A retrospective study of parotid gland tumors at a single institution

The aim of the present study was to analyze the clinical characteristics, surgical treatments and clinical outcome of patients with parotid gland tumors and to compare the results with those cited in the literature. A retrospective study was conducted in 140 patients (male, n=77; female, n=63) with parotid gland tumors who underwent parotidectomy at Hokuto Hospital Department of Otolaryngology-Head and Neck Surgery (Obihiro, Japan) between April 2007 and December 2021. Of the 140 patients enrolled, 118 (84.3%) patients had benign tumors, including 63 (45%) patients with pleomorphic adenomas and 43 (30.7%) patients with Warthin tumors, and 22 patients (15.7%) had parotid carcinoma. Comparison of the three groups of patients with parotid gland tumors indicated that pack years as an indicator of smoking status were significantly higher in patients with Warthin tumors than in those with parotid carcinomas (P=0.011) or pleomorphic adenoma (P<0.001). Fine-needle aspiration cytology (FNAC) was non-diagnostic for only 6 (4.3%) of 140 patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC by both conventional smear and liquid-based cytology (LBC) for parotid carcinomas were 70, 99, 93.3, 94.4 and 82.9%, respectively. Among the 22 patients with parotid carcinoma, extended total/total and superficial parotidectomy were performed in 10 (45%) and 11 (50%) cases, respectively. Total and selective neck dissection of the area from level II to I, II and III were performed in 6 (24%) and 7 (32%) patients, respectively. Postoperative radiotherapy (50 Gy) was performed in 15 (68%) patients. The overall survival (OS) and disease-free survival (DFS) rates at 5 years were 51.5 and 76.4%, respectively. Univariate analysis revealed that age >65 years was significantly associated with poorer 5-year OS (P<0.001) and DFS (P<0.001). Multivariate analysis revealed that an age of more than 65 years combined with high-grade histologic malignancy was associated with worse DFS (P=0.02; hazard ratio, 3.628; 95% confidence interval, 1.283-9.514). In conclusion, the clinical characteristics and treatment outcomes of parotid gland tumors were consistent with the results of previous reports. Smoking may be closely related to the pathogenesis of Warthin tumors. LBC potentially provides improved accuracy in FNAC.

Value of dynamic contrast enhanced MRI in differential diagnostics of Warthin tumors and parotid malignancies

To define an algorithm for differential diagnostics of parotid malignancies and Warthin tumors (WTs) based on dynamic contrast enhanced MRI (DCE-MRI). 55 patients with parotid tumors treated surgically were analyzed. Of which, 19 had parotid malignancy and 36 had WTs confirmed with postoperative histopathological examination. Accuracy of DCE-MRI parameters (T_peak and WR) was compared with the histopathological diagnosis. ROC analysis was performed to determine sensitivity and specificity of DCE-MRI with various T_peak and WR cut-off values. WT showed significantly lower median T_peak and higher median WR than malignant lesions. The cut-off values for T_peak and WR providing maximum sensitivity (84.2%) and specificity (86.1%) for malignant tumors were T_peak > 60 s and WR ≤ 30%. Different diagnostic algorithm, i.e., lower cut-off value for T_peak (T_peak = 60 s), increases sensitivity of DCE-MRI in differentiating parotid malignancies from WTs. However, WR > 30% seems to be a key diagnostic criterion for benign lesions. Precise and reliable preoperative diagnostics of parotid tumors aids in careful surgical planning, thereby assisting in achieving sufficient surgical resection margins and facial nerve preservation.

Management of Salivary Gland Malignancy: ASCO Guideline

PURPOSE

To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy.

METHODS

ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations.

RECOMMENDATIONS

When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.

Clinical and demographic data improve diagnostic accuracy of dynamic contrast-enhanced and diffusion-weighted MRI in differential diagnostics of parotid gland tumors

PURPOSE

To verify if differential diagnostic algorithms based on selected parameters of dynamic and diffusion-weighted MRI, clinical and demographic variables are accurate enough to differentiate between parotid malignancies, pleomorphic adenomas and Warthin tumors.

MATERIALS AND METHODS

The study included 84 patients, among them 19 (23%) with postoperative diagnosis of a parotid malignancy, 37 (44%) with Warthin tumors and 28 (33%) with pleomorphic adenomas. Accuracy of dynamic and diffusion-weighted MRI parameters (T_peak, T_max, WR and ADC), clinical parameters of the tumor (location in the superficial or deep parotid lobe, single vs. multiple lesion, concomitant lymphadenopathy) and demographic characteristics of the patient (age, sex) was determined on ROC analysis.

