Diagnosis Of Parotid Malignancies Research Articles

Rate of Occult Neck Nodal Metastasis in Parotid Cancer: A Meta-Analysis.

The risk for occult neck nodal metastasis in carcinoma of the parotid gland is inconclusive. Therefore, addressing a negative neck prophylactically and the extent to do so remain controversial. This systematic review aimed to determine the rate of occult nodal metastasis for each neck level, and consequently, to elucidate the proper extent of elective neck dissection (END). A meta-analysis of all studies that included patients with a diagnosis of parotid malignancies who underwent an END was performed. The risk for occult nodal metastasis was calculated for each neck level separately. The search strategy identified 124 papers from January 1980 to December 2019 in the various databases. Nine retrospective studies (n =548) met the inclusion criteria. The risk for occult neck nodal metastasis ranged from 0.0 to 9.43% with a random-effect model of 2.2% for level 1 (n =459), from 3.4 to 28.38% with a random-effect model of 16.51% for level 2 (n =548), from 0.0 to 21.63% with a random-effect model of 4.23% for level 3 (n =518), from 0.0 to 17.02% with a fixed-effect model of 0.39% for level 4 (n =310), and from 0.0 to 11.63% with a fixed-effect model of 1.7% for level 5 (n =417). The rate of occult neck nodal metastasis in parotid malignancies is low, with neck level 2 the most commonly involved. The results of this meta-analysis prevented the authors from substantiating the appropriate extent of an END in parotid cancer.

The Diagnostic Accuracy of Fine‐Needle Aspiration for Parotid Malignancy

Objectives: Determine the sensitivity and specificity of fine-needle aspiration (FNA) in the diagnosis of parotid malignancy and analyze those histologies most often associated with false negative and false positive results. Methods: A retrospective chart review was performed for all patients who had a parotidectomy at the University of Wisconsin from 1994 to 2013. Patients who underwent preoperative FNA were identified, and FNA results were categorized as benign, malignant, or indeterminate. Surgical pathology was utilized as the gold standard. Results: A total of 771 patients underwent parotidectomy from 1994 to 2013, and 280 patients (36.3%) had a preoperative FNA. Based on surgical pathology, 178 (63.6%) patients had benign disease and 102 (36.4%) had malignant parotid neoplasms. 174 (62.1%) FNAs were benign, 94 (33.6%) were malignant, and 12 (4.3%) were indeterminate. Excluding indeterminate cases, the sensitivity and specificity for FNA in the diagnosis of parotid malignancy were 83.7% (95% confidence interval [CI]: (74.8%, 90.4%)) and 93.0% (95% CI: (88.0%, 96.3%)), respectively. Moreover, FNA correctly categorized malignancy in 83.7% (n = 82) and benign in 92.9% (n = 158) of cases. There were 16 false negatives (16.3%) with mucoepidermoid carcinoma having a diagnostic accuracy of 60% and acinic cell carcinoma 50%. Both were most commonly mistaken for pleomorphic adenoma. There were 12 false positives (7.1%), most commonly pleomorphic adenoma (n = 4) and warthins (n = 3). Conclusions: This study demonstrates that FNA has high sensitivity (83.7%) and specificity (93.0%) for the diagnosis of parotid malignancy. However, mucoepidermoid carcinoma and acinic cell carcinoma are more commonly associated with a false negative FNA.

The role of indeterminate fine‐needle biopsy in the diagnosis of parotid malignancy

To examine the significance of indeterminate fine needle aspiration biopsy in the diagnosis of parotid gland malignancy. Retrospective case series, academic tertiary referral center. A total of 559 parotidectomies performed between the years of 2005 and 2010 were reviewed, with 56.7% (N = 317) meeting investigation eligibility criteria: primary parotid tumor, availability of fine-needle aspiration biopsy, intraoperative frozen section, and final pathologic diagnosis. One-hundred fifteen (n = 115, 36.3%) of the 317 parotid biopsies were interpreted as indeterminate. Clinical history, physical examination, operative findings, and histopathologic characteristics were analyzed. Multiple logistic regression, with deviation from means coding, was used to estimate the odds of malignancy in the indeterminate group and provide a comparison with reference to the average odds of malignancy over the overall sample. Overall final pathologic distribution of parotid masses (N = 317) was 82.3% benign and 17.7% malignant. Overall final pathologic distribution of parotid masses in the indeterminate group (n = 115) was 31.3% malignant and 68.7% benign. In comparison, the overall group (N = 317) had a decreased comparative percentage of malignant specimens at 17.7%. Interestingly, in the instance of an indeterminate biopsy, the odds of having a malignancy was estimated to increase by 1.98-fold compared to overall mean odds of malignancy in the sample. Other statistically significant clinical predictors of parotid malignancy included history of prior malignancy, current tobacco user, locally invasive characteristics intraoperatively, and facial nerve involvement intraoperatively. In the context of an indeterminate fine-needle aspiration biopsy, an elevated index of suspicion for parotid malignancy may be warranted.

Case 171: Facial Nerve Hemangioma

The patient’s imaging features, especially the honeycomb pattern of ossific changes in the geniculate fossa, were virtually pathognomonic for ossifying hemangioma of the facial nerve.