Accuracy of fine-needle aspiration biopsy for Warthin's tumours

BACKGROUND: Although the overall accuracy of fine-needle aspiration biopsy (FNAB) for salivary gland neoplasms has been well established, definitive results for Warthin's tumour (WT) are lacking. For most salivary gland tumours, surgery is recommended because of progressive enlargement and the risk of malignant transformation. This behaviour is unusual with WT, and surgery is usually advocated for pathologic confirmation. A highly accurate diagnosis of WT by FNAB may justify conservative management for the asymptomatic patient. However, if the reliability of this diagnostic procedure is questionable, there should be little hesitation in recommending parotidectomy. METHODS: A retrospective study design was used to evaluate the accuracy of FNAB for parotid WTs. All consecutive parotid FNABs and parotidectomy specimens from 1992 to 2000 were reviewed, and cases suggestive of WT were identified. The fine-needle cytology and histopathology results were then correlated. The true-positive, false-positive, and false-negative rates were tabulated to determine the sensitivity and positive predictive value (PPV) of FNAB for WT. RESULTS: A total of 41 patients were included in the study. Of these, 33 patients had FNABs suggestive or diagnostic of WT that were confirmed following parotidectomy (true positives = 33). In 4 patients, the FNAB incorrectly suggested WT, with the surgical histopathology confirming different diagnoses (false positives = 4) (3 acinic cell carcinomas and 1 pleomorphic adenoma). Four patients had surgically confirmed WTs with FNABs suggestive of other diagnoses (false negatives = 4) (1 cystic squamous cell carcinoma, 1 simple cyst, 1 "inflammatory process," and 1 "negative for malignant cells"). The sensitivity and PPV were 89.2% and 89.2%, respectively. CONCLUSION: Although the sensitivity and PPV in this study are high, the false-positive rate is clinically significant given the type of lesions missed. Three acinic cell carcinomas and one pleomorphic adenoma were misdiagnosed as WT on FNAB. One must be cautious in recommending conservative management for parotid tumours even when a WT is suggested by FNAB.     

Demographics of benign parotid tumours: Warthin’s tumour versus other benign salivary tumours

Conclusion: Some variation from the ‘classical’ clinical picture for Warthin’s tumours is evident in these patients. A predilection for the parotid tail and a propensity for multiplicity has been confirmed. Objectives: This study sought to analyse demographic and clinical features of a Warthin’s patient population. Methods: Retrospective review of patients presenting with a benign parotid tumour. The group of Warthin’s tumours was compared with the group of patients with other benign parotid tumours. Results: Of 170 primary parotid tumours, 41 (24%) were Warthin’s tumour. Mean age of Warthins patients was significantly older (60 years vs 48 years, p?=?0.001) and male gender more prevalent (61% vs 33%, p?=?0.015) than in other benign tumours. Most (86%) Warthin’s tumours were found in the parotid tail, compared with 61% of other benign tumours (p?=?0.002). There was no significant ethnic predilection for Warthin’s tumours. Bilaterality (30%) and multiplicity (27%) were common. Significance of gender differences disappeared with logistic regression analysis.     

Thirteen years' experience with superficial partial parotidectomy as treatment for benign parotid tumours

IntroductionMost authors agree that surgery is the treatment of choice for benign tumours of the parotid gland. However, the best surgical technique and the extent of surgery remain controversial. This study attempts to establish whether the implementation of a partial superficial parotidectomy (PSP) is appropriate for the treatment of benign parotid gland tumours.Material and methodsWe selected 63 patients with benign parotid gland surgery, of whom 43 had a pleomorphic adenoma and 20, a Warthin tumour. Of this group of 63 patients, 6 could not be included. We consequently studied 57 patients, 41 of them diagnosed as pleomorphic adenoma and 16, as Warthin tumours. In all of them, a PSP was performed without intraoperative monitoring of the facial nerve.ResultsTransient facial nerve paralysis, 14 patients (24.5%). Ten cases were resolved within the first month after surgery and 4 before the third month, after indicating facial physiotherapy. One patient (1.7%) had a permanent difficulty in keeping one side of the lower lip aligned under pressure-mobility, without altering commissure mobility. None of the patients studied had a recurrence (control, 3-13 years).ConclusionsAlthough PSP is a technique with a few complications, it has a recurrence rate comparable to or lower than other techniques used for the treatment of pleomorphic adenomas or Warthin parotid tumours. Intraoperative facial nerve monitoring can be helpful during surgery. The lack of monitoring would not be considered a contraindication for surgery.     

