Abstract
Purpose
Fine needle aspiration cytology (FNAC) is a commonly performed procedure for parotid masses, although its accuracy in detecting malignancies widely varies through different series. We evaluated our single-center cohort of parotidectomies to highlight possible limitations of preoperative FNAC.
Methods
Seven hundred and eighteen consecutive patients submitted to parotid surgery at San Raffaele Scientific Institute (Milan) were retrospectively evaluated (2002–2018). Five hundred and fifty four FNAC were analyzed. FNAC accuracy was assessed with and without inclusion of “inconclusive” results. The peculiar role of lower grade primary parotid cancers was investigated.
Results
FNAC reports were “diagnostic” in 502 cases (90.4%) and “inconclusive” in 52 (9.6%). Histopathology revealed 488 benign lesions (88.1%) and 66 malignancies (11.9%). FNAC sensitivity, specificity, PPV, NPV and accuracy in detecting malignancies were 59%, 99%, 89%, 95%, and 95%, respectively. Sensitivity fell to 48%, when “inconclusive” FNAC was computed. Within 66 parotid cancers, FNAC could discriminate malignancy in 32 cases (48.5%), provide proper grading in 21 (31.8%), and precise histopathological diagnosis in 15 (22.7%). Malignancy was more likely in patients with “inconclusive” FNAC than in those with “diagnostic” cytologies (23.1% vs 10.8%, p = 0.003). Low-intermediate-grade primary parotid cancers were associated to a higher rate of FNAC failure in comparison with high-grade ones (86.4% vs 19.0%; p < 0.001).
Conclusion
FNAC is an important tool for preoperative assessment of parotid masses, though its sensitivity in detecting malignancy remains poor. “Inconclusive” FNAC results could further jeopardize FNAC accuracy and should elicit resorting to additional tests, especially when a lower grade parotid cancer is suspected.
Similar content being viewed by others
References
Liu CC, Jethwa AR, Khariwala SS, Johnson J, Shin JJ (2016) Sensitivity, specificity, and posttest probability of parotid fine-needle aspiration: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 154(1):9–23. https://doi.org/10.1177/0194599815607841
Frable MA, Frable WJ (1991) Fine-needle aspiration biopsy of salivary glands. Laryngoscope. 101(3):245–249. https://doi.org/10.1288/00005537-199103000-00005
O'Brien CJ (2003) Current management of benign parotid tumors–the role of limited superficial parotidectomy. Head Neck 25(11):946–952. https://doi.org/10.1002/hed.10312
Suzuki M, Kawata R, Higashino M, Nishikawa S, Terada T, Haginomori SI et al (2019) Values of fine-needle aspiration cytology of parotid gland tumors: a review of 996 cases at a single institution. Head Neck 41(2):358–365. https://doi.org/10.1002/hed.25503
Zbaren P, Schar C, Hotz MA, Loosli H (2001) Value of fine-needle aspiration cytology of parotid gland masses. Laryngoscope 111(11 Pt 1):1989–1992. https://doi.org/10.1097/00005537-200111000-00023
Zbaren P, Vander Poorten V, Witt RL, Woolgar JA, Shaha AR, Triantafyllou A et al (2013) Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery? Am J Surg. 205(1):109–118. https://doi.org/10.1016/j.amjsurg.2012.05.026
Piccioni LO, Fabiano B, Gemma M, Sarandria D, Bussi M (2011) Fine-needle aspiration cytology in the diagnosis of parotid lesions. Acta otorhinolaryngol Ital 31(1):1–4
Rossi ED, Faquin WC (2018) The Milan system for reporting salivary gland cytopathology (MSRSGC): an international effort toward improved patient care-when the roots might be inspired by Leonardo da Vinci. Cancer Cytopathol. 126(9):756–766. https://doi.org/10.1002/cncy.22040
Wu M (2011) A comparative study of 200 head and neck FNAs performed by a cytopathologist with versus without ultrasound guidance: evidence for improved diagnostic value with ultrasound guidance. Diagn Cytopathol. 39(10):743–751. https://doi.org/10.1002/dc.21460
El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ (2017) WHO classification of head and neck tumours, 4th edn, IARC, Lyon
Carrillo JF, Ramirez R, Flores L, Ramirez-Ortega MC, Arrecillas MD, Ibarra M et al (2009) Diagnostic accuracy of fine needle aspiration biopsy in preoperative diagnosis of patients with parotid gland masses. J Surg Oncol 100(2):133–138. https://doi.org/10.1002/jso.21317
Eytan DF, Yin LX, Maleki Z, Koch WM, Tufano RP, Eisele DW et al (2018) Utility of preoperative fine needle aspiration in parotid lesions. Laryngoscope. 128(2):398–402. https://doi.org/10.1002/lary.26776