RESULTS

Compared to Warthin tumors, parotid malignancies showed higher T_peak, T_max and ADC, lower WR, were more often located in the deep lobe of the parotid and presented as single lesions with concomitant lymphadenopathy. Consideration of all these variables provided 100% sensitivity and 89.2% specificity of the differential diagnostic algorithm. Compared to pleomorphic adenomas, parotid malignancies presented with lower ADC and T_peak, higher T_max, were more often located in the deep lobe of the parotid, associated with concomitant lymphadenopathy, diagnosed in men and individuals older than 66 years. Consideration of all these variables provided 100% sensitivity and 96.4% specificity of the differential diagnostic algorithm.

CONCLUSION

Combined analysis of clinical data and results of dynamic and diffusion-weighted MRI may provide nearly ideal accuracy in differential diagnostics of parotid malignancies and the two most common histological types of benign tumors.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases

Introduction  Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective  To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods  A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results  Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion  Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

Cytology of the Salivary Glands

Common usage of fine-needle aspirate (FNA) for salivary gland lesions is the preoperative determination of whether a lesion is neoplastic, its lineage, and if neoplastic, whether it is low grade/benign, or high grade. Immunohistochemical stains can be performed on cell blocks to determine lineage and help refine diagnosis, although their performance is not always equivalent to that seen in surgical specimens. Several characteristic translocations have been described in various entities in these categories, and these can be evaluated using fluorescence in situ hybridization. In the future, high-throughput next-generation sequencing panels may further refine cytologic diagnosis in salivary tumors.

The role of pre-operative CT-guided FNAB for parapharyngeal space tumors

Objective

To determine the role of computed tomography (CT)-guided fine needle aspiration biopsy (FNAB) in surgical planning for parapharyngeal space (PPS) tumors.

Design and Setting

Chart review of 49 consecutive patients with surgically treated PPS tumors from 1995 to 2005.

Results

Twenty-nine patients had CT-guided FNAB. A cytopathologic diagnosis that was the same as final pathology was rendered in 14 (48%) patients; suggestive but not conclusive in 6 (21%) patients; discordant in 3 (10%) patients; and 6 (21%) patients had a nondiagnostic result. Fourteen of 15 patients who had a final histopathologic finding of pleomorphic adenoma had a correct or highly suggestive preoperative FNAB diagnosis. The positive predictive value for CT-guided FNAB to identify benign tumors is 90%, (18 of 20) but to identify malignant PPS tumors is 75% (3 of 4).

Conclusion

CT-guided FNAB of PPS tumors is helpful to predict the nature of the PPS tumors (especially benign), which allows the surgeon and patient to plan for treatment, accordingly.

Fine needle aspiration: an atraumatic method to diagnose head and neck masses

Background

Patients presenting with a mass require tissue biopsy for histological diagnosis and treatment. Fine needle aspiration (FNA) is offered as an atraumatic, well tolerated, and inexpensive method for obtaining a biopsy from these lesions.

Objectives

In this study we evaluated the accuracy of FNA as an atraumatic method among patients with nonthyroidal masses for diagnosis of neoplastic masses compared to open surgery.

Patients and Methods

In a cross-sectional study, 65 patients with a head and neck masses (nonthyroidal) referred to us from 2004 to 2009. Those who had both FNA and open biopsy (the gold standard) were assessed for specificity, sensitivity, positive and negative predictive values of FNA in diagnoses.

Results

Sixty-five cases with both definite diagnoses of open biopsy and FNA were assessed. The mean (± standard deviation) age of patients was 39.96 ± 19.69 years (range 10 to 82 years). Twenty-five (40.8%) subjects were categorized as malignant neoplasms, 16 (19.4%) as benign neoplasms, and 24 (39.8%) as non-neoplastic lesions. The sensitivity, specificity, positive and also negative predictive values of FNA in the diagnosis of neoplastic masses were 95%, 85%, 92.68%, and 91.66% respectively, and the diagnostic accuracy was 92.3%.

Conclusions

It seems that FNA is a useful atraumatic diagnostic technique with a high diagnostic accuracy which can provide a highly sensitive diagnosis with low false positive diagnoses in patients with nonthyroidal masses.

