Biopsy of parotid masses: Review of current techniques

Abstract

Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology (FNAC) or ultrasound guided core biopsy (USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section (IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.

A comparison study of the reporting systems for salivary gland fine needle aspirations: Are they really different?

“…FNA is commonly reported to have fewer complications when compared to core biopsy and with less potential for tumor seeding . Nonetheless, some recent studies question this assumption and defend the use of core biopsy as safe and with potentially superior diagnostic yield . Notwithstanding, FNA is certainly a less costly option which can be performed on a one‐stop clinic setting and most studies find it an excellent pre‐surgical triage tool, distinguishing accurately neoplastic from non‐neoplastic lesions …”

Descriptive epidemiology of salivary gland neoplasms in Nigeria: An AOPRC multicenter tertiary hospital study

“…FNAC can be subject to sampling bias, particularly if the tumor is in the deep lobe of the parotid (Thoeny, ). Not least, some authors have reported cases of tumor capsule seeding following FNAC procedures (Freling, Crippa, & Maroldi, ; Haldar, Sinnott, Tekeli, Turner, & Howlett, ; Sood, McGurk, & Vaz, ). Other diagnostic imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasonography (US) have been found highly beneficial in the diagnosis of SGC tumor location, extent, and the presence of perineural invasion (Haldar et al, ; Rudack, Jörg, Kloska, Stoll, & Thiede, ).…”

“…Not least, some authors have reported cases of tumor capsule seeding following FNAC procedures (Freling, Crippa, & Maroldi, ; Haldar, Sinnott, Tekeli, Turner, & Howlett, ; Sood, McGurk, & Vaz, ). Other diagnostic imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasonography (US) have been found highly beneficial in the diagnosis of SGC tumor location, extent, and the presence of perineural invasion (Haldar et al, ; Rudack, Jörg, Kloska, Stoll, & Thiede, ). Although revision of the current preoperative diagnostic approaches is deemed necessary, as neither CT, US nor MRI was found to be superior in the diagnostic work‐up of SGCs (Rudack et al, ).…”

The advantage of MRI in detection of Coincidental adenocarcinoma of palate and pleomorphic adenoma of parotid - a case report

“…The present case showed clear microscopic features of PAC, in addition there is no conclusive evidence that (MASC) should be treated differently than any other low-grade malignant salivary gland tumors, though when used in conjunction with a cytology and Image guidance. In the present case US was used to guide fine needle aspiration cytology (FNAC) to overcome sampling error [15,16] . CT with contrast is the most commonly used investigation in diagnosis of salivary tumors.…”