The diagnostic value of cytology in parotid Warthin's tumors: international multicenter series
Corresponding Author
Daniele Borsetto MD
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Correspondence
Daniele Borsetto, Queen Elizabeth University Hospital, Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
Email: [email protected]
Search for more papers by this authorJonathan M. Fussey FRCS (ORL-HNS)
Department of Otolaryngology, Royal Devon and Exeter Hospital, Exeter, UK
Search for more papers by this authorDiego Cazzador MD
Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
Search for more papers by this authorJoel Smith FRCS (ORL-HNS)
Department of Otolaryngology, Royal Devon and Exeter Hospital, Exeter, UK
Search for more papers by this authorAndrea Ciorba PhD
ENT Department, University Hospital of Ferrara, Ferrara, Italy
Search for more papers by this authorStefano Pelucchi MD
ENT Department, University Hospital of Ferrara, Ferrara, Italy
Search for more papers by this authorSara Donà
Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
Search for more papers by this authorPaolo Boscolo-Rizzo MD
Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
Search for more papers by this authorMichele Tomasoni
Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Search for more papers by this authorDavide Lombardi MD
Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Search for more papers by this authorPiero Nicolai MD
Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Search for more papers by this authorElisabetta Zanoletti MD
Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
Search for more papers by this authorRoberta Colangeli
Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
Search for more papers by this authorEnzo Emanuelli MD
Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
Search for more papers by this authorMax S. Osborne MRCS (ENT)
Head and Neck Department, Princess Royal Hospital, Telford, UK
Search for more papers by this authorSyed F. Ahsan FCRS (ORL-HNS)
Head and Neck Department, Princess Royal Hospital, Telford, UK
Search for more papers by this authorMargherita Tofanelli MD
ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
Search for more papers by this authorGiancarlo Tirelli MD
ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
Search for more papers by this authorKatherine McNamara FRCS (ORL-HNS)
Department of ENT, New Cross Hospital, Wolverhampton, UK
Search for more papers by this authorLeonard Liew FRCS (ORL-HNS)
Department of ENT, New Cross Hospital, Wolverhampton, UK
Search for more papers by this authorKatherine Harrison FRCPath
Department of Histopathology, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
Search for more papers by this authorAmbrogio Fassina MD
Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
Search for more papers by this authorSamantha Sarcognato MD
Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
Search for more papers by this authorNeil Sharma PhD
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
Search for more papers by this authorKanishka Rao MS (ENT)
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Search for more papers by this authorPaul Pracy FRCS (ORL)
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Search for more papers by this authorPaul Nankivell PhD
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
Search for more papers by this authorCorresponding Author
Daniele Borsetto MD
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Correspondence
Daniele Borsetto, Queen Elizabeth University Hospital, Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
Email: [email protected]
Search for more papers by this authorJonathan M. Fussey FRCS (ORL-HNS)
Department of Otolaryngology, Royal Devon and Exeter Hospital, Exeter, UK
Search for more papers by this authorDiego Cazzador MD
Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
Search for more papers by this authorJoel Smith FRCS (ORL-HNS)
Department of Otolaryngology, Royal Devon and Exeter Hospital, Exeter, UK
Search for more papers by this authorAndrea Ciorba PhD
ENT Department, University Hospital of Ferrara, Ferrara, Italy
Search for more papers by this authorStefano Pelucchi MD
ENT Department, University Hospital of Ferrara, Ferrara, Italy
Search for more papers by this authorSara Donà
Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
Search for more papers by this authorPaolo Boscolo-Rizzo MD
Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
Search for more papers by this authorMichele Tomasoni
Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Search for more papers by this authorDavide Lombardi MD
Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Search for more papers by this authorPiero Nicolai MD
Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Search for more papers by this authorElisabetta Zanoletti MD
Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
Search for more papers by this authorRoberta Colangeli
Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
Search for more papers by this authorEnzo Emanuelli MD
Department of Neurosciences, Section of Otolaryngology, University of Padova, Padua, Italy
Search for more papers by this authorMax S. Osborne MRCS (ENT)
Head and Neck Department, Princess Royal Hospital, Telford, UK
Search for more papers by this authorSyed F. Ahsan FCRS (ORL-HNS)
Head and Neck Department, Princess Royal Hospital, Telford, UK
Search for more papers by this authorMargherita Tofanelli MD
ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
Search for more papers by this authorGiancarlo Tirelli MD
ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
Search for more papers by this authorKatherine McNamara FRCS (ORL-HNS)
Department of ENT, New Cross Hospital, Wolverhampton, UK
Search for more papers by this authorLeonard Liew FRCS (ORL-HNS)
Department of ENT, New Cross Hospital, Wolverhampton, UK
Search for more papers by this authorKatherine Harrison FRCPath
Department of Histopathology, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
Search for more papers by this authorAmbrogio Fassina MD
Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
Search for more papers by this authorSamantha Sarcognato MD
Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
Search for more papers by this authorNeil Sharma PhD
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
Search for more papers by this authorKanishka Rao MS (ENT)
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Search for more papers by this authorPaul Pracy FRCS (ORL)
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Search for more papers by this authorPaul Nankivell PhD
Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
Search for more papers by this authorAbstract
Introduction
Warthin's tumor (WT) is a common benign salivary gland neoplasm with a negligible risk of malignant transformation. However, there is a risk of malignant tumors being misdiagnosed as WT on cytology and inappropriately managed conservatively.
