Fine-needle aspiration cytology for parotid lesions, can we
Departments of Otorhinolaryngology-Head
and Neck Surgery, Rabin Medical Center,
Petach Tikva, Israel
Departments of Medical Statistics, Rabin
Medical Center, Petach Tikva, Israel
Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
Departments of Pathology & Cytology,
Rabin Medical Center, Petach Tikva, Israel
G. Bachar, Department of Otolaryngology-
Head and Neck Surgery, Rabin Medical
Center, Petach Tikva, Israel.
Objective: Salivary gland neoplasms are rare tumours, with most arising in the paro-
tid gland. Fine-needle aspiration cytology (FNAC) is a common method for preoper-
ative evaluation of parotid masses, although its usefulness is controversial. This
study was designed to evaluate the accuracy of FNAC in a large cohort of patients,
with emphasis on diagnosis of benign tumours and especially Warthin tumour which
can be managed conservatively.
Study Design: Retrospective case series with chart review.
Setting: Tertiary medical centre.
Subjects and Methods: From 1991 to 2014, all patients 18 or older with both pre-
operative FNAC and postoperative pathology report were included. Patients with a
history of head and neck malignancy or chronic sialoadenitis and patients who had
undergone prior oncological treatment were excluded.
Results: 470 patients were available for analysis. Overall accuracy was 82.6%. Posi-
tive predictive value (PPV) varied between 88.6% and 94.3% for pleomorphic ade-
noma and 77.1%-100% for Warthin tumour, with values varying depending on
different characteristics of patients (eg age, smoking status). For pathologically pro-
ven malignant tumours, the FNAC diagnosis was benign or non-diagnostic in 26% of
Conclusion: Fine-needle aspiration cytology has limited utility in confirming a
benign diagnosis of a parotid mass for most patients, although for some subpopula-
tions, the PPV may be high enough to defer surgery.
Salivary gland neoplasms account for only 3% of all tumours; most
(80%) arise in the parotid gland.
The reported malignancy rate of
parotid gland neoplasms ranges from 13% to 32%.
The two most
common benign parotid lesions are pleomorphic adenoma and
The two most common malignancies are
metastatic squamous cell carcinoma and mucoepidermoid carci-
Patient age at diagnosis is about 60 years for malignant par-
otid tumours and lower for benign tumours.
Traditionally, parotid neoplasms are evaluated by fine-needle
aspiration cytology (FNAC). However, although FNAC has been
found to be highly accurate for the diagnosis of neoplasm in other
sites of the head and neck (eg thyroid, lymph nodes), its benefit in
the parotid is controversial due to lower accuracy, mainly due to the
many different pathologies encountered in the parotid gland.
studies of preoperative FNAC showed a sensitivity of 62%-85% and
a specificity of 85%-98% for malignant parotid tumours,
were limited by a small number of participants (100-150). More
This work was presented in the Israeli Otolaryngology-Head & Neck society meeting in
Eilat, Israel on February 2016.
Rabin Medical Center is affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel
Correction added on 9 January 2018, after first online publication: A. Mizrachi’s surname
has been corrected.
Accepted: 21 November 2017
© 2017 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/coa Clinical Otolaryngology. 2018;43:632–637.