Abstract
Objective
To evaluate the precision and utility of Fine‐needle aspiration (FNA) in differentiating between benign and malignant parotid tumors, and the implications of FNA results on management and outcomes.
Design
Retrospective case series.
Setting
Tertiary medical center.
Participants
All adults who underwent preoperative FNA, followed by postoperative histological examination, between 1986‐2014.
Main outcome measures
Differences in clinical management and outcomes of patients with parotid masses in light of FNA results.
Results
We analyzed 505 samples from 485 patients. According to histopathological results, preoperative FNA successfully identified benign tumors in 89% of the cases (362/405), and only 59% of malignant tumors (59/100). Overall sensitivity and specificity of FNA in distinguishing between different subtypes of benign lesions were 80% and 99%, respectively, whereas positive predictive value (PPV) and negative predictive value (NPV) were 85% and 98%. Moreover, malignant lesions subtyping had high false‐positive and false‐negative rates with sensitivity, specificity, PPV and NPV of 44%, 100%, 75% and 99%, respectively. Additionally, when FNA falsely classified malignant tumors as benign, surgeries were inappropriately delayed and the durations of surgeries and hospitalizations were shorter, compared to true malignant‐FNA results. Interestingly, survival was not affected in falsely benign lesions that were mostly low‐grade, conversely non‐diagnostic FNA for malignant tumors resulted in decreased survival.
Conclusions
Our findings highlight the limitations of FNA as a decision‐making tool in preoperative evaluation of parotid masses. Clinicians should take into account that FNA is inaccurate for identifying specific subtypes of malignant lesions, which may eventually delay treatment and influence outcome.
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