The diagnostic value of fine needle aspiration in parotid lumps

INTRODUCTION

Fine needle aspiration (FNA) is a safe and quick method of diagnosing superficial lumps, which aids preoperative planning. However, FNA of the parotid gland has not gained the widespread acceptance noted in other head and neck lumps. The aim of this study was to determine the ability of FNA of the parotid gland to differentiate benign and malignant disease, and to determine the impact on surgical outcome.

METHODS

A retrospective analysis of 201 consecutive parotid operations with preoperative FNA in a large district hospital in the UK was performed. The diagnostic characteristics were calculated for benign and malignant disease, and the impact on surgical procedure was determined.

RESULTS

In identifying benign disease, FNA has a sensitivity of 85% and a specificity of 76%. In detecting malignant disease, FNA has a sensitivity and specificity of 52% and 92% respectively. A false positive on FNA was associated with a higher incidence of neck dissection.

CONCLUSIONS

FNA is a useful diagnostic test. However, owing to low sensitivity, it is necessary to interpret it in the context of all other clinical information.

Quality Appraisal of Diagnostic Accuracy Studies in Fine-Needle Aspiration Cytology: A Survey of Risk of Bias and Comparability

Context.—The quality of diagnostic accuracy studies is determined by 2 key factors: risk of bias and comparability. Bias can distort accuracy estimates and poor reporting impairs comparability. While diagnostic accuracy studies for fine-needle aspiration cytology (FNAC) are frequently published, the methodologic issues associated with this body of literature have never been reviewed.

Objective.—To assess the quality of design and reporting of diagnostic test accuracy studies in FNAC.

Data Sources.—Diagnostic accuracy studies were identified by a Medline (US National Library of Medicine) search. Sixty-four FNAC diagnostic test accuracy studies were randomly selected for structured review with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) survey. Studies were divided between 2 time periods: 2000-2001 and 2009-2011.

Conclusions.—Diagnostic test accuracy studies of FNAC suffer from numerous deficiencies in study design, which negatively affect the reliability of accuracy estimates.

Accuracy of fine needle aspiration cytology of salivary gland lesions: routine diagnostic experience in Bangkok, Thailand

Fine needle aspiration (FNA) cytology is well accepted as a safe, reliable, minimal invasive and cost-effective method for diagnosis of salivary gland lesions. This study evaluated the accuracy and diagnostic performance of FNA cytology in Thailand. A consecutive series of 290 samples from 246 patients during January 2001-December 2009 were evaluated from the archive of the Anatomical Pathology Department of our institution and 133 specimens were verified by histopathologic diagnoses, obtained with material from surgical excision or biopsy. Cytologic diagnoses classified as unsatisfactory, benign, suspicious for malignancy and malignant were compared with the histopathological findings. Among the 133 satisfactory specimens, the anatomic sites were 70 (52.6%) parotid glands and 63 (47.4 %) submandibular glands. FNA cytological diagnoses showed benign lesions in 119 cases (89.5 %), suspicious for malignancy in 3 cases (2.2 %) and malignant in 11 cases (8.3%). From the subsequent histopathologic diagnoses, 3/133 cases of benign cytology turned out to be malignant lesions, the false negative rate being 2.2 % and 1/133 case of malignant cytology turned out to be a benign lesion, giving a false positive rate was 0.8%. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 97.0% (95% CI, 70.6%-99.4%), 81.3% (95% CI, 54.4%-96.0%), 99.1% (95% CI, 95.4%-100%), 92.9% (95% CI, 66.1%-99.8), 97.5% (95% CI, 92.8%-99.5%), respectively. This study indicated that FNA cytology of salivary gland is a reliable and highly accurate diagnostic method for diagnosis of salivary gland lesions. It not only provides preoperative diagnosis for therapeutic management but also can prevent unnecessary surgery.

Fine needle aspiration biopsy: in the diagnosis of salivary gland neoplasms compared with histopathology

Fine needle aspiration biopsy is commonly used for pre operative evaluations of salivary gland masses. We would like to focus on this diagnostic tool for the salivary gland lesions by reviewing Ankara Oncology Hospital's case lists. Cytological and postoperatively histological reassessment is done for 115 cases. Fine needle aspiration biopsy's sensitivity was 80.8 %, specificity 95.1 %, positive predictive value was 84 % and negative predictive value was 93.9 %. False positive range was 4.9 % and false negative range was 19.2 %. Salivary gland masses can be assessed by cytology preoperatively.

Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery?

