Clinical Paper
Head and Neck Oncology
Diagnostic investigation of parotid neoplasms: a 16-year experience of freehand fine needle aspiration cytology and ultrasound-guided core needle biopsy

https://doi.org/10.1016/j.ijom.2014.09.025Get rights and content

Abstract

This study aimed to examine the diagnostic yield of fine needle aspiration cytology (FNAC) and ultrasound-guided core needle biopsy (USCB) in the diagnosis of parotid neoplasia. A 16-year retrospective analysis was performed of patients entered into our pathology database with a final diagnosis of parotid neoplasia. FNAC and USCB data were compared to surgical excision where available. One hundred and twenty FNAC, 313 USCB, and 259 surgical specimens were analyzed from 397 patients. Fifty-six percent of FNAC and 4% of USCB were non-diagnostic. One hundred and thirty-two (33%) patients had a final diagnosis made by USCB and did not undergo surgery. Surgery was performed in 257 (65%) patients, 226 (88%) of whom had a preoperative biopsy. Most lesions were benign, but there were 62 parotid and 13 haematological malignancies diagnosed; false-negative results were obtained in three FNAC and two USCB samples. The sensitivity and specificity of FNAC were 70% and 89%, respectively, and for USCB were 93% and 100%, respectively. This study represents the largest series of patients with a parotid neoplasm undergoing USCB for diagnosis. USCB is highly accurate with a low non-diagnostic rate and should be considered an integral part of parotid assessment.

Section snippets

Materials and methods

Ethical exemption was granted for the study; approval was not required for this retrospective study at our centre. Patients were identified from the pathology database for a 16-year period (March 1997 to June 2013). Specimens were entered into the APEX pathology database (medical database software) using specific Systematized Nomenclature of Medicine (SNOMED) topography and morphology codes for salivary gland neoplasms. All patients with a pathological diagnosis of parotid neoplasia were

Results

There were 200 female and 197 male patients with an age range of 21–104 years (mean age 67 years). A primary diagnostic surgical excision was performed in 31 patients (7.8%). Of the 397 patients, 305 had USCB and 110 had FNAC. Eight repeat USCB and 10 repeat FNAC were undertaken, giving a total of 313 USCB and 120 FNAC. Surgery was performed in a total of 257 patients (including the 31 primary excisions); two patients had further surgery for recurrence of malignancy. Among USCBs, 33.1% of

Discussion

Ultrasound imaging is sensitive in identifying parotid lesions and on its own is able to differentiate benign from malignant lesions with an accuracy of greater than 90%.12 However due to the overlap in imaging features between benign and malignant lesions, ultrasound in combination with needle biopsy is necessary to improve preoperative diagnosis. The histopathology of salivary gland neoplasia is complex, with overlapping morphological characteristics, often posing a diagnostic challenge for

Funding

None.

Competing interests

None.

Ethical approval

Not applicable.

Patient consent

Not required.

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