Role of Fine-Needle Aspiration Biopsy and Imaging in the Preoperative Workup of Salivary Gland Mass Lesions
Geir Tryggvason, Michael Gailey, Stephanie Hulstein, Lucy Karnell, Chris Jensen, Douglas Van Daele. The University of Iowa Hospitals and Clinics, Iowa City, IA
Background: Although not without controversy, fine-needle aspiration (FNA) and imaging are commonly used in the preoperative assessment of salivary gland mass lesions. Interestingly, few studies have examined the relative clinical value of these two assessment modalities. The goal of this retrospective study was to clarify the role of FNA and imaging in the workup of salivary gland masses.
Design: A computer-based search identified all patients with FNA of a salivary gland lesion during a ten-year study period. Only patients who had subsequent excision of their tumor with histologic diagnosis were included in the study. Chart review of all study patients was performed and information on lesion site, age, gender, radiologic diagnosis, pain in the tumor area, and facial paralysis was recorded and analyzed.
Results: 543 patients had FNA and subsequent histopathology. The majority of the tumors were in the parotid gland (n=492; 90.9%), followed by submandibular gland (n=45; 8.3%). The incidence of malignancy across all sites was 29.5%. The mean age was 54.1 years; 54.1% being female. The sensitivity, specificity, and diagnostic accuracy rates for FNA were 84.4%, 99.2%, and 94.8%, respectively. 464 patients had available radiologic studies. The sensitivity, specificity and diagnostic accuracy rates for imaging were 80.7%, 67.3%, and 71.7%. Older age, facial pain, and facial paralysis were independent predictors for malignancy (p-values <0.001, 0.006, and <0.001 by univariate analysis, respectively; odds ratio 1.470, 1.960, and 14.674 by multivariate analysis, respectively.)
Conclusions: Contrary to previous reports, FNA is more reliable than radiologic imaging in evaluating benign and malignant salivary gland lesions and is helpful in surgical planning and counseling. Routine imaging may not be necessary and may be most appropriately suited for anatomic definition of the lesion and assessing for metastatic disease in selected cases. We emphasize:
1. FNA is a reliable tool in the preoperative workup of both benign and malignant salivary gland lesions.
2. Preoperative imaging has a lower sensitivity and specificity than FNA and is not as accurate at differentiating benign from malignant lesions.
3. Older age, facial pain and facial paralysis are independently associated with malignancy.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 85, Wednesday Afternoon