Sensitivity, Specificity, and Posttest Probability of Parotid Fine‐Needle Aspiration

Abstract

Objectives (1) To analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease. (2) To determine the anticipated posttest probability of malignancy and probability of non-diagnostic and indeterminate cytology with parotid FNA. Data Sources Independently corroborated computerized searches of PubMed, Embase, and Cochrane Central Register were performed. These were supplemented with manual searches and input from content experts. Review Methods Inclusion/exclusion criteria specified diagnosis of parotid mass, intervention with both FNA and surgical excision, and enumeration of both cytologic and surgical histopathologic results. The primary outcomes were sensitivity, specificity, and posttest probability of malignancy. Heterogeneity was evaluated with the I2 statistic. Meta-analysis was performed via a 2-level mixed logistic regression model. Bayesian nomograms were plotted via pooled likelihood ratios. Results The systematic review yielded 70 criterion-meeting studies, 63 of which contained data that allowed for computation of numerical outcomes (n = 5647 patients; level 2a) and consideration of meta-analysis. Subgroup analyses were performed in studies that were prospective, involved consecutive patients, described the FNA technique utilized, and used ultrasound guidance. The I2 point estimate was >70% for all analyses, except within prospectively obtained and ultrasound-guided results. Among the prospective subgroup, the pooled analysis demonstrated a sensitivity of 0.882 (95% confidence interval [95% CI], 0.509–0.982) and a specificity of 0.995 (95% CI, 0.960–0.999). The probabilities of nondiagnostic and indeterminate cytology were 0.053 (95% CI, 0.030–0.075) and 0.147 (95% CI, 0.106–0.188), respectively. Conclusion FNA has moderate sensitivity and high specificity in differentiating malignant from benign parotid lesions. Considerable heterogeneity is present among studies.

Utility of preoperative fine needle aspiration in parotid lesions

“…In our study, we found a sensitivity of 82.4% and specificity of 90.4% for detecting malignancy. The higher rate of specificity compared to sensitivity is consistent with the findings of prior studies . This indicates that a positive result on FNA is highly likely to be truly positive for malignancy, and thus can be reliably used to guide management.…”

“…Prior studies have reported a wide range of results on accuracy of FNA for detecting malignancy, with sensitivities ranging from 33% to 100% and specificities ranging from 67% to 100% . A 2016 systematic review by Liu et al reported a pooled analysis of 63 studies including 5,647 patients, and demonstrated sensitivity of 88.2% and specificity of 99.5% . In our study, we found a sensitivity of 82.4% and specificity of 90.4% for detecting malignancy.…”

A pattern‐based risk‐stratification scheme for salivary gland cytology: A multi‐institutional, interobserver variability study to determine applicability

“…A more recent meta-analysis has shown similar estimates for the ability of parotid FNA to differentiate benign versus malignant (sensitivity 78% and specificity 98%). 3 Although both of these studies show good sensitivity and specificity there is considerable heterogeneity among individual studies ranging from 0% to 100% for sensitivity and 67% to 100% for specificity. 2, 3 …”

Diagnostic value of fine needle aspiration biopsy in parotid gland neoplasm

“…The most common location, as reported in the literature is on the parotid gland. [1][2][3] The salivary gland tumours are usually encountered clinical problems. In the literature, there is inconstancy between the time the tumour is first noticed by the patient and when it is presented to the physician.…”

“…Also, diagnostic tests seem to be very significant in management of parotid neoplasms. 1 Three diagnostic tests are recommended to definitively diagnose a tumour as benign or malignancy. The first diagnostic test is fine-needle aspiration biopsy (FNAB).…”