1
|
Yeom S, Lee DH, Lee JK, Lim SC. Growth rates over time of unoperated parotid benign tumors. Am J Otolaryngol 2024; 45:104183. [PMID: 38211399 DOI: 10.1016/j.amjoto.2023.104183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION The treatment of parotid benign tumor is in principle surgery, but observation may be necessary in some cases. The purpose of this study was to investigate the growth rates over time of unoperated parotid benign tumors. METHODS We retrospectively reviewed the medical records of 63 patients with unoperated parotid benign tumors diagnosed at our institution between January 2010 and December 2022. RESULTS Forty-nine of the 63 patients had a Warthin tumor and 13 patients had a pleomorphic adenoma. On average, the unoperated parotid benign tumors grew 0.02 cm in length and 0.4 cm3 in volume per year. Compared to pleomorphic adenomas, Warthin tumors were more predominant in male patients and in those with a smoking history and a longer duration of smoking history; patients with Warthin tumors were also followed up longer (p < 0.05). However, the length and volume growth rates of unoperated Warthin tumors and pleomorphic adenomas did not significantly differ. CONCLUSION Surgery is the standard treatment for parotid benign tumors. However, small benign parotid tumors identified during preoperative examination can be observed through close follow-up, taking into account the patient's medical and general condition.
Collapse
Affiliation(s)
- Sujung Yeom
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea.
| | - Joon Kyoo Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| |
Collapse
|
2
|
Sirviö M, Aro K, Naukkarinen M, Mäkitie A, Tarkkanen J, Kelppe J, Atula T. Clinical decision making when cytology indicates a Warthin tumor. Sci Rep 2024; 14:8832. [PMID: 38632256 PMCID: PMC11023945 DOI: 10.1038/s41598-024-58892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Warthin tumor (WT) is a benign tumor usually affecting the parotid gland. The main diagnostic tool remains ultrasound combined with fine-needle aspiration cytology (FNAC). This study aims to examine how reliably FNAC indicates WT for clinical decision making regarding surgical versus conservative management. We included all patients who underwent FNAC from a parotid gland lesion between 2016 and 2018 at our institution, and whose FNAC revealed WT suspicion. The FNACs were divided into three groups based on the cytology report: certain, likely, and possible WT. The patients were divided into two groups based on having had either surgery or follow-up. We sent a questionnaire to patients who had not undergone surgery in order to obtain follow-up for a minimum of four years. Altogether, 135 FNAC samples, from 133 tumors and 125 patients, showed signs of WT. Of the 125 patients, 44 (35%) underwent surgery, and 81 (65%) were managed conservatively. Preoperative misdiagnosis in FNAC occurred in three (7%) surgically treated tumors. Their FNACs were reported as possible WTs, but histopathology revealed another benign lesion. In the conservatively treated group, two patients underwent surgery later during the follow-up. Cytological statements of WT were seldom false, and none were malignant. The majority of the patients were only followed-up and rarely required further treatment. A certain or likely diagnosis of WT in the FNAC report by an experienced head and neck pathologist is highly reliable in selecting patients for conservative surveillance.
Collapse
Affiliation(s)
- Minna Sirviö
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland.
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Mira Naukkarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Pathology, Helsinki University Hospital Diagnostic Center, Helsinki, Finland
| | - Jetta Kelppe
- Pathology, Helsinki University Hospital Diagnostic Center, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
3
|
Nishimura H, Kawata R, Kinoshita I, Higashino M, Terada T, Haginomori SI, Tochizawa T. Management for Warthin Tumor of the Parotid Gland: Surgery or Observation. A 21-Year Retrospective Study of 387 Cases. EAR, NOSE & THROAT JOURNAL 2022:1455613221080927. [PMID: 35393868 DOI: 10.1177/01455613221080927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study investigated the characteristics, diagnosis, and treatment of Warthin tumors (WTs) to explore the possibility of managing patients by observation. METHODS We reviewed the records of 1167 patients with benign parotid tumors who were seen in our department between September 1999 and April 2021. Among them, 387 cases were WT and 668 cases were pleomorphic adenoma. We evaluated preoperative diagnoses of WT by symptoms/signs, fine-needle aspiration cytology (FNAC), imaging, such as ultrasonography and magnetic resonance imaging, and technetium-99m pertechnetate (Tc-99m) scintigraphy. Fisher's exact test and the Mann-Whitney U test were used in statistical analyses. RESULTS Warthin tumors were treated by surgery in 238 cases and follow-up in 149 cases. The 238 patients were diagnosed as WT at the final pathology after surgery. Among them, 172 patients (72.3%) were determined as benign histological type by preoperative FNAC; in these 172 patients, 170 (71.4%) were correctly diagnosed as WT in the final pathology. Preoperative Tc-99m scintigraphy was performed in 69 patients diagnosed with WT by final pathology or FNAC, and the positive rate of Tc-99m scintigraphy in WT was 75.4%. CONCLUSIONS Combining FNAC and Tc-99m scintigraphy, as well as considering clinical findings, enables the diagnosis of WT in most cases. In particular, WT is more common in the elderly, grows more slowly, and is less likely to be malignant. Therefore, if WT can be diagnosed preoperatively with a high rate of correct diagnosis, it could be an accurate and effective means of managing patients through follow-up without surgery.
