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Objective To highlight the importance of salivary gland fine needle aspiration ( FNA) cytology as a triage tool for surgery and to determine its sensitivity and specificity. To discuss the diagnostic pitfalls and potential role of ancillary techniques in diagnosis and prognosis. Methods The study included a total of 920 cases of salivary gland FNAs received in the cytopathology department of University College London Hospital during December 2004 to December 2012. The cases with known histological outcomes were analysed to determine the sensitivity and specificity. Results Surgery was carried out on 180 (19.6%) of 920 patients. Excluding nine with inadequate/non-diagnostic cytology, the sensitivity of FNA cytology for a malignant outcome was 89% (33/37) and the specificity was 97% (130/134). Diagnostic pitfalls are discussed with respect to eight FNAs with discrepant histology. Histological outcome was not available for 740 cases (80.4%): excluding 88 non-diagnostic FNAs, 324 (49.7%) had non-neoplastic diagnoses (not indicating surgery) and 328 (50.3%) had neoplastic diagnoses, which included recurrences/metastases of known tumours. Patients with other neoplasms on FNA were lost to follow-up and may have had surgery elsewhere. Cases with clinical concerns were discussed at weekly multidisciplinary meetings. Conclusion Salivary gland FNA is crucial in the distinction of non-neoplastic from neoplastic lesions, emphasizing the fact that FNA is an excellent triage tool for surgery. Salivary gland FNA has a high sensitivity and specificity. However, it is important to interpret the cytological diagnoses in the light of clinical findings and imaging. Diagnostic pitfalls are seen in a minority of cases and could potentially be overcome with the help of recently described diagnostic and prognostic markers. [ABSTRACT FROM AUTHOR]

Objective We aimed to assess the potential role of interpretation by cytopathologists on the level of diagnostic adequacy of head and neck fine needle aspirations ( FNAs). Methods An audit ('first audit') was performed between 1 May 2007 and 30 April 2008 using data from three different hospitals (A, B and C). The specimens were interpreted by two cytopathologists with specific experience in head and neck pathology in hospitals A and B, and by any of the eight cytopathologists (only two of whom were experienced in head and neck cytopathology) in hospital C. Following the analysis of the initial findings, there was a change in practice in hospital C, after which specimens were also read only by two experienced cytopathologists. A new audit ('second audit') was then performed between 20 January 2011 and 20 December 2012 in the same three hospitals. Results During the first audit, the diagnostic adequacy of FNAs from hospital C was 84.2% compared with 96.6% in hospital A and 97.7% in hospital B ( P = 0.000). No significant difference in the diagnostic adequacy rate of the FNAs performed in hospitals A and B was found when comparing the first and second audits. The FNA diagnostic adequacy for hospital C increased significantly in the second relative to the first audit (95.5% versus 84.2%, P = 0.000). Conclusions Our study confirms that expert cytology interpretation is important in achieving optimal diagnostic adequacy of head and neck FNAs. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the imaging preferences for the diagnosis of unilateral vocal cord palsy.

The article presents a case study of a 67-year-old woman with Riedel's thyroiditis (RT). The patient was noted with an enlarged thyroid gland with extension to jugular and carotid vessels. The patient has undergone a repeated fine needle aspiration cytology (FNAC), results revealed a moderate cellularity fragments of fibrous tissue. The patient was opted for an elective thyroidectomy.