Methods
Patients from nine centers in Italy and the United Kingdom undergoing parotid surgery for cytologically diagnosed WT were included in this multicenter retrospective series. Definitive histology was compared with preoperative cytological diagnoses. Surgical complications were recorded.
Results
A total of 496 tumors were identified. In 88.9%, the final histological diagnosis was WT. In 21 cases (4.2%) a malignant neoplasm was diagnosed, which had been incorrectly labeled as WT on cytology.
Conclusions
The risk of undiagnosed malignancy should be balanced against surgical risks when considering the management of WT. Although nonsurgical management remains an appropriate option, there may be a rationale for serial clinical or radiological evaluation if surgical excision is not performed.
CONFLICT OF INTEREST
The authors declare no potential conflict of interest.
REFERENCES
- 1Pinkston JA, Cole P. Incidence rates of salivary gland tumors: results from a population-based study. Otolaryngol Head Neck Surg. 1999; 120: 834-840.
- 2Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg. 1986; 8: 177-184.
- 3Speight PM, Barrett AW. Salivary gland tumours. Oral Dis. 2002; 8: 229-240.
- 4Jeannon JP, Calman F, Gleeson M, et al. Management of advanced parotid cancer. A systematic review. Eur J Surg Oncol. 2009; 35: 908-915.
- 5Seifert G, Brocheriou C, Cardesa A, Eveson JW. WHO international histological classification of Tumours. Tentative histological classification of salivary gland tumours. Pathol, Res Pract. 1990; 186: 555-581.
- 6Colella G, Cannavale R, Flamminio F, Foschini MP. Fine-needle aspiration cytology of salivary gland lesions: a systematic review. J Oral Maxillofac Surg. 2010; 68: 2146-2153.
- 7Schmidt RL, Hall BJ, Wilson AR, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology for parotid gland lesions. Am J Clin Pathol. 2011; 136: 45-59.
- 8Wei S, Layfield LJ, LiVolsi VA, Montone KT, Baloch ZW. Reporting of fine needle aspiration (FNA) specimens of salivary gland lesions: a comprehensive review. Diagn Cytopathol. 2017; 45: 820-827.
- 9Franzen AM, Kaup Franzen C, Guenzel T, Lieder A. Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation. Eur Arch Otorhinolaryngol. 2018; 275: 2593-2598.
- 10Olsen KD, Lewis JE. Carcinoma ex pleomorphic adenoma: a clinicopathologic review. Head Neck. 2001; 23: 705-712.
- 11El-Nagar AKCJ, Grandis JR, Takata T, Slootweg PJ. World Health Organization Classification of Head and Neck Tumours. 4th ed. Lyon, France: International Agency for Research on Cancer; 2017.
- 12Schwalje AT, Uzelac A, Ryan WR. Growth rate characteristics of Warthin's tumours of the parotid gland. Int J Oral Maxillofac Surg. 2015; 44: 1474-1479.
- 13Thielker J, Grosheva M, Ihrler S, Wittig A, Guntinas-Lichius O. Contemporary management of benign and malignant parotid tumors. Front Surg. 2018; 5: 39.