Parotidectomy and submandibulectomy for benign diseases in Thuringia, Germany: a population-based study on epidemiology and outcome

Although salivary gland surgery for benign diseases is an integral part of clinical routine of head and neck surgeons, there is not many population-based data published on incidence and efficiency of this surgery. Parotidectomy was performed in 180 patients and submandibulectomy in 97 patients for benign diseases in eight otorhinolaryngology and two maxillofacial surgery departments in Thuringia, Germany, in 2005. All patients were analysed regarding patients’ characteristics, therapy, complications and further course of disease. Predominant indications were epithelial tumours for parotidectomy (79 %) and sialolithiasis for submandibulectomy (50 %). The most frequent tumour types were pleomorphic adenoma (46 %) and Warthin tumours (29 %). Pleomorphic adenoma was significantly more frequent in female patients and Warthin tumours in male patients and smokers. The incidence of parotidectomy, i.e. the surgical rate, was 7.8/100,000 habitants and of submandibulectomy 4.1/100,000 habitants. One hundred and seventy-eight tumours including 154 epithelial tumours resulted in an incidence of 7.6/100,000 habitants for all treated tumours and of 6.6/100,000 for epithelial tumours, respectively. The majority of parotid cases were treated by lateral parotidectomy (79 %). Relevant complications were observed in 22 % of patients. After parotidectomy and submandibulectomy a postoperative facial palsy was observed in 28 and 2 % of cases, respectively. Only 1 % was permanent. During a mean follow-up time of 9.6 months, 3 % of parotidectomy patients developed a Frey’s syndrome needing treatment and 0.8 % developed a tumour recurrence. This population-based analysis shows that salivary gland surgery is performed in higher incidence than expected, effectively and with low-risk in daily routine of head and neck surgeons.     

The role of fine needle aspiration biopsy in deep lobe parotid tumors: Comparison of preoperative cytology and postoperative histopathologic results

PurposeMajor salivary gland tumors constitute almost 3% of head and neck tumors. Tumors located exclusively in the deep lobe are not common and 20% of parotid gland tumors originate from deep lobe under the branches of the facial nerve. Accuracy of fine needle aspiration biopsy (FNAB) procedure in salivary gland tumors have been studied extensively, however there isn't any data regarding usefulness of FNAB in tumors located exclusively in deep lobe of parotid gland. In this study we aimed to assess the use of FNAB in deep lobe parotid tumors.Materials and methodsWe retrospectively analyzed 51 patients with deep lobe parotid tumors who underwent surgery in our clinic between January 2013–December 2018. Characteristics of patients were recorded. Preoperative FNAB results and postoperative final histopathologic diagnosis were compared. Statistical analysis was performed using SPSS 24.0 was used for statistical analysis.ResultsThe number of patients that met the inclusion criteria was 51. The mean age of patients were 49.2(14–86). In 40 (78.4) of the patients, tumor was reported as benign and in 11 (21.6) patients FNAB diagnosis was suspicious for malignancy, malignant or non-diagnostic. In final histopathologic diagnosis, 42 of the tumors were benign and 9 were malignant. The most common benign tumor type was pleomorphic adenoma which constitutes 27 of the cases (52.9%). Regarding detection of malignant disease, the sensitivity of FNAB was 90.4%, specificity was 77.7%, positive predictive value was 95%, negative predictive value was 63.6%. There was a substantial agreement between FNAB and final histopathologic diagnosis(kappa = 0,628).ConclusionsFNAB is a safe and reliable tool to evaluate deep lobe parotid tumors. It is an important part of preoperative surgical planning and can help the surgeon in patient counseling. FNAB with ultrasound guidance is recommended for deep lobe tumors.     