BACKGROUND

Optimal surgery for pleomorphic adenoma of the parotid is controversial. In the present review, we discuss the advantages and disadvantages of the various approaches after addressing the surgical pathology of the parotid pleomorphic adenoma capsule and its influence on surgery.

DATA SOURCES

PubMed literature searches were performed to identify original studies.

CONCLUSIONS

Almost all pleomorphic adenomas can be effectively treated by formal parotidectomy, but the procedure is not mandatory. Extracapsular dissection is a minimal margin surgery; therefore, in the hands of a novice or occasional parotid surgeon, it may result in higher rates of recurrence. Partial superficial parotidectomy may be a good compromise. The tumor is removed with a greater cuff of healthy parotid tissue than in extracapsular dissection. This may minimize the recurrence rate. On the other hand, the removal of healthy parotid tissue compared with formal parotidectomy is limited, thus minimizing complications such as facial nerve dysfunction and Frey syndrome.

Pediatric parotid tumors: clinical review of 24 cases in a Chinese population

OBJECTIVE

To evaluate the incidence, types, and treatment outcomes of pediatric parotid tumors in Chinese population.

METHODS

Pediatric salivary gland tumors treated at Stomatolgy Hospital, of Wuhan University, from 1990 to 2010, were analyzed retrospectively.

RESULTS

One hundred and two patients 18 years old or younger were diagnosed as parotid mass, of which 24 (23.5%) were parotid tumors. Of these patients, 11 (45.8%) were benign and 13 (54.2%) malignant. Hemangioma was the most frequent no-epithelial tumor. The most common benign epithelial tumor was pleomorphic adenoma (63.6%), and the most common malignant epithelial tumor was mucoepidermoid carcinoma (38.5%), with both of them showing a female to male predominance. The most common treatment was parotidectomy (83.3%).

CONCLUSIONS

Although pediatric parotid masses are unusual, they can represent a variety of pathological diagnoses, including malignancy. The intralesional injection can treat parotid hemangiomas in pediatric population effectively. Parotidectomy remains the mainstay treatment for both pediatric parotid gland benign and malignancies of epithelial cell origin. Adjuvant radiotherapy should be used judiciously in pediatric patients due to the higher risk of post-irradiation complications.

Value of fine-needle aspiration cytology in the evaluation of parotid tumors

Fine needle aspiration cytology (FNAC) is commonly used in the study of parotid masses; however controversy exists regarding its diagnostic accuracy. The objective of this study was to evaluate the effectiveness of FNAC as a preoperative diagnostic tool of parotid tumors. Sixty-five patients had satisfactory preoperative FNAC and underwent subsequent surgery to the parotid between March 2002 and July 2009 at our institution. The results of the FNAC were compared to the permanent histopathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and the overall accuracy of FNAC for parotid masses were 57.9, 97.8, 91.7, 84.9, and 86%, respectively. FNAC is useful in the preoperative assessment of parotid tumors and surgical planning. The non-diagnostic and false-negative results are the limitations of FNAC that should be reduced to improve its usefulness in the evaluation of parotid tumors.

A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology for parotid gland lesions

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.

Diagnostic accuracy of fine needle aspiration cytology in parotid lesions

Objective. Histopathology of parotid gland tumors is extremely varied and complex due to heterogeneous cellular composition. Preoperative diagnostic tools include fine needle aspiration cytology, the role of which remains controversial. The aim of this paper is to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of parotid gland tumors. Methods. We retrospectively reviewed charts of 129 patients who underwent parotidectomy for parotid lesions at Aga Khan University Hospital from 2002 to 2010. We compared the results of preoperative FNAC with final histopathological diagnosis. Results. Concordance with histological results was observed in 86%, specificity was 98%, sensitivity was 84%, and diagnostic accuracy was 94%. Conclusion. Our results demonstrate that preoperative cytology in parotid lesions is fairly accurate and useful in diagnosing benign from malignant and in planning appropriate approach for treatment.

Differentiation of benign and malignant parotid tumors using deconvolution-based perfusion CT imaging: Feasibility of the method and initial results

AIM

We evaluated the feasibility of perfusion CT (CTP) of the parotid gland and attempted to differentiate benign from malignant tumors.

MATERIALS AND METHODS

CTP was performed in 17 patients with benign tumors and 10 patients with malignant parotid tumors. Data were postprocessed by using deconvolution-based perfusion analysis. Postprocessing-generated maps showed blood flow (BF), blood volume (BV), mean transit time (MTT), and capillary permeability surface product (PS). Regions of interest were placed through the tumor site and the contralateral healthy parotid tissue. Ratios of the perfusion values between the tumors and the contralateral healthy structures were also calculated. Pearson correlation coefficients were determined to compare the agreement between the two readers.

