Abstract
Fine-needle aspiration (FNA) biopsy reliably diagnoses parotid gland lesions preoperatively, whereas intraoperative frozen section (FS) has the additional benefit of assessing surgical margins and refining diagnoses; however, the role of FS in the setting of prior FNA diagnosis is not well established. Our aim was to determine whether FS should still be performed after a prior FNA/ CNB diagnosis. Parotid gland resections from January 2009 to January 2020 were identified; however, only patients who had both FNA and FS constituted our study population. For the purpose of statistical analysis, FNA diagnoses were classified into non-diagnostic (ND), non-neoplastic (NN), benign neoplasm (BN), indeterminate, and malignant. FS diagnoses were classified into benign, indeterminate, or malignant. Resections were dichotomized into benign and malignant and regarded as the gold standard to subsequently calculate diagnostic accuracy of FNA and FS. A total of 167 parotid gland resections were identified, but only 76 patients (45.5%) had both FNA and FS. In 35 cases deemed as benign preoperatively, three (8.6%) were reclassified as malignant on FS. Out of 18 lesions reported as malignant on FNA, four (22.2%) were interpreted as benign on FS, with three of these benign lesions confirmed on permanent slides. In addition, in patients with both FNA and FS, compared to FNA, FS was able to provide a definitive diagnosis in all five ND cases and in 61.1% (11/18) of indeterminate tumors. Intraoperative assessment provided a relative increase of 33.3% in specificity and 38.5% in positive predictive value when compared to preoperative FNA. The addition of FS to FNA was helpful to further refine the diagnoses of parotid gland lesions, which may provide better guidance for surgical intervention.
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References
Guzzo M, Locati LD, Prott FJ, et al. Major and minor salivary gland tumors. Crit Rev Oncol Hematol. 2010;74(2):134–48 (PMID: 19939701).
Gandolfi MM, Slattery W 3rd. Parotid Gland Tumors and the Facial Nerve. Otolaryngol Clin North Am. 2016;49(2):425–34 (PMID: 27040587).
Salivary Gland Cancer: Statistics | Cancer.Net [Internet]. [cited 2020 Oct 16]. https://www.cancer.net/cancer-types/salivary-gland-cancer/statistics
Rivera Rolon M, Schnadig VJ, Faiz S, Nawgiri R, Clement CG. Salivary gland fine-needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6-year study. Diagn Cytopathol. 2020. https://doi.org/https://doi.org/10.1002/dc.24478. Epub ahead of print. PMID: 32452653.
Leite AA, Vargas PA, dos Santos Silva AR, Galvis MM, de Sá RS, Lopes Pinto CA, Kowalski LP, Saieg M. Retrospective application of the Milan System for reporting salivary gland cytopathology: a Cancer Center experience. Diagn Cytopathol. 2020;48(9):821–6 (PMID: 32374949).
Rohilla M, Singh P, Rajwanshi A, Gupta N, Srinivasan R, Dey P, Vashishta RK. Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification. Cancer Cytopathol. 2017;125(10):767–75 (PMID: 28786207).
Rossi ED, Wong LQ, Bizzarro T, Petrone G, Mule A, Fadda G, Baloch ZM. The impact of FNAC in the management of salivary gland lesions: Institutional experiences leading to a risk-based classification scheme. Cancer Cytopathol. 2016;124(6):388–96 (PMID: 26959289).
Hughes JH, Volk EE, Wilbur DC. Pitfalls in salivary gland fine-needle aspiration cytology: lessons from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med. 2005;129(1):26–31 (PMID: 15628905).
Hanege FM, Tuysuz O, Sakallioglu O, Arslan Solmaz O. Diagnostic value of preoperative fine needle aspiration cytology in parotid gland tumors. Diagn Cytopathol. 2020. https://doi.org/https://doi.org/10.1002/dc.24514. Epub ahead of print. PMID: 32562515.
Griffith CC, Pai RK, Schneider F, Duvvuri U, Ferris RL, Johnson JT, Seethala RR. Salivary gland tumor fine-needle aspiration cytology: a proposal for a risk stratification classification. Am J Clin Pathol. 2015;143(6):839–53 (PMID: 25972326).
Seethala RR, LiVolsi VA, Baloch ZW. Relative accuracy of fine-needle aspiration and frozen section in the diagnosis of lesions of the parotid gland. Head Neck. 2005;27(3):217–23 (PMID: 15672359).
Upton DC, McNamar JP, Connor NP, Harari PM, Hartig GK. Parotidectomy: ten-year review of 237 cases at a single institution. Otolaryngol - Head Neck Surg. 2007;136(5):788–92 (PMID: 17478217).
Zbaren P, Guelat D, Loosli H, Stauffer E. Parotid tumors: fine-needle aspiration and/or frozen section. Otolaryngol Head Neck Surg. 2008;139: 811-815. http://doi.org/https://doi.org/10.1016/j.otohns.2008.09.013 PMID: 19041508
Schmidt RL, Hunt JP, Hall BJ, Wilson AR, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of frozen section for parotid gland lesions. Am J Clin Pathol. 2011;136(5):729–38 (PMID: 22031311).