Positive predictive values of MRI and ultrasound-guided fine-needle aspiration biopsy for isolated parotid swelling in adults: A STARD comparative analysis

ObjectivesTo evaluate positive predictive values (PPVs) of magnetic resonance imaging (MRI) and ultrasound-guided fine-needle aspiration biopsy (UFNAB) in patients with isolated parotid swelling.Material and methodsObservational study following the STARD guideline, based on a cohort of 212 patients from 18 to 93 years of age, with isolated parotid swelling (malignant: 16.9%; benign: 83.1%), consecutively operated on between 2015 and 2020, after work-up including MRI and UFNAB in an otorhinolaryngology department of a university hospital. The main endpoint was PPV for diagnosis of benign tumor, malignant tumor and the most frequent etiology. Secondary endpoints were correlations between PPVs and clinical factors for malignancy, and the impact on PPV of various situations: dynamic analysis on MRI; diagnostic disagreement between MRI and UFNAB; and UFNAB PPV according to MRI diagnosis.ResultsPPVs for MRI and UFNAB were respectively 45.4% and 88.8% for malignant tumor, 89.6% and 46.9% for benign tumor, and 88.1% and 85.2% for pleomorphic adenoma (the most frequent etiology). Tumor fixation and history of head and neck radiation therapy PPVs were the only one higher than the MRI one for malignant tumor. MRI PPV did not differ between groups with or without dynamic analysis. PPV for malignant tumor, benign tumor and pleomorphic adenoma on MRI and UFNAB was respectively 42.8% and 33.3%, 42.8% and 100%, and 36.3% and 50% in case of diagnostic discordance. When MRI suggested malignant tumor, UFNAB PPV was 51.8% for malignant tumor, 67.7% for benign tumor, and 37.5% for pleomorphic adenoma; when MRI suggested benign tumor, it was 32.2% for malignant tumor, 91.5% for benign tumor, and 88.5% for pleomorphic adenoma; and, when MRI suggested pleomorphic adenoma, it was 23.5% for malignant tumor, 93.9% for benign tumor, and 92% for pleomorphic adenoma.ConclusionSystematic association of UFNAB to MRI did not fundamentally improve diagnostic accuracy. UFNAB appeared most valuable in case of history of radiation therapy, in case of tumor fixation, and when MRI diagnosis was uncertain and/or suggested malignant tumor and/or the apparent diffusion coefficient (ADC) was low. The contribution of UFNAB when MRI suggested benign tumor or especially pleomorphic adenoma was more limited.     

Results of the surgical management and histopathological evaluation of 88 parotid gland Warthin’s tumours

With the introduction of parotidectomy after identification of the facial nerve the recurrence rates for benign tumours has declined rapidly. Subsequently, attention was focused on other sequelae of parotid surgery. To reduce the specific surgical morbidity, several modifications of parotidectomy have been implemented. This study compares the results of the different surgical techniques with regard to the histopathological findings and recurrence rate for Warthin’s tumour of the parotid gland. Eighty-eight primary surgical parotid procedures were performed on 85 patients for a Warthin’s tumour. The surgical procedures included 52 ‘partial’ superficial parotidectomies, 22 ‘standard’ superficial parotidectomies, 12 partial superficial/deep lobe parotidectomies, and two ‘selective’ deep lobe parotidectomies. No patient developed a recurrence or experienced permanent facial nerve paresis/paralysis, the median follow-up being 93 months. Histopathological examination revealed a multifocal origin in 23% (20/88) of the surgical specimens. Partial parotidectomy is an effective treatment for Warthin’s tumour. There is no need for extended follow-up.     

Multifocal multi-site Warthin tumour

The unique case of a 55-year-old man with multifocal adenolymphoma (Warthin’s tumour) of both parotid glands, the neck and post-nasal space is presented. Warthin tumour is almost exclusively a parotid tumour but is known to be bilateral in 7–10% of cases and multifocal in 2% of cases. Most extraglandular Warthin tumours have been located in neck lymph nodes and only a few cases have been reported from other sites. The presented case is unique in having synchronous and metachronous Warthin tumours, as well as one of the tumours being neither truly parotid, nor within a lymph node.     

