Utility of preoperative fine needle aspiration in parotid lesions

Eytan, Danielle F.; Yin, Linda X.; Maleki, Zahra; Koch, Wayne M.; Tufano, Ralph P.; Eisele, David W.; Boahene, Kofi; Fakhry, Carole; Bishop, Justin A.; Westra, William H.; Gourin, Christine G.

doi:10.1002/lary.26776

Cited by 57 publications

(58 citation statements)

References 24 publications

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“…Adequate sampling, the application of ancillary tests (such as immunohistochemical studies), awareness of prior history of malignancy, and familiarity with metaplastic and atypical changes in both benign and malignant conditions may improve the diagnosis. Reviewing the case in multidisciplinary tumor boards and in intraoperative consultation and microscopic examination of frozen section of the neoplasm would assist the otolaryngologist in determining the optimal management of patients with SUMP …”

Section: Discussionmentioning

confidence: 99%

“…Fine‐needle aspiration (FNA) is a well accepted tool for the diagnosis and subsequent management of salivary gland mass lesions because of its accuracy in discrimination between nonneoplastic versus neoplastic entities, minimal invasiveness, and cost‐effectiveness . Overall, studies show from 60% to 97% sensitivity, from 81% to 95% specificity, and from 91% to 92% diagnostic accuracy for FNA of salivary gland lesions .…”

Section: Introductionmentioning

confidence: 99%

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Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi‐institutional study

Chowsilpa

Lose

et al. 2019

Cancer Cytopathology

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BACKGROUND: Salivary gland neoplasm of uncertain malignant potential (SUMP) is a diagnostic category in the Milan System for Reporting Salivary Gland Cytopathology. The objective of this study was to assess the risk of neoplasm (RON) and the risk of malignancy (ROM) in SUMP cases by evaluating them based on their prominent cytomorphology. METHODS:The pathology databases were searched for cases of fine-needle aspiration-diagnosed SUMP at The Johns Hopkins Hospital and Northwestern University from 2013 to 2018. Only cytopathology cases diagnosed as SUMP that had available surgical follow-up were included. RESULTS: Sixty-five patients with SUMP were identified, including 31 men and 34 women who ranged in age from 15 to 87 years (mean age, 55.2 years). Sixty-five cases had histologic follow-up, including 13 (20%) with basaloid features, 13 (20%) with oncocytic features, and 39 (60%) with unspecified features. No cases with clear cell features were found. Overall, the RON in the SUMP category was 95.4% (62 of 65 cases), and the ROM was 33.8% (22 of 65 cases). The RON in SUMPs with basaloid, oncocytic, and unspecified subtypes was 92.3%, 100%, and 94.9%, respectively, whereas the ROM was 38.5%, 7.7%, and 41%, respectively. The most common benign neoplasm was pleomorphic adenoma (23.1%), whereas mucoepidermoid carcinoma (9.2%) was the most common malignant neoplasm. CONCLUSIONS: This study shows that the ROM differs significantly based on cytomorphology subtypes, whereas the overall ROM is approximately the same as the target rate in the Milan System for Reporting Salivary Gland Cytopathology. Moreover, the RON remains high in the SUMP category among different cytomorphology subtypes.Adequate sampling, immunohistochemical staining, and familiarity with metaplastic and reactive changes may improve the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi‐institutional study

Chowsilpa

Lose

et al. 2019

Cancer Cytopathology

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“…Despite of some disadvantages of FNA, patients may gain considerable profit by this diagnostic approach when providing conclusive results. 6 Particularly, early knowledge on the actual state of disease provides the possibility for precise planning of the extent of tumour resection and neck dissection and for early and accurate patient information. 7 Nishikawa and co-authors showed that performance of FNA or FS enables determination of tumour cell grading, which subsequently is a key factor for the planning of the extent of tumour resection.…”

Section: Discussionmentioning

confidence: 99%

Fine‐needle aspiration cytology and intraoperative frozen section in parotid gland tumour surgery: A retrospective multicenter analysis of 417 cases

Grasl

Kadletz

Janik

et al. 2019

Clinical Otolaryngology

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“…Preoperative diagnosis of a parotid malignancy by biopsy may allow for optimal surgical planning, including preparation for total parotidectomy and/or facial nerve sacrifice if involvement is identified intraoperatively, and avoidance of conservative extracapsular dissection or excisional biopsy, subsequently improving the chances for adequate margin‐free resection and adequate nodal sampling . A recent single center study of 477 patients with surgically treated parotid masses who underwent FNA found that FNA changed the surgical management in 19% of patients, resulting in an added neck dissection when tumors were identified as malignant and downgrading to excisional biopsy in case of a benign entity …”

Section: Discussionmentioning

confidence: 99%

Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins

et al. 2019

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Objectives Determine rate of preoperative biopsy in parotid malignancies, identify factors associated with its use, and its association with surgical margins. Study Design Retrospective cohort. Setting Commission on Cancer–Accredited Institutions. Subjects and Methods We included 5533 patients treated surgically for a parotid malignancy 2004–2014 in the National Cancer Database. Chi‐squared tests, univariable, and multivariable logistic regressions were used to evaluate predictors of preoperative biopsy (defined as needle, aspiration, or incisional), and associate biopsy with surgical margins. Results Preoperative biopsy was utilized in 26.0% of patients. Biopsy was more likely in patients >60 years (odds ratio [OR]: 1.19, P = .035), advanced clinical T stage (vs. T1,T2 OR: 1.23, P = .009; T3 OR: 1.26, P = .026; T4A OR: 2.05, P < .001), advanced clinical N stage (vs. N0, N1: OR: 1.39, P = .013; N2/3: OR: 1.63, P < .001), in academic centers (OR: 1.18, P < .024), and in higher volume centers (vs. low, medium OR: 1.28, P = .002; high OR: 2.16, P < .001). Biopsy use increased over time (vs. 2004–2006, 2007–2010 OR: 1.20, P = .047; 2011–2014 OR: 1.39, P < .001). Biopsy was associated with a reduced risk of positive margins in patients with clinical T1 stage (OR: 0.70, P = .012), and younger than 61 (OR: 0.79, P = .036). Conclusion The national rate of preoperative biopsy in parotid malignancy is low at 26.0%, but has increased over time. Preoperative biopsy is associated with a reduced risk of positive margins in younger patients and those with early clinical stage, suggesting its increased use may improve surgical outcomes and decrease reoperation or adjuvant therapy in these subgroups of patients. Level of Evidence 3 Laryngoscope, 130:1450–1458, 2020

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Utility of preoperative fine needle aspiration in parotid lesions

Abstract: 4. Laryngoscope, 128:398-402, 2018.

Cited by 57 publications

References 24 publications

Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi‐institutional study

Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi‐institutional study

Fine‐needle aspiration cytology and intraoperative frozen section in parotid gland tumour surgery: A retrospective multicenter analysis of 417 cases

Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins

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