Grasl S, Kadletz L, Janik S, Riedl A, Erlacher B, Formanek M, Grasl MC, Erovic BM. Fine-needle aspiration cytology and intraoperative frozen section in parotid gland tumour surgery: A retrospective multicenter analysis of 417 cases. Clin Otolaryngol. 2019;44(3):461–5 (PMID: 30779480).
Moore MG, Yueh B, Lin DT. Controversies in the workup and surgical management of parotid neoplasms. Otolaryngol Head Neck Surg. 2020;164(1):27–36 (PMID: 32571148).
Zhou X, Obuchowski N, McClish D. Statistical Methods in Diagnostic Medicine. Wiley Series in Probability and Statistics. 2nd ed. Hoboken, New Jersey: John Wiley & Sons; 2011.
Leisenring W, Alonzo T, Pepe MS. Comparisons of predictive values of binary medical diagnostic tests for paired designs wendy. Biometrics. 2000;56:345–51.
Perkins C, Toll E, Reece P. Fine-needle aspiration cytology and radiological imaging in parotid gland tumours: our experience in 103 patients. Clin Otolaryngol. 2019;44(6):1124–7 (PMID: 31368198).
Suzuki M, Kawata R, Higashino M, Nishikawa S, Terada T, Haginomori SI, Kurisu Y, Hirose Y. Values of fine-needle aspiration cytology of parotid gland tumors: a review of 996 cases at a single institution. Head Neck. 2019;41(2):358–65 (PMID: 30548147).
Shkedy Y, Alkan U, Mizrachi A, Shochat T, Dimitstein O, Morgenstern S, Shpitzer T, Bachar G. Fine-needle aspiration cytology for parotid lesions, can we avoid surgery? Clin Otolaryngol. 2018;43(2):632–7.
Eytan DF, Yin LX, Maleki Z, Koch WM, Tufano RP, Eisele DW, Boahene KDO, Fakhry C, Bishop JA, Westra WH, Gourin CG. Utility of preoperative fine needle aspiration in parotid lesions. Laryngoscope. 2018;128(2):398–402 (PMID: 28782105).
Salehi S, Maleki Z. Diagnostic challenges and problem cases in salivary gland cytology: A 20-year experience. Cancer Cytopathol. 2018;126(2):101–11 (PMID: 29131559).
Dostalova L, Kalfert D, Jechova A, Koucky V, Novak S, Kuchar M, Zabrodsky M, Novakova Kodetova D, Ludvikova M, Kholova I, Plzak J. The role of fine-needle aspiration biopsy (FNAB) in the diagnostic management of parotid gland masses with emphasis on potential pitfalls. Eur Arch Otorhinolaryngol. 2020;277(6):1763–9. https://doi.org/10.1007/s00405-020-05868-1 (Epub 2020 Feb 27 PMID: 32107613).
Liu CC, Jethwa AR, Khariwala SS, Johnson J, Shin JJ. Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration. Otolaryngol Neck Surg [Internet]. 2016 Jan;154(1):9–23. http://journals.sagepub.com/doi/https://doi.org/10.1177/0194599815607841
Patel KR, Scognamiglio T, Kutler DI, Kuhel WI, Gromis J, Phillips CD, Cohen MA. Retrospective assessment of the utility of imaging, fine-needle aspiration biopsy, and intraoperative frozen section in the management of parotid neoplasms: The weill cornell medical college experience. Orl. 2015;77(3):171–9 (PMID: 26159894).
Faquin WC, Rossi ED, Baloch Z, Barkan GA, Foschini MP, Kurtycz DFI, Pusztaszeri M, Vielh P. The Milan system for reporting salivary gland cytopathology. The Milan System for Reporting Salivary Gland Cytopathology. 2018.
Schmidt RL, Hall BJ, Wilson AR, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology for parotid gland lesions. Am J Clin Pathol. 2011;136(1):45–59 (PMID: 21685031).
Badoual C, Rousseau A, Heudes D, Carnot F, Danel C, Meatchi T, Hans S, Bruneval P, Brasnu D, Laccourreye O. Evaluation of frozen section diagnosis in 721 parotid gland lesions. Histopathology. 2006;49(5):538–40 (PMID: 17064302).
Mianroodi AAA, Sigston EA, Vallance NA. Frozen section for parotid surgery: Should it become routine? ANZ J Surg. 2006;76(8):736–9 (PMID: 16916397).
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Pastorello, R.G., Rodriguez, E.F., McCormick, B.A. et al. Is there a Role for Frozen Section Evaluation of Parotid Masses After Preoperative Cytology or Biopsy Diagnosis?. Head and Neck Pathol 15, 859–865 (2021). https://doi.org/10.1007/s12105-021-01306-8
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DOI: https://doi.org/10.1007/s12105-021-01306-8