Parotid tumours: correlation between fine needle aspiration biopsy and histological findings

ObjectivesTo evaluate the role of the fine needle aspiration biopsy (FNAB) in the study of parotid masses.MethodsRetrospective review of FNAB results compared with final histological diagnosis in 148 patients with a parotid mass from 1993 to 2003.ResultsFNAB was performed in 93.92% of parotid masses. Eleven of these were not conclusive. The FNAB diagnosis of malignant o suspicious lesion had 81.25% of sensibility, 96.87% of specificity and positive and negative predictive values of 89.65% and 93.94%, respectively. The FNAB specific histopathologic diagnosis in the benign parotid masses were 92%, and 57.69% in the malign masses.ConclusionsFNAB is a diagnostic tool with a high negative predictive value, very usotul in the study of suspicious malignant parotid masses and whenever surgery is not possible.     

内镜辅助经口入路颌下腺切除的初步经验

目的 探讨内镜辅助经口入路颌下腺切除术的指征和利弊.方法 同顾性分析12例内镜辅助经口入路颌下腺切除术患者的临床资料.术前诊断慢性颌下腺炎8例(2例含涎石),多形性腺瘤3例,颌下腺囊肿1例.所有病例术前经影像学评估,其中8例经细针穿刺细胞学或细针穿刺组织学活检确诊.结果 术后2例出现暂时性的舌体麻木和舌体运动障碍,1～3个月后完全缓解;无其他并发症.术后1个月未损害面容满意度采用视觉模拟量表评分均为10分,所有患者都满意.多形性腺瘤患者随访时间12～48个月(中位数36个月),未见复发.结论 内镜辅助经口入路良性颌下腺病损切除术安全、可行,优点是无颈部瘢痕和面神经下颌缘支损伤的风险.

Abstract：

Objective To discuss the indications, risks and benefits of endoscope-assisted transoral approach to excise the submandibular gland. Methods A retrospective review of a series of 12 patients treated by endoscope-assisted transoral submandibular gland excision was carried out. Of the 12 patients, 8were chronic sialoadenitis (2 cases with sialolith), 3 were pleomorphic adenoma, and 1 was cyst of submandibular gland. Preoperatively, all patients were diagnosed as benign diseases by Ultrasonography, CT or MRI. Pathologic diagnosis of 8 cases were identified by fineneedleaspiration cytology (FNAC) or fineneedle aspiration biopsy (FNAB). Results Temporary lingual sensory paresis and temporary limitation of tongue movement were found in two patients. However, these signs soon resolved spontaneously within 1-3 months. There were no other complications. Postoperatively, mean satisfaction score with cosmetic results was 10. All patients were satisfied with the cosmetic results. No recurrences were found in patients with pleomorphic adenoma with a follow-up period ranged from 12 months to 48 months(median follow-up period:36 months). Conclusions Endoscope-assisted transoral excision of the submandibular gland is a feasible and safe approach for the benign diseases of the submandibular gland . The major advantages of this approach are no external scar and no injury to the marginal mandibular nerve.     

Parapharyngeal tumours: a review of 23 cases

The anatomy of the parapharyngeal space is described and experience with 23 patients with parapharyngeal tumours seen over a 10-year period is reported. Despite reaching a large size, these tumours may be relatively asymptomatic, or be discovered incidently. CT scan, MRI, arteriography and fine needle aspiration are useful in establishing a diagnosis. The most common histological type (13/23 patients) was pleomorphic adenoma and these tumours were managed by transoral removal if small, or a combined transoral-external approach if large. No patient required a mandibulotomy for access and no benign tumour recurred. The outcome was poor in the 5 patients with malignant tumours and a more radical approach, midline mandibulotomy, should be considered if malignancy is suspected.     

Basal cell adenoma and lymphoepithelial cyst as recurrent tumors of pleomorphic adenoma of the parotid gland

Basal cell adenoma of the parotid gland is a rare benign tumor. Lymphoepithelial cyst of the parotid gland is also a rare benign tumor-like lesion. We report an elderly woman, who previously underwent a removal of pleomorphic adenoma, with multiple masses in the left parotid gland. Physical, MR and intra-operative examination suggested the masses as multiple recurrences of the previous pleomorphic adenoma. A total parotidectomy with facial nerve preservation was performed. The histological examination revealed that the masses were two basal cell adenomas and one lymphoepithelial cyst. These rare tumors should be considered in the differential diagnosis of recurrent masses after a removal of pleomorphic adenoma of the parotid gland.     

