Improving cytological diagnosis and surgical management of parotid adenolymphoma

Lewis, David R.; Webb, A. J.; Lott, M.; Brookes, ST; Farndon, J. R.

doi:10.1046/j.1365-2168.1999.01282.x

Cited by 19 publications

(19 citation statements)

References 16 publications

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“…The initial diagnostic accuracy of FNA for WT in this study was 52.4%, which is lower than the values reported elsewhere [14,17,25,26,27]. Upon review, the diagnostic rate increased slightly (from 11 to 13 patients) and was elevated to 85.7% when benign lesions were included.…”

Section: Discussioncontrasting

confidence: 76%

Fine-Needle Aspiration Cytology with c-kit Immunocytochemical Staining in the Diagnosis of Warthin’s Tumor

Kim¹,

Yoo

Kwon³

et al. 2012

Acta Cytologica

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Objective: Although Warthin’s tumor (WT) is one of a few salivary gland tumors that have distinct cytologic findings, it can be confused with malignant tumors at times. We assessed the overall accuracy, unusual features, and diagnostic points of fine-needle aspiration (FNA) of WT. Study Design: We retrospectively collected histologically confirmed WT from 21 patients and reviewed preoperative FNA slides. Smears were subject to immunocytochemical staining for carcinoembryonic antigen (CEA) and c-kit and compared to metastatic squamous cell carcinoma. Results: All of the cases were in the parotid gland; the mean size was 3.6 ± 1.2 cm. Of 21 patients, 19 were male (age 59.7 ± 9.4 years) and had a history of smoking. The initial FNA diagnoses were WT (11 patients, 52.4%), benign lesion (7 patients, 33.3%), and malignant neoplasm (3 patients, 14.3%). Only 6 patients (28.6%) showed typical FNA features of WT. The dominant cell types in the smears were macrophages (76.2%), squamous-like cells (66.7%), oncocytes (61.9%), and lymphoid cells (57.1%). Some showed atypical degenerated features, a necrotic background, and inflammatory cells, leading to misdiagnosis. CEA positivity and c-kit positivity in WT were noted in 0 and 75.0% of cases, respectively, whereas metastatic squamous cell carcinoma showed positive rates of 16.7 and 0%, respectively. Conclusion: Awareness of potential sources of misdiagnosis together with combination of c-kit/CEA immunostaining may result in an increased diagnostic rate of WT in FNA.

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Section: Discussioncontrasting

confidence: 76%

Fine-Needle Aspiration Cytology with c-kit Immunocytochemical Staining in the Diagnosis of Warthin’s Tumor

Kim¹,

Yoo

Kwon³

et al. 2012

Acta Cytologica

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“…The authors later added 40 additional cytological slides from a wide variety of parotid lesions, including malignant tumors. None of the additional malignant cytological examinations were diagnosed as Warthin tumor [8]. However, one must take into consideration that the cytopathologists were aware of the study's goals.…”

Section: Discussionmentioning

confidence: 99%

“…Although most previous studies analyzed Warthin tumor patients who underwent a pre-operative FNA [5][6][7][8], the risk of missing malignant tumors, falsely demonstrating a cytological benign Warthin tumor in the pre-operative FNA, is still slight. We present our experience in managing Warthin tumor and the accuracy of a pre-operative FNA-based diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Is Surgery for an FNA proven Warthin's Tumor Passé?

Hirshoren¹,

Cohen²,

Neuman³

et al. 2012

J Cancer Ther Res

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Background: Warthin tumor is a common benign salivary gland lesion. Its optimal treatment mode is controversial. We analyze the accuracy of Warthin tumor pre-operative fine-needle aspiration (FNA)-based diagnosis and reassess the treatment paradigm. The risk of missing malignant tumors, falsely demonstrating a cytological benign Warthin tumor in the pre-operative FNA, is to be explored. Methods: Retrospective cohort study in a tertiary university hospital. Data on all parotidectomy cases between 1996 and 2010 (n=238) was analyzed. Cytological accuracy was calculated in 2 different opposing ways. First, we considered cases with a correct pre-operative identification of histologically proven Warthin tumors as true positives. The second assessment was done by gathering all cytological examinations suggesting a Warthin tumor, which were later excised. The histological identification of a malignant tumor was considered as a false negative. Results: FNA was found to be accurate in 48 out of the 61 patients who had a final pathologic diagnosis of Warthin tumor, i.e. a 78.7% sensitivity. In the second step, there were 50 FNA's suggesting a Warthin tumor, One case turned out to be malignant: a low-grade muco-epidermoid carcinoma. The negative predictive value was therefore 98%. Conclusions:The overall accuracy of FNA suggesting Warthin tumor in a tertiary university hospital is high. We offer, in selected patients, observation as a reasonable alternative treatment to surgery. However, we also advise a repeat ultrasound-guided FNA to confirm the initial diagnosis.

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“… 49 – 52 The two main sources of error include failure to obtain a representative sample and the variable cytological appearance of WT 51 53. The former can be minimised by recruiting a cytopathologist to perform the procedure.…”

Section: Diagnosismentioning

confidence: 99%

“…This led to superficial parotidectomy being considered the most suitable option 9. Early concerns have now been dispelled, and excellent outcomes have been noted in patients treated by limited resections 10 52. Nevertheless, there is still no unified opinion among authors as to the most appropriate operative strategy, and therefore treatment varies considerably.…”

Section: Managementmentioning

confidence: 99%

Current controversies in the management of Warthin tumour

Thangarajah

Reddy

Castellanos-Arango

et al. 2009

Postgraduate Medical Journal

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Warthin tumour is the second most common benign neoplasm of the parotid gland. It has a low rate of growth and exhibits malignant transformation in 0.3% of cases. Although its aggressiveness has not been a concern, surgical resection remains the most common treatment modality. This entails the risk of a general anaesthetic and those pertaining to the procedure itself, most notably permanent facial nerve damage. This has led some authors to use conservative management, albeit rarely. There are those who condemn such a policy despite the encouraging results reported thus far. To understand the rationale underpinning non-operative management, it is imperative that one has a comprehensive understanding of the pathogenesis, clinical presentation and diagnosis of Warthin tumour. The aim of this review therefore is to detail these elements and clarify the current controversies in managing this lesion.

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Improving cytological diagnosis and surgical management of parotid adenolymphoma

Abstract: Attention to the features of squamoid metaplasia and infarction improves cytological diagnosis and directs appropriate surgical management.

Cited by 19 publications

References 16 publications

Fine-Needle Aspiration Cytology with c-kit Immunocytochemical Staining in the Diagnosis of Warthin’s Tumor

Fine-Needle Aspiration Cytology with c-kit Immunocytochemical Staining in the Diagnosis of Warthin’s Tumor

Is Surgery for an FNA proven Warthin's Tumor Passé?

Current controversies in the management of Warthin tumour

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