Abstract
Purpose
This study aims to determine the relationship of frozen section (FS) to final histology and determine how incorporating FS may change preoperative malignancy risk estimates based on preoperative fine needle aspiration cytology (FNAC). The secondary aim is to determine if FS is useful in influencing intraoperative decision-making.
Methods
Retrospective review of 426 intraoperative FS for parotidectomies performed for primary parotid lesions.
Results
Risk of malignancy with a benign FS was 2.5%, with indeterminate 36.1%, and with malignant 100%. Incorporating FS to fine needle aspiration for cytology helped to stratify malignancy risk especially in the Milan categories of atypia of undetermined significance, neoplasm of uncertain malignant potential and non-diagnostic categories, where a malignant FS increased malignancy risk significantly. FS was only able to identify 11% of high-risk histological subtypes for which a neck dissection would be recommended.
Conclusions
FS may be used to stratify malignancy risk intraoperatively but has limited utility in clinical decision-making to perform a neck dissection and more extensive parotid resection in high-risk histological subtypes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Not applicable.
Code availability
Not applicable.
References
Guzzo M, Locati LD, Prott FJ et al (2010) Major and minor salivary gland tumors. Crit Rev Oncol Hematol 74(2):134–148. https://doi.org/10.1016/j.critrevonc.2009.10.004
Spiro RH (1987) Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg 8(3):177–184. https://doi.org/10.1002/hed.2890080309
Pfister DG, Spencer S, Adelstein D et al (2018) NCCN clinical practice guidelines: head and neck cancers. Version 1.2018. J Natl Compehensive Cancer Netw. 15(6):761–770
Schmidt RL, Hall BJ, Wilson AR et al (2011) A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology for parotid gland lesions. Am J Clin Pathol 136:45–59. https://doi.org/10.1309/AJCPOIE0CZNAT6SQ
Longuet M, Nallet E, Guedon C et al (2001) Diagnostic value of needle biopsy and frozen section histological examination in the surgery of primary parotid tumors. Rev Laryngol Otol Rhinol (Bord) 122(1):51–55
Iwai H, Yamashita T, Izumikawa M et al (1999) Evaluation of frozen section diagnosis of parotid gland tumors. Nihon Jibiinkoka Gakkai Kaiho 102(11):1227–1233. https://doi.org/10.3950/jibiinkoka.102.1227
Zheng T, Holford TR, Chen Y et al (1997) Are cancers of the salivary gland increasing? Experience from Connecticut, USA. Int J Epidemiol 26(2):264–271. https://doi.org/10.1093/ije/26.2.264
Wong DSY, Li GKH (2000) The role of fine-needle aspiration cytology in the management of parotid tumors: a critical clinical appraisal. Head Neck 22(5):469–473. https://doi.org/10.1002/1097-0347(200008)22:5%3c469::AID-HED5%3e3.0.CO;2-7
Seethala RR, LiVolsi VA, Baloch ZW (2005) Relative accuracy of fine-needle aspiration and frozen section in the diagnosis of lesions of the parotid gland. Head Neck 27(3):217–223. https://doi.org/10.1002/hed.20142
Badoual C, Rousseau A, Heudes D et al (2006) Evaluation of frozen section diagnosis in 721 parotid gland lesions. Histopathology 49(5):538–540. https://doi.org/10.1111/j.1365-2559.2006.02527.x
Tew S, Poole AG, Philips J (1997) Fine-needle aspiration biopsy of parotid lesions: comparison with frozen section. ANZ J Surg 67(7):438–441. https://doi.org/10.1111/j.1445-2197.1997.tb02010.x
Wong DSY (2002) Frozen section during parotid surgery revisited: Efficacy of its applications and changing trend of indications. Head Neck 24(2):191–197. https://doi.org/10.1002/hed.10072
Choy KCC, Bundele MM, Li H et al (2019) Risk stratification of fine-needle aspiration cytology of parotid neoplasms based on the Milan system—Experience from a tertiary center in Asia. Head Neck 41(9):3125–3132. https://doi.org/10.1002/hed.25804
Barbarite E, Puram SV, Derakhshan A et al (2020) A call for universal acceptance of the milan system for reporting salivary gland cytopathology. Laryngoscope 130(1):80–85. https://doi.org/10.1002/lary.27905
Faquin WC, Rossi ED, Baloch ZW et al (2018) The Milan System for reporting salivary gland cytopathology. Springer International Publishing, Cham, Switzerland
Seethala RR (2009) An update on grading of salivary gland carcinomas. Head Neck Pathol 3(1):69–77. https://doi.org/10.1007/s12105-009-0102-9
El-Naggar AK, Chan JKC, Rubin Grandis J et al (2017) WHO classification of head and neck tumours. international agency for research on cancer. World Health Organization, Geneva
Skalova A, Sima R, Kaspirkova-Nemcova J et al (2011) Cribriform adenocarcinoma of minor salivary gland origin principally affecting the tongue: characterization of new entity. Am J Surg Pathol 35(8):1168–1176. https://doi.org/10.1097/PAS.0b013e31821e1f54
Zbaren P, Guelat D, Loosli H et al (2008) Parotid tumors: Fine-needle aspiration and/or frozen section. Otolaryngol - Head Neck Surg 139(6):811–815. https://doi.org/10.1016/j.otohns.2008.09.013
Upton DC, McNamar JP, Connor NP et al (2007) Parotidectomy: ten-year review of 237 cases at a single institution. Otolaryngol - Head Neck Surg 136(5):788–792. https://doi.org/10.1016/j.otohns.2006.11.037
de Carvalho MB, Soares JMA, Rapoport A et al (1999) Perioperative frozen section examination in parotid gland tumors. Sao Paulo Med J 117(6):233–237. https://doi.org/10.1590/S1516-31801999000600002
Nishikawa S, Kawata R, Higashino M et al (2015) Assessing the histological type and grade of primary parotid carcinoma by fine-needle aspiration and frozen section. Auris Nasus Larynx 42:463–468. https://doi.org/10.1016/j.anl.2015.03.002
Skov BG, Braendstrup O, Hirsch FR et al (1994) Are pathologists biased by clinical information?: a blinded cross-over study of the histopathological diagnosis of mesothelial tumours versus pulmonary adenocarcinoma. Lung Cancer 11(5–6):365–372. https://doi.org/10.1016/0169-5002(94)92165-2
Funding
The authors did not receive support from any organization for the submitted work.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kevin Choy, Manish Bundele and Ming Yann Lim. The first draft of the manuscript was written by Kevin Choy and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
Ethical approval was sought from the Domain Specific Review Board of the Office of Human Research Protection Programme of the National Healthcare Group, Singapore.
Informed consent
Data are non-identifiable and collected retrospectively with no change to clinical management.
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
Choy, K.C.C., Bundele, M.M., Fu, E.W. et al. Risk stratification of parotid neoplasms based on intraoperative frozen section and preoperative fine needle aspiration cytology. Eur Arch Otorhinolaryngol 279, 2117–2131 (2022). https://doi.org/10.1007/s00405-021-07015-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-021-07015-w