DNA ploidy and proliferative activity in salivary gland tumours]

DNA ploidy and S-Phase fraction (SPF) of 279 salivary gland tumours were analysed using high-resolution DNA flow cytometry. All 229 benign neoplasms were diploid while 12 of 50 malignant tumours showed cell populations with aneuploid DNA content. The SPF values of diploid malignancies were significantly higher if compared with pleomorphic adenomas but did not differ from that of the zystadenolymphoma (Warthin tumour) group. While aneuploidy represents a distinct indicator of malignancy SPF values are of minor relevance for dignity assessment in salivary gland tumours.     

Basal cell adenoma of the parotid gland: a clinicopathological study of nine cases—basal cell adenoma versus pleomorphic adenoma and Warthin’s tumor

The aim of this study is to investigate the clinical and pathological characteristics of basal cell adenoma (BCA) and to compare the diagnosis/treatment of BCA with those of Warthin’s tumor (WT) and pleomorphic adenoma (PA). Among 192 patients with benign tumors of the parotid gland who underwent surgery, 9 had BCA. All of these tumors showed a benign pattern on computed tomography and magnetic resonance imaging. The accuracy of fine needle aspiration biopsy (FNAB) for diagnosis of BCA was slightly lower than for PA and WT. Most PA and BCA lesions developed in the upper part of the parotid gland. Considering the gender difference, tumor site, and age, it is necessary to differentiate BCA from PA rather than from WT. There were no significant differences in the duration of surgery, the blood loss, and the incidence of transient facial paralysis between surgical resection of BCA and surgery for PA or WT. BCA is the third most common of the benign parotid tumors, following WT and PA, although its incidence is low. When PA and WT are ruled out by FNAB after a tentative diagnosis of benign tumor has been based on imaging findings, BCA should be considered.     

Analysis of 216 cases of pleomorphic adenoma of the parotid gland

Pleomorphic adenoma is the most frequent benign tumour of the salivary glands. The most common localization is the parotid gland. The authors present a clinical analysis of the group of 216 patients, who was treated in ENT Department and who was diagnosed as pleomorphic adenoma. The frequency of incidence of mixed tumours is 50.70% of all 426 cases of parotid gland's tumours. In 92, 13% cases the tumours was localized in the superficial part, only in 7.87% in deep part of the gland. Sixteen patient was operated on because of the recurrence of mixed tumours. In one case we observed the syndrome of the auriculotemporal nerve. The temporary paresis of facial nerve after operation occurred in 19 patients. We don't noticed the incidence of salivary fistula in our material.     

腮腺良性肿瘤的手术方式与术后复发和并发症

目的;研究腮腺良性肿瘤手术方式与复发和术后并发症的关系。方法 在１９８７～１９９７年手术治疗腮腺良性肿瘤５５例（单纯肿瘤除２０例,腮腺浅地切除２８例,全腮腺切除７例）的临床随访资料进行分析。结果 单纯肿瘤切除中肿瘤复发６例,并发持续性面瘫１例,腮腺浅叶切除中复发１０例,并发暂时性面瘫４例腮腺瘘２例,Ｆｒｅｙ综合征２例,腮腺全切除中复发１例,并发暂时性面瘫２例,持续性面瘫１例,腮腺瘘２例,Ｆｒｅｙ综     

Diagnostic value of needle biopsy and frozen section histological examination in the surgery of primary parotid tumors

The necessity of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of parotid gland lesions is still controversial. We examined the accuracy of cytology and histology in a review of 128 parotid gland tumors who underwent surgery with FNAB, n = 102 and/or frozen section examination (FS), n = 94. The diagnostic sensibility and specificity for malignant or benign lesions was respectively 81.5% and 97.5% for FNAB and 75% and 100% for FS as compared with definite histology (110 tumors were benign and 18 malignant). Insufficient material for FNAB evaluation was found in 12 patients mainly with small tumors (p = 0.043) or with tumors located in the deep process of the parotid gland (p = 0.029). Surgery was inappropriate (superficial lobe resection for malignant tumor) because of 4 false negative FS diagnoses. FNAB offers valuable information in the diagnosis of nonsurgical lesions and permits to avoid FS if FNAB identify a benign lesion. FS remains mandatory if FNAB evaluation is not possible or suggests a neoplastic tumor.     

