Abstract
BackgroundConservative management of Warthin tumor (WT) may be a viable alternative to surgery, but there are concerns of missed malignancies on fine needle aspiration biopsy (FNAB). The purpose of this study is to measure the sensitivity and positive predictive value of FNAB for WT, and to identify clinical features associated with WT that can aid in this diagnosis.MethodsRetrospective analysis of patients from January 1, 2006 to April 30, 2017 at a tertiary care center in London, Ontario, Canada. All patients with a diagnosis of WT on FNAB or resection were included. Electronic medical records were identified for 177 patients that fit the criteria. Study outcomes included the sensitivity and positive predictive value of FNAB alone for WT, and, when including clinical features associated with WT.ResultsThe mean age of patients in this study was 63.2 years (SD 10.4); 115 (65%) were male, and 157 (89%) were past or present smokers. The measured sensitivity and positive predictive value of FNAB for WT were 95.8 and 97.2% respectively. Two cases were classified as WT on FNAB but confirmed at resection as mucoepidermoid carcinoma and acinic cell carcinoma. When only patients with multifocal, bilateral or incidental tumors were assessed, sensitivities and positive predictive values for each were 100%. Isolating for inferior pole location also resulted in a positive predictive value of 100%.ConclusionsThe sensitivity and positive predictive value of FNAB for WT in this study are high, with two false negatives on FNAB. Multifocal, bilateral, incidentaloma and inferior pole location were identified as potential clinical features that may increase the diagnostic confidence for WT, strengthening the argument for conservative management in these patients. Overall, this study serves as an initial exploration into whether clinical features may be included with FNAB results to improve the sensitivity and positive predictive value of diagnosing WT. Further research is necessary before these findings can be translated into clinical practice.
Highlights
Conservative management of Warthin tumor (WT) may be a viable alternative to surgery, but there are concerns of missed malignancies on fine needle aspiration biopsy (FNAB)
Electronic medical records were present for 177 patients with a diagnosis of WT on FNAB or resection from January 1, 2006 to April 30, 2017 at London Health Sciences Centre (LHSC)
The sensitivity and positive predictive value (PPV) of FNAB consistent with WT diagnosing a final histology of WT measured in this study are high, with two false negatives
Summary
Conservative management of Warthin tumor (WT) may be a viable alternative to surgery, but there are concerns of missed malignancies on fine needle aspiration biopsy (FNAB). Warthin tumor (WT), the second most common benign tumor of the parotid gland, makes up approximately 15% of all parotid tumors [1]. WT has a slow growth rate, is typically asymptomatic, is more common in smokers, is rarely associated with malignancy, and generally occurs in patients in their 60s [2, 6]. Given that many of these patients are older, usually smokers with other comorbidities and the tumor is found incidentally, conservative management is an attractive alternative to surgery [3, 4, 7]. Literature on the safety of observation for patients with WT is sparse [3]
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