Objective: This review highlights the role of cytopathology in cancer management within UK Head and Neck Cancer Networks and informs on the issues raised by recent UK Department of Health documents and other UK professional guidance. UK guidance requires the formal involvement of cytopathologists within multidisciplinary cancer teams, with medical and non-medical cytopathology staff setting up and running rapid access lump clinics, and support for image-guided fine needle aspiration cytology (FNAC) services. UK guidance also makes recommendations for training, resources and quality control. This review also highlights the resource gap between best practice evidence-based guidance for head and neck (HN) cancer services and existing UK provision for cytopathology, as evidenced by lack of availability of experienced staff and adequacy of training and quality control (QC). Finally, it stresses the importance in the UK of the Royal College of Pathologists’ guidance, which defines the need for training, the experience needed for new consultants, the requirements for audit and QC. The implications for the additional resources required for HN cancer cytopathology services are discussed. Recent professional guidance specifying the provision of HN cancer services in the UK includes a cytopathology service for cancer networks, such as rapid access FNAC clinics. Although these clinics already operate in some institutions, there are many institutions where they do not and where the provision of cytopathology services would have to be restructured. This would need the support of local cancer networks and their acceptance of the detailed requirements for cytopathology, including resources, training and QC. The standards are not defined locally, as Strategic Health Authorities and Primary Care Trusts have been instructed by the Department of Health to support, invest and implement them. [ABSTRACT FROM AUTHOR]

Objective: To describe the long-term audiologic findings in pediatric patients with enlarged vestibular aqueducts (EVAs). The relationship between the hearing loss (HL) and the dimensions of the EVA, enlarged endolymphatic duct (EED), or enlarged endolymphatic sac (EES) was also investigated. The influence of a Pendred syndrome (PS) diagnosis on the audiologic phenotype was also examined. Study Design: Retrospective analysis of case notes and imaging records, including measurement of the dimensions of the EVA, EED, and EES. Setting: Tertiary referral center. Patients: Twenty-seven patients (21 female, 6 male) had an EVA in at least one ear. Eighty-five percent had bilateral enlargements. Median age at onset of follow-up was 5.0 years, and median follow-up was 9.7 years. Main Outcome Measures: Hearing thresholds at the start and end of follow-up, rate of progression of HL, history of sudden drops in hearing. Results: : All ears with an EVA had HL. Average HL at the start and end of follow-up was severe. Thirty-seven percent of patients had progressive HL, and 33% reported sudden drops in hearing. Progression was significantly associated with a history of sudden drops. PS patients had worse hearing at the end of follow-up as compared with nonsyndromic patients. There was no evidence of a relationship between the dimensions of the EVA, EED, or EES and the severity or progression of HL. Conclusions: Patients with EVAs should be advised to avoid known trigger factors for sudden drops in hearing (e.g., minor head trauma). A diagnosis of PS may be associated with a worse audiologic prognosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to investigate whether the type of instrumental swallowing examination (Fibreoptic Endoscopic Evaluation of Swallowing (FEES) or videofluoroscopy) influences perception of post-swallow pharyngeal residue. Design: Prospective, single-blind assessment of residue from simultaneous videofluoroscopy and FEES recordings. All raters were blind to participant details, to the pairing of the videofluoroscopy and FEES examinations and to the other raters’ scores. Setting: Tertiary specialist ENT teaching hospital. Participants: Fifteen adult participants consecutively recruited; seven women and eight men aged between 22 and 73, mean age 53. All participants underwent one FEES examination and one videofluoroscopy examination performed simultaneously. Inclusion criteria: referred to speech and language therapy for assessment of dysphagia. Exclusion criteria: nil by mouth or judged to be at high risk of aspiration. Main outcome measures: The FEES and videofluoroscopy examinations were recorded simultaneously. Fifteen speech and language therapists independently scored pharyngeal residue as none, coating, mild, moderate or severe. All examinations were scored twice by all raters. Results: Intra- and inter-rater agreement were similar for both examinations. There were significant differences between FEES and videofluoroscopy pharyngeal residue severity scores (anova, P < 0.001). FEES residue scores were consistently higher than videofluoroscopy residue scores. Conclusions: Pharyngeal residue was consistently perceived to be greater from FEES than from videofluoroscopy. These findings have significant clinical implications as FEES and videofluoroscopy findings are used to judge aspiration risk and to make recommendations for oral intake. Further research is required to examine the impact of FEES and videofluoroscopy examinations on treatment decisions. [ABSTRACT FROM AUTHOR]