High risk for bilateral Warthin tumor in heavy smokers--review of 185 cases

CONCLUSIONS: We identified smoking as a significant risk factor for multilocular Warthin tumor development. Therefore, we recommend taking history of smoking into account when making the decisions for surgical strategy. OBJECTIVES: Warthin tumor is a common benign neoplasm of the parotid gland. Risk factors for multilocular development have not been defined. PATIENTS AND METHODS: A total of 185 consecutive patients treated for Warthin tumor were included. Charts were reviewed for symptoms, risk factors, and diagnostic and surgical procedures. Patients were followed for facial function and recurrence. Risk factors were evaluated. RESULTS: Overall, in 203 parotid operations, a lateral parotidectomy (77%) was performed in most cases; 94% were primary surgery and 6% were revision surgery. In 89% of patients swelling was the only symptom. Bilateral Warthin tumor was seen in 17% of patients. Of these cases synchronous and metachronous bilateral tumors were observed in 61% and 39%, respectively. The median time period for second contralateral tumor development was 7 years. Postoperative transient facial dysfunction was observed in 31%, which recovered within 3 months in all cases. Evaluation of risk factors revealed that 89% of the subjects were smokers and 66% were heavy smokers. The risk for bilateral Warthin tumors correlated significantly with the amount of nicotine intake (p=0.003).     

Immunohistochemical distribution of CD9 in parotid gland tumors

OBJECTIVE: CD9 is a member of the tetra-membrane-spanning glycoprotein family called tetraspanin. CD9 suppresses breeding and motion in some types of cancer cells. At present, the expression of CD9 in the salivary gland has not yet been elucidated. METHODS: We examined the expression of CD9 not only in the normal salivary glands of human embryo and adults but also in the parotid gland tumors using immunohistochemical staining. RESULTS: CD9 was not detected in embryos at 18 weeks of gestation, but was observed at 24 weeks in the salivary gland. CD9 was constantly detected in the adult normal parotid gland. In benign parotid gland tumors, CD9 was present in the 11 of 16 pleomorphic adenomas, every Warthin tumors (18/18) and basal cell adenoma (1/1). In contrast, positive staining for CD9 in malignant parotid tumors was observed in only the case of mucoepidermoid carcinomas. Neither acinic cell carcinomas or adenoid cystic carcinomas did show positive reaction in examined cases. The localization of CD9 was also observed in intercalated duct cells. CONCLUSION: There was a statistically significant reduced expression of CD9 in malignant parotid gland tumors as compared to benign parotid gland tumors (P = 0.003).     

Outcome of curative management of malignant tumours of the parotid gland.

PURPOSE: The optimal management of malignant parotid gland tumours remains to be defined precisely. Specifically, a further understanding of the tumour features that influence treatment outcome is needed. MATERIALS AND METHODS: A retrospective review was conducted on 184 patients who were registered at the Princess Margaret Hospital with a diagnosis of a primary malignant parotid gland tumour. RESULTS: All patients were initially managed with a parotidectomy, and postoperative x-ray radiation therapy (XRT) was administered to 159 patients. The actuarial 5-year cause-specific survival and locoregional control rates were 76% and 81%, respectively. The survival and locoregional control rates for patients treated with surgery alone versus surgery plus postoperative XRT were not statistically different. A multiple regression analysis identified only age and tumour category to be independently significant prognostic factors for both survival and locoregional control. CONCLUSION: We would recommend that patients with malignant parotid gland tumours be managed with parotidectomy, followed by postoperative XRT for tumours with residual disease, aggressive histology, and/or positive lymph nodes.