RESULTS

Perfusion maps of all tumors were successfully obtained. High Pearson correlation coefficients comparing the two readers' visually measured abnormalities were observed (r=0.79-0.86, P=0.001) for all perfusion maps, The MTT and PS values between malignant and benign tumors were not significantly different. The BF and BV values were statistically significant different between the benign and malignant tumors (0.00<P<0.02). Only the BV ratio criterion between malignant and benign neoplasms was statistically significant (P<0.004).

CONCLUSIONS

CTP of the parotid gland is feasible and may differentiate malignant from non-malignant lesions by means of absolute BF, BV and BV ratio values.

Identification of Warthin tumor: magnetic resonance imaging versus salivary scintigraphy with technetium-99m pertechnetate

OBJECTIVE

The aim of this study was to evaluate the accuracy of technetium-99m (Tc-99m) pertechnetate scintigraphy and magnetic resonance (MR) imaging in the diagnosis of Warthin tumor.

METHODS

Sixteen cases of Warthin tumor and 17 cases of non-Warthin tumor were examined by Tc-99m pertechnetate scintigraphy with lemon juice stimulation and MR imaging, including T1-weighted, T2-weighted, short inversion time inversion recovery, diffusion-weighted, and contrast-enhanced dynamic images. We used the receiver operating characteristic (ROC) curve to evaluate diagnostic accuracy.

RESULTS

The mean area under the ROC curves of MR imaging in the diagnosis of Warthin tumor (0.97) was higher than that of Tc-99m pertechnetate scintigraphy (0.88).

CONCLUSION

Magnetic resonance imaging is more useful in the evaluation of Warthin tumor than Tc-99m pertechnetate scintigraphy.

Management of primary malignant epithelial parotid tumors

Parotid cancers are infrequently encountered. These tumors carry a prolonged risk of recurrence and metastasis. Controversies surrounding pre-treatment evaluation by imaging and fine needle aspiration, utility of operative frozen section are partly resolved. Though surgery remains the mainstay of treatment, radiation is being recognized as a useful adjuvant. Facial nerve preservation is one of the important goals at surgery. The role of chemotherapy is still investigational. The prognosis and necessity of elective neck treatment are mainly guided by the tumor grade and stage.

Diagnostic accuracy of fine-needle aspiration cytology and frozen section in primary parotid carcinoma

BACKGROUND

The low incidence and histologic heterogeneity of primary parotid carcinomas makes it difficult to evaluate the value of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen section (FS) analysis. In the current study, the authors reviewed a single institution's experience regarding the preoperative and intraoperative diagnostic value of FNAC and FS in primary salivary gland carcinomas.

METHODS

Between January 1990 and December 2002, 108 primary parotid carcinomas were resected at the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Berne, Inselspital (Berne, Switzerland). Included in the study were a total of 101 carcinomas with preoperative FNAC results in 88 tumors and/or intraoperative FS results in 45 tumors. In a retrospective study, the results of FNAC and FS were analyzed and compared with the corresponding histopathologic diagnoses.

RESULTS

The cytologic findings were true-positive for malignancy in 63 tumors (72%), false-negative in 22 tumors (25%), and nondiagnostic in 3 tumors (3%). The tumor grading was correct in 29 of 63 tumors (46%), and the exact tumor typing was correct in 27 of 63 (43%) true-positive tumors. The FS findings were true-positive for malignancy in 43 of 45 tumors (96%), the tumor grading was correct in 35 of 45 tumors (78%), and the tumor typing was correct in 32 of 45 tumors (71%). Overall, at the time of surgery, of the 101 parotid carcinomas, the tumor was known to be malignant in 83 tumors (82%), and the correct grade and the exact tumor type were known in 55 tumors (54%) and 48 tumors (48%), respectively.

CONCLUSIONS

FNAC recognized malignancy in 72% of tumors, but it could not be relied upon to provide an accurate tumor grading or typing. Therefore, FNAC alone is not prone to determine the surgical management of primary parotid carcinomas. The current analysis showed the statistically significant superiority of FS compared with FNAC regarding the diagnosis of malignancy, tumor grading, and tumor typing in primary parotid carcinomas.