The use of softer-energy X-rays produced by synchrotron radiation for diffraction is an area of current interest. In this paper, experiments exploiting resonant scattering at the L absorption edges of 3d transition metal elements are reported. Such energies, typically 500–1000 eV, are at the extreme limit of soft X-ray diffraction where absorption effects are so severe that the sample and diffractometer must be placed in a windowless high-vacuum vessel. In addition, the Ewald sphere is so small as to likely contain, at most, only a single Bragg reflection. Advantages of using such radiation for the study of weak diffraction effects such as anomalous scattering, charge ordering, magnetic diffraction and orbital ordering are reported. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate whether it would be possible to measure accurately a range of stapes prostheses of different lengths and makes using spiral CT imaging and a radiologist who would report the images in a blinded fashion. To establish the distance from the tip of each prosthesis to the metallic component in metal – plastic prostheses. Method. Eight stapes prostheses (2 fluoroplastic-stainless steel; 2 fluoroplastic-platinum; 2 fluoroplastic-nitinol; 2 fluoroplastic only) were selected and placed onto the long process of the incus and over the oval window of a dried temporal bone preparation. CT scans were then performed and multiplanar reformatting techniques used to allow measurement of the length of the prostheses. The prostheses were then photographed and measured using high definition digital prints after slicing them in half to expose the central metallic component. Results. The median difference between the actual and observed length of the 6 metallic/fluoroplastic stapes prostheses was 0.25 mm (0.05–0.55 mm). In contrast the 2 fluoroplastic prostheses were accurately measured as 4 and 5 mm respectively. The median distance of the metallic component from the end of the prosthesis was found to be 1.75 mm (1.5–1.9 mm). Conclusion. Modern spiral CT scanners can visualise the fluoroplastic component of stapes prostheses to assess its position. However, our series shows that the length of mixed metallic/fluoroplastic prostheses may be still be inaccurately measured by up to 0.55 mm. Reliance on measuring the metallic component of the prosthesis may also overestimate the proportion of prostheses that are short of the footplate. References. 1 Kosling S. & Bootz F. (2001) CT and MR imaging after middle ear surgery. Eur. J. Radiol. 40, 113–118 2 Pickuth D., Brandt S., Berghaus A., Spielmann R.P. & Heywang-Kobrunner S.H. (2000) Vertigo after stapes surgery: the role of high resolution CT. Br. J. Radiol. 73, 1021–1023 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To validate a follow-up protocol based on the long-term outcomes and recurrence rates in patients who have undergone surgical treatment for olfactory neuroblastoma., Methods: A prospective review of all patients treated for olfactory neuroblastoma at our institution over a 35-year period., Results: Ninety-five patients were treated from 1978 to 2013, with craniofacial (65 patients) or endoscopic resection (30 patients). Duration of follow-up ranged from 1 to 309 months (mean, 88.66 months). Fifty-six patients were alive and well, and 13 were alive with recurrent disease. Twenty-one patients had died of disease, and three had died of intercurrent disease. Overall survival was 83.4% at 5 years and 76.1% at 10 years. Disease-free survival at 5 years was 80% and at 10 years was 62.8%. A Cox regression analysis showed orbital extension and intracranial involvement to be significant independent factors affecting outcome. Local and regional recurrence occurred after an average of 49 months but with a range of 3 to 233 months., Conclusions: In our series, olfactory neuroblastoma most commonly recurred within the first 4 years but can recur very late, after 19.4 years in one case. There is currently no universally accepted follow-up regime, but even late recurrence is eminently treatable. We therefore propose a protocol for lifelong follow-up with both clinical examination and serial imaging, including the neck and entire intracranial compartment., Level of Evidence: 4., (© 2013 The American Laryngological, Rhinological and Otological Society, Inc.)