Collapse
Affiliation(s)
- Hiromi Nishimura
- Department of Otorhinolaryngology - Head and Neck Surgery, 13010Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology - Head and Neck Surgery, 13010Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Ichita Kinoshita
- Department of Otorhinolaryngology - Head and Neck Surgery, 13010Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Masaaki Higashino
- Department of Otorhinolaryngology - Head and Neck Surgery, 13010Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Tetsuya Terada
- Department of Otorhinolaryngology - Head and Neck Surgery, 13010Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shin-Ichi Haginomori
- Department of Otorhinolaryngology - Head and Neck Surgery, 13010Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Takeshi Tochizawa
- Institutional Research Office, 13010Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| |
Collapse
|
4
|
Fíková A, Kuchař M, Kalfeřt D, Dostálová L, Balko J, Zábrodský M, Plzák J. Experience with follow-up strategy in selected patients with Warthin tumour diagnosed by ultrasound-guided fine-needle aspiration biopsy (FNAB). Eur Arch Otorhinolaryngol 2021; 279:2049-2055. [PMID: 34212241 DOI: 10.1007/s00405-021-06959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Warthin tumour (WT) management options comprise surgery or follow-up. The purpose of this study was to asses our experience with the follow-up strategy in selected patients with an ultrasound-guided fine-needle aspiration biopsy (FNAB) showing WT. METHODS We performed a retrospective analysis of patients diagnosed with WT using FNAB between 1.1.2006 and 31.12.2019. Patients were divided into three groups according to the therapeutic approach-immediate surgery, follow-up or surgery and follow-up. RESULTS 323 patients were diagnosed with WT and met the study's inclusion criteria (154 women, 47.7% and 169 men, 52.3%). 192 patients were operated right after the diagnosis, 109 patients were observed with their first detected tumour and 22 patients had parotid WT surgery and were in the wait-and-scan protocol with a contralateral tumour, recurrence or both. The growth rate (GR) of observed WT was highly variable (mean GR 1.0 mm/year (5%), median GR 0.8 mm (9%), range - 19.7 to +20.0 mm/year). From 131 patients in the follow-up group, 19 patients underwent surgery and definitive histology revealed 17 WTs and 2 adenocarcinomas. However, these 2 patients had changes in sonographic findings at their next control. The mean observation time was 44.7 months (range 12-138 months) in patients followed exclusively at our institution and 50.9 months (range 12-110 months) in patients observed in cooperation with an otorhinolaryngologist at the patients' place of residence. CONCLUSION Ultrasound-guided FNAB is an accurate and simple method in WT diagnosis and based on its result a follow-up strategy can be chosen for selected patients with WT.
Collapse
Affiliation(s)
- Alžběta Fíková
- Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine, Charles University, Faculty Hospital Motol, Postgraduate Medical School, V Úvalu 84, 150 06, Prague, Czech Republic.
| | - Martin Kuchař
- Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine, Charles University, Faculty Hospital Motol, Postgraduate Medical School, V Úvalu 84, 150 06, Prague, Czech Republic
| | - David Kalfeřt
- Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine, Charles University, Faculty Hospital Motol, Postgraduate Medical School, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Lucie Dostálová
- Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine, Charles University, Faculty Hospital Motol, Postgraduate Medical School, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Jan Balko
- Department of Pathology and Molecular Medicine 2nd Faculty of Medicine, Charles University, Faculty Hospital Motol, V Úvalu 84, 15006, Prague, Czech Republic
| | - Michal Zábrodský
- Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine, Charles University, Faculty Hospital Motol, Postgraduate Medical School, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Jan Plzák
- Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine, Charles University, Faculty Hospital Motol, Postgraduate Medical School, V Úvalu 84, 150 06, Prague, Czech Republic
| |
Collapse
|