive. Sensitivity of FNAC was 81%, and specificity was 98%. FNAC results provide useful predictive preoperative information and better preparation the surgeon and patient for surgical procedure.

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Fine Needle Aspiration Cytology in the Evaluation of Parotid Gland Tumors

Background. Although odontogenic infections are relatively frequent in the general population, intrathoracic dissemination is a rare complication. Acute purulent mediastinitis, known as descending necrotizing mediastinitis (DNM), causes high mortality rate, even up to 40%, despite high efficacy of antibiotic therapy and surgical interventions. In rare cases, unilateral or bilateral pleural empyema develops as a complication of DNM. Case report. This case report presents the treatment of a young, previously healthy patient with mediastinitis and bilateral pleural empyema caused by an odontogenic infection. After a neck and pharynx re-incision, and as CT confirmed propagation of the abscess to the thorax, thoracotomy was performed followed by CT-controlled thoracic drainage with continued antibiotic therapy. The patient was cured, although the recognition of these complications was relatively delayed. Conclusions. Early diagnosis of DNM can save the patient, so if this severe complication is suspected, thoracic CT should be performed.

/pdf/mediastinitis-and-bilateral-pleural-empyema-caused-by-an-521x1enhq5.pdf

Mediastinitis and bilateral pleural empyema caused by an odontogenic infection

Blokatori beta-adrenergickih receptora ostvaruju povoljne ucinke kroz citav kardiovaskularni kontinuum. U odnosu na neselektivne beta-blokatore, kardioselektivni beta- 1 blokatori imaju prednost u bolesnika u kojih želimo izbjeci blokadu beta-2 receptora u bronhima i perifernim krvnim žilama, u bolesnika s bronhoopstruktivnom i/ili perifernom arterijskom bolesti. Selektivnim djelovanjem pokusava se izbjeci i negativan utjecaj na homeostazu glukoze te erektilnu funkciju. Metoprolol je u svijetu dugo i dobro poznat te siroko primjenjivan i provjeren kardioselektivni beta-blokator. Brojnim klinickim istraživanjima jasno je dokazan terapijski ucinak metoprolola u arterijskoj hipertenziji, akutnim i kronicnim oblicima koronarne bolesti srca, postinfarktnoj profilaksi, srcanim aritmijama i sindromu kronicnog zatajivanja srca. U svim ispitivanjima metoprolol je imao dobru podnosljivost i sigurnost. Uz ispravno doziranje i vođenje bolesnika, nuspojave su rijetke, blage i reverzibilne. Danas je metoprolol sukcinat i u Hrvatskoj dostupan u obliku s produljenom apsorpcijom i postupnim plazmatskim klirensom, s mogucnoscu doziranja jednom na dan koje osigurava stabilnu koncentraciju lijeka u plazmi i djelovanje tijekom 24 sata. Time se postiže sigurniji ucinak i bolja suradljivost bolesnika neophodna za uspjeh lijecenja.

/pdf/clinical-effects-of-metoprolol-across-the-cardiovascular-4drm1xaeow.pdf

David Gobić

Papers

Risk factors for wound infection after oral cancer surgery

Drug-Coated Balloon Versus Drug-Eluting Stent in Primary Percutaneous Coronary Intervention: A Feasibility Study.

Fine Needle Aspiration Cytology in the Evaluation of Parotid Gland Tumors

Mediastinitis and bilateral pleural empyema caused by an odontogenic infection

Clinical Effects of Metoprolol Across the Cardiovascular Continuum.