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European Archives of Oto-Rhino-Laryngology

Erschienen in:

19.11.2019 | Head and Neck

Fine needle aspiration cytology for parotid neoplasms: risk of malignancy through inconclusive results and lower grade tumors

verfasst von: Andrea Galli, Michele Tulli, Leone Giordano, Matteo Biafora, Davide Di Santo, Stefano Bondi, Lucia Oriella Piccioni, Mario Bussi

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 3/2020

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Abstract

Purpose

Fine needle aspiration cytology (FNAC) is a commonly performed procedure for parotid masses, although its accuracy in detecting malignancies widely varies through different series. We evaluated our single-center cohort of parotidectomies to highlight possible limitations of preoperative FNAC.

Methods

Seven hundred and eighteen consecutive patients submitted to parotid surgery at San Raffaele Scientific Institute (Milan) were retrospectively evaluated (2002–2018). Five hundred and fifty four FNAC were analyzed. FNAC accuracy was assessed with and without inclusion of “inconclusive” results. The peculiar role of lower grade primary parotid cancers was investigated.

Results

FNAC reports were “diagnostic” in 502 cases (90.4%) and “inconclusive” in 52 (9.6%). Histopathology revealed 488 benign lesions (88.1%) and 66 malignancies (11.9%). FNAC sensitivity, specificity, PPV, NPV and accuracy in detecting malignancies were 59%, 99%, 89%, 95%, and 95%, respectively. Sensitivity fell to 48%, when “inconclusive” FNAC was computed. Within 66 parotid cancers, FNAC could discriminate malignancy in 32 cases (48.5%), provide proper grading in 21 (31.8%), and precise histopathological diagnosis in 15 (22.7%). Malignancy was more likely in patients with “inconclusive” FNAC than in those with “diagnostic” cytologies (23.1% vs 10.8%, p = 0.003). Low-intermediate-grade primary parotid cancers were associated to a higher rate of FNAC failure in comparison with high-grade ones (86.4% vs 19.0%; p < 0.001).

Conclusion

FNAC is an important tool for preoperative assessment of parotid masses, though its sensitivity in detecting malignancy remains poor. “Inconclusive” FNAC results could further jeopardize FNAC accuracy and should elicit resorting to additional tests, especially when a lower grade parotid cancer is suspected.

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Titel: Fine needle aspiration cytology for parotid neoplasms: risk of malignancy through inconclusive results and lower grade tumors
verfasst von: Andrea Galli
Michele Tulli
Leone Giordano
Matteo Biafora
Davide Di Santo
Stefano Bondi
Lucia Oriella Piccioni
Mario Bussi
Publikationsdatum: 19.11.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Archives of Oto-Rhino-Laryngology / Ausgabe 3/2020
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-019-05733-w

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Fine needle aspiration cytology for parotid neoplasms: risk of malignancy through inconclusive results and lower grade tumors