- 14Suzuki M, Kawata R, Higashino M, et al. Values of fine-needle aspiration cytology of parotid gland tumors: a review of 996 cases at a single institution. Head Neck. 2019; 41: 358-365.
- 15Veder LL, Kerrebijn JD, Smedts FM, den Bakker MA. Diagnostic accuracy of fine-needle aspiration cytology in Warthin tumors. Head Neck. 2010; 32: 1635-1640.
- 16Liu Y, Li J, Tan YR, Xiong P, Zhong LP. Accuracy of diagnosis of salivary gland tumors with the use of ultrasonography, computed tomography, and magnetic resonance imaging: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119: 238-245.
- 17Reddy VM, Thangarajah T, Castellanos-Arango F, Panarese A. Conservative management of warthin tumour. J Otolaryngol Head Neck Surg. 2008; 37: 744-749.
- 18Raymond MR, Yoo JH, Heathcote JG, McLachlin CM, Lampe HB. Accuracy of fine-needle aspiration biopsy for Warthin's tumours. J Otolaryngol. 2002; 31: 263-270.
- 19Zhang D, Liao X, Tang Y, et al. Warthin-like mucoepidermoid carcinoma of the parotid gland: unusual morphology and diagnostic pitfalls. Anticancer Res. 2019; 39: 3213-3217.
- 20Ballo MS, Shin HJ, Sneige N. Sources of diagnostic error in the fine-needle aspiration diagnosis of Warthin's tumor and clues to a correct diagnosis. Diagn Cytopathol. 1997; 17: 230-234.
10.1002/(SICI)1097-0339(199709)17:3<230::AID-DC12>3.0.CO;2-G CAS PubMed Web of Science® Google Scholar
- 21Chai C, Dodd LG, Glasgow BJ, Layfield LJ. Salivary gland lesions with a prominent lymphoid component: cytologic findings and differential diagnosis by fine-needle aspiration biopsy. Diagn Cytopathol. 1997; 17: 183-190.
10.1002/(SICI)1097-0339(199709)17:3<183::AID-DC3>3.0.CO;2-G CAS PubMed Web of Science® Google Scholar
- 22Flezar M, Pogacnik A. Warthin's tumour: unusual vs. common morphological findings in fine needle aspiration biopsies. Cytopathology. 2002; 13: 232-241.
- 23Parwani AV, Ali SZ. Diagnostic accuracy and pitfalls in fine-needle aspiration interpretation of Warthin tumor. Cancer. 2003; 99: 166-171.
- 24Kim HJ, Kim JS. Ultrasound-guided core needle biopsy in salivary glands: a meta-analysis. Laryngoscope. 2018; 128: 118-125.
- 25Teymoortash A, Werner JA. Tissue that has lost its track: Warthin's tumour. Virchows Arch. 2005; 446: 585-588.
- 26Neumann A, Rosenberger D, Vorsprach O, Dazert S. The incidence of Frey syndrome following parotidectomy: results of a survey and follow-up. HNO. 2011; 59: 173-178.
- 27Dell'Aversana Orabona G, Bonavolonta P, Iaconetta G, Forte R, Califano L. Surgical management of benign tumors of the parotid gland: extracapsular dissection versus superficial parotidectomy–our experience in 232 cases. J Oral Maxillofac Surg. 2013; 71: 410-413.
- 28Mantsopoulos K, Koch M, Klintworth N, Zenk J, Iro H. Evolution and changing trends in surgery for benign parotid tumors. Laryngoscope. 2015; 125: 122-127.
- 29Xie S, Wang K, Xu H, et al. PRISMA-extracapsular dissection versus superficial parotidectomy in treatment of benign parotid tumors: evidence from 3194 patients. Medicine. 2015; 94:e1237.
- 30Foresta E, Torroni A, Di Nardo F, et al. Pleomorphic adenoma and benign parotid tumors: extracapsular dissection vs superficial parotidectomy–review of literature and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 117: 663-676.
- 31Deschler DG. Extracapsular dissection of benign parotid tumors. JAMA Otolaryngol Head Neck Surg. 2014; 140: 770-771.
- 32Brennan PA, Ammar M, Matharu J. Contemporary management of benign parotid tumours - the increasing evidence for extracapsular dissection. Oral Dis. 2017; 23: 18-21.
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