Tryggvason G, Gailey MP, Hulstein SL, Karnell LH, Hoffman HT, Funk GF et al (2013) Accuracy of fine-needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically. Laryngoscope. 123(1):158–163. https://doi.org/10.1002/lary.23613
Zbaren P, Nuyens M, Loosli H, Stauffer E (2004) Diagnostic accuracy of fine-needle aspiration cytology and frozen section in primary parotid carcinoma. Cancer 100(9):1876–1883. https://doi.org/10.1002/cncr.20186
Que Hee CG, Perry CF (2001) Fine-needle aspiration cytology of parotid tumours: is it useful? ANZ J Surg. 71(6):345–348
Zbaren P, Zbaren S, Caversaccio MD, Stauffer E (2008) Carcinoma ex pleomorphic adenoma: diagnostic difficulty and outcome. Otolaryngol Head Neck Surg 138(5):601–605. https://doi.org/10.1016/j.otohns.2008.01.013
Fundakowski C, Castano J, Abouyared M, Lo K, Rivera A, Ojo R et al (2014) The role of indeterminate fine-needle biopsy in the diagnosis of parotid malignancy. Laryngoscope 124(3):678–681. https://doi.org/10.1002/lary.24341
Feinstein AJ, Alonso J, Yang SE, St John M (2016) Diagnostic accuracy of fine-needle aspiration for parotid and submandibular gland lesions. Otolaryngol Head Neck Surg 155(3):431–436. https://doi.org/10.1177/0194599816643041
Badlani J, Gupta R, Balasubramanian D, Smith J, Luk P, Clark J (2018) Primary salivary gland malignancies: a review of clinicopathological evolution, molecular mechanisms and management. ANZ J Surg. 88(3):152–157. https://doi.org/10.1111/ans.14201
Espinoza S, Malinvaud D, Siauve N, Halimi P (2013) Perfusion in ENT imaging. Diagn Interv Imaging. 94(12):1225–1240. https://doi.org/10.1016/j.diii.2013.06.003
Schmidt RL, Hunt JP, Hall BJ, Wilson AR, Layfield LJ (2011) A systematic review and meta-analysis of the diagnostic accuracy of frozen section for parotid gland lesions. Am J Clin Pathol 136(5):729–738. https://doi.org/10.1309/AJCP2SD8RFQEUZJW
Cibas ES, Ali SZ (2017) The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 27(11):1341–1346. https://doi.org/10.1089/thy.2017.0500
Sood S, McGurk M, Vaz F (2016) Management of salivary gland tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 130(S2):S142–S149. https://doi.org/10.1017/S0022215116000566
Nishikawa S, Kawata R, Higashino M, Lee K, Terada T, Kurisu Y et al (2015) Assessing the histological type and grade of primary parotid carcinoma by fine-needle aspiration and frozen section. Auris Nasus Larynx 42(6):463–468. https://doi.org/10.1016/j.anl.2015.03.002
Nagao T, Sugano I, Ishida Y, Hasegawa M, Matsuzaki O, Konno A et al (1998) Basal cell adenocarcinoma of the salivary glands: comparison with basal cell adenoma through assessment of cell proliferation, apoptosis, and expression of p53 and bcl-2. Cancer 82(3):439–447
Tabatabai ZL, Auger M, Kurtycz DF, Laser A, Souers RJ, Laucirica R et al (2015) Performance characteristics of adenoid cystic carcinoma of the salivary glands in fine-needle aspirates: results From the College of American Pathologists Nongynecologic Cytology Program. Arch Pathol Lab Med. 139(12):1525–1530. https://doi.org/10.5858/arpa.2013-0173-CP
Lombardi D, McGurk M, Vander Poorten V, Guzzo M, Accorona R, Rampinelli V et al (2017) Surgical treatment of salivary malignant tumors. Oral Oncol. 65:102–113. https://doi.org/10.1016/j.oraloncology.2016.12.007
Mantsopoulos K, Koch M, Klintworth N, Zenk J, Iro H (2015) Evolution and changing trends in surgery for benign parotid tumors. Laryngoscope 125(1):122–127. https://doi.org/10.1002/lary.24837
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None of the authors has potential conflicts of interest to disclose.
Research involving human participants and/or animals
All performed procedures and retrospective data management were in accordance with the ethical standards of our institutional and national research ethical committee and with the principles stated in the Declaration of Helsinki “Ethical Principles for Medical Research Involving ‘Human Subjects”, adopted by the 18th World Medical Assembly (Helsinki, Finland, June 1964) and as amended most recently by the 64th World Medical Assembly (Fortaleza, Brazil, October 2013).
Informed consent
Informed consent for retrospective data management was obtained for all subjects.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Galli, A., Tulli, M., Giordano, L. et al. Fine needle aspiration cytology for parotid neoplasms: risk of malignancy through inconclusive results and lower grade tumors. Eur Arch Otorhinolaryngol 277, 841–851 (2020). https://doi.org/10.1007/s00405-019-05733-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-019-05733-w