Exfoliative cytology in the preoperative diagnosis of parotid tumors.

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In the current literature most authors agree that no completely satisfactory method exists for the preoperative diagnosis of parotid tumor. Blady and Hocker state that on sialography most malignant tumors show infiltration of the ducts, which they feel is diagnostic. The present study was undertaken to see whether such infiltrating lesions shed malignant cells which might be collected in the saliva and studied in the same manner as are bronchial washings. I t was felt that if positive results could be obtained with Papanicolaou smears, surgeons might be encouraged to adopt more radical initial surgical measures in the hope of improving the present discouraging results in the treatment of malignant lesions of the parotid gland. We have found no such study recorded in the English literature. This investigation was made on 33 patients who underwent surgical treatment of parotid tumors at the Mayo Clinic from July 1 to December 5, 1953. A total of 45 patients underwent such treatment during this period, but because of the nature of the previous operations and other factors, the remaining 12 were not considered suitable for study. On the night before operation, a specimen was collected from each parotid gland, the normal side thus serving as a control. In the first patients studied, Stensen's duct was cannulated, but in the remaining patients the simple but efficient device of Curby was used. Salivary flow was stimulated by unsweetened lemon juice. From 2 to 5 ml. of secretion was obtained in all cases, which was stained by a method previously described for bronchial washings. Three slides were made from each specimen. After the tumor was removed, fresh imprints were made in most cases and these were fixed and stained in the same manner as the secretions; these slides showed the appearance of known tumor cells stained by the same technic and served as further controls. All frozen-section diagnoses were confirmed by paraffin sections. Table 1 lists the diagnoses made on the basis of the tumors removed. All the smears showed a few scattered normal-appearing squamous cells and occasional columnar cells. No cells characteristic of the various benign tumors, as seen on the fresh imprints, were found. In the 7 cases in which the tumor was malignant, the slides made from the secretion in 1 of the cases of muco-epidermoid tumor were suggestive of malignancy, while those made in 1 of the cases of adenocarcinoma and in the case of undifferentiated carcinoma showed a few