Fine needle aspiration cytology for parotid lesions, can we avoid surgery?

Abstract

Objective

Salivary gland neoplasms are rare tumors, with most arising in the parotid gland. Fine-needle aspiration cytology (FNAC) is a common method for pre-operative evaluation of parotid masses, although its usefulness is controversial. This study was designed to evaluate the accuracy of FNAC in a large cohort of patients, with emphasis on diagnosis of benign tumors and especially Warthin tumor which can be managed conservatively.

Study Design

Retrospective case series with chart review.

Setting

Tertiary medical center.

Subjects and Methods

From 1991 to 2014, all patients 18 or older with both pre-operative FNAC and post-operative pathology report were included. Patients with a history of head and neck malignancy, sialoadenitis or had undergone prior oncological treatment were excluded.

Results

470 patients were available for analysis. Overall accuracy was 82.6%. Positive predictive value (PPV) varied between 88.6-94.3% for pleomorphic adenoma and 77.1-100% for Warthin tumor, with values varying depending on different patient charcteristics (e.g. age, smoking status). For pathologically proven malignant tumors, the FNAC diagnosis was benign or non-diagnostic in 26% of cases.

Conclusion

FNAC has limited utility in confirming a benign diagnosis of a parotid mass for most patients, although for some sub-populations the PPV may be high enough to defer surgery.

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