Current management of benign parotid tumors--the role of limited superficial parotidectomy

BACKGROUND

Parotid tumors are mostly benign, but their evaluation and treatment require a thorough knowledge of the relevant anatomy and pathology. Surgical treatment of benign tumors is aimed at complete removal of the mass with facial nerve preservation. The aim of this study was to evaluate the results of treatment of benign parotid neoplasms when surgery entailed limited superficial parotidectomy.

METHODS

All patients with benign parotid tumors treated by the author from 1988 to 2002 were reviewed. Data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, RPAH. Limited superficial parotidectomy was carried out in all previously untreated patients with tumors superficial to the plane of the facial nerve. Median follow-up time was 6 years (range, 1-14 years).

RESULTS

A total of 363 parotidectomies was carried out on 355 patients, 29 of whom (8%) were previously treated. Tumors arose deep to the plane of the facial nerve in 40 patients (11%), and, of these, 16 occupied the parapharyngeal space. Pleomorphic adenoma (70%) and Warthin's tumors (15%) were the most common pathologic types. Temporary postoperative facial weakness occurred after 98 operations (27%). Facial weakness was permanent in 2.5% of patients (9 cases) who had normal preoperative function; however, in this group the facial nerve was intentionally resected in 2 patients, 3 others had had previous surgery, and 1 had a deep lobe tumor. Tumor recurrence developed in three patients (0.8%), two of whom had been previously treated.

CONCLUSION

Complete superficial parotidectomy is unnecessary in the treatment of benign localized parotid tumors. Limited parotidectomy is associated with very low rates of morbidity and recurrence. Preoperative investigations should be used selectively; however, the author recommends routine (or at least liberal) use of fine-needle aspiration biopsy.

Inter- and Intratumoral Variability in Magnetic Resonance Imaging of Pleomorphic Adenoma

OBJECTIVES

The purpose of our study was to describe the various magnetic resonance (MR) findings of pleomorphic adenoma and to interpret these findings.

METHODS

MR studies of 33 pleomorphic adenomas and 13 malignant tumors in the major salivary glands were reviewed.

RESULTS

High signal intensity on short-inversion-time inversion recovery (STIR) and T2-weighted (T2W) images, progressive enhancement on dynamic MR images, and high apparent diffusion coefficient (ADC) values on diffusion-weighted (DW) images reflected myxoid-dominant components in pleomorphic adenomas. Hypercellularity with less-myxoid stroma showed reduced signal intensity on STIR and T2W images and also reduced ADC values on DW images, and the peak of time versus signal intensity curves (TICs) was reached earlier on dynamic MR images.

CONCLUSIONS

The MR images of hypercellularity components in pleomorphic adenoma overlap with those of malignant parotid tumors. Detecting myxoid components by STIR, T2W, DW, and dynamic MR images is useful for predicting whether salivary gland tumors are pleomorphic adenoma or not.

Fine-needle Aspiration Cytology in the Management of Salivary Gland Tumors: An Australian Experience

We conducted a retrospective study of 104 cases of salivary gland tumors that were initially assessed by fine-needle aspiration biopsy (FNAB). Based on subsequent histopathologic analysis of excised specimens, we found that preoperative FNAB was highly sensitive and specific for both benign and malignant tumors—including the most common, pleomorphic adenomas and squamous cell carcinomas, respectively. Despite its possible drawbacks, we conclude that preoperative FNAB is a useful tool in the management of salivary gland tumors.

Accuracy of fine-needle aspiration cytology of salivary gland lesions in the netherlands cancer institute

BACKGROUND

To evaluate the accuracy of fine-needle aspiration cytology (FNAC) in salivary gland lesions in a tertiary referral center.

METHODS

A cytohistologic correlation study was performed using an automated pathology database of 1023 patients diagnosed with a salivary gland lesion.

RESULTS

In 388 cases, both cytology and histology were available. Using cytologic confirmation of malignancy as the starting point, the sensitivity, specificity, and accuracy of FNAC in this study were 88%, 99%, and 96%, respectively. Exact type-specific concordance of the malignant diagnosis was achieved in 66 (88%) of 75 cases and in 211 (95%) of 223 benign cases. Of the 19 cases with a cytologic diagnosis "cyst," four proved to be malignant. A non-neoplastic lesion at cytology proved to be correctly classified in 53 (68%) of 80 patients.

CONCLUSIONS

Our data show that cytology is a reliable and accurate technique to assess lesions of the salivary glands. The cytologic diagnosis of "cysts" and "non-neoplastic lesions" should be interpreted with caution.