Surgical treatment strategy in Warthin tumor of the parotid gland

Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

doi:10.1016/j.bjorl.2018.04.004

Cited by 13 publications

(14 citation statements)

References 11 publications

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“… 15‐17 Warthin tumors have characteristic clinical features, eg, they are soft, cystic tumors arising in the lower pole of the parotid gland in middle‐aged to older men. On the basis of these characteristic features, a clinical diagnosis can be made in many cases 29 . It might be necessary to reconsider the clinicocytologic diagnostic criteria for Warthin tumors used in Japan to reduce the RON value of the AUS category.…”

Section: Discussionmentioning

confidence: 99%

A multi‐institutional study of salivary gland cytopathology: Application of the Milan System for Reporting Salivary Gland Cytopathology in Japan

Higuchi

Urano

Akiba

et al. 2021

Cancer Cytopathology

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BACKGROUND:The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a risk-stratification reporting system that was introduced in 2018. The objective of this multi-institutional study was to evaluate the utility of the MSRSGC in Japan. METHODS: In total, 1608 fine-needle aspiration samples with matching histologic diagnoses were retrieved from 12 large institutions in Japan. The diagnostic categories of the MSRSGC were assigned prospectively or retrospectively, and the results were compared with the histologic diagnoses. RESULTS: The cases were classified as follows: nondiagnostic, 18.1%; non-neoplastic, 4.1%; atypia of undetermined significance, 11.5%; neoplasm-benign, 43.7%; salivary gland neoplasm of uncertain malignant potential, 9.6%; suspicious for malignancy, 3.6%; and malignant, 9.4%. The risk of neoplasm and the risk of malignancy in each MSRSGC category were as follows: nondiagnostic, 72.9% and 13.4%, respectively; non-neoplastic, 15.2% and 9.1%, respectively; atypia of undetermined significance, 77.9% and 24.9%, respectively; neoplasm-benign, 99% and 1.8%, respectively; salivary gland neoplasm of uncertain malignant potential, 94.8% and 37%, respectively; suspicious for malignancy, 100% and 89.7%, respectively; and malignant, 100% and 99.3%, respectively. The accuracy of the MSRSGC for diagnosing neoplasms was 97.8%, and its accuracy for diagnosing malignancy was 97.3%. Institutions that used Romanowsky-stained preparations had lower nondiagnostic rates and lower risks of neoplasm and malignancy in the non-neoplastic category. CONCLUSIONS:The MSRSGC is useful for risk stratification and quality control. Widespread use of the MSRSGC would improve the accuracy of salivary gland cytology and lead to better patient care in Japan. Cancer Cytopathol 2021;0:1-11.

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Section: Discussionmentioning

confidence: 99%

A multi‐institutional study of salivary gland cytopathology: Application of the Milan System for Reporting Salivary Gland Cytopathology in Japan

Higuchi

Urano

Akiba

et al. 2021

Cancer Cytopathology

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“…In addition, Warthin tumor shows clinical characteristics, being more common in the inferior pole of the parotid gland in older men with a history of smoking. Warthin tumor shows bilaterality (approximately 10%) [28] oval-shaped and well-defined tumors that are hypoechoic with blood flow on ultrasonography [29]. Therefore, it might be possible to make a diagnosis of Warthin tumor in cases in which only degenerated cylindrical cells are observed in a dirty proteinaceous background, which may lead to a reduction in AUS cases in Japan.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

et al. 2020

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Objective: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a recently published evidence-based categorization system for salivary gland fine-needle aspiration (FNA). We applied MSRSGC to Japanese cases and evaluated its utility. Study Design: A total of 480 FNA cases were reviewed. We recategorized each case into one of the MSRSGC categories. The risk of neoplasm (RON) and the risk of malignancy (ROM) for each diagnostic category in MSRSGC, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for malignancy and for neoplasms were calculated for cases with histological follow-up. In addition, the overall ROM (O-ROM) was calculated for all FNA cases. Results: RON, ROM, and O-ROM rates were as follows – non-diagnostic: 51.3, 5.1, and 1.0%; non-neoplastic: 0, 0, and 0%; atypia of undetermined significance: 83.9, 12.9, and 7.3%; neoplasm, benign: 100, 0, and 0%; salivary gland neoplasm of uncertain malignant potential: 100, 32.1, and 23.7%; suspicious for malignancy: 100, 85.7, and 60%; and malignant: 100, 100, 81.8%. The sensitivity, specificity, and accuracy with (without) indeterminate cases for malignancy were 65 (100), 99 (99), 92% (99%) and PPV and NPV were 96 and 100%, respectively, and those for neoplasms were 84 (100), 100 (100), 85% (100%), and PPV and NPV were 100 and 100%, respectively. Conclusions: The MSRSGC is useful for stratification of ROM and for promoting the performance of salivary gland FNA. The MSRSGC could be easily introduced in Japan and may improve the Japanese salivary gland FNA status.

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“…Although in the past some authors [32] did recommend total parotidectomy as the modality of choice for all WTs due to the high incidence of multifocality, currently this option is mainly proposed for those rare cases with multiple WTs additionally involving the deep lobe [33] or for cases with multiple WTs when the surgeon wants to minimize the risk of occult deep lobe lesions [34]. The advantage of total parotidectomy in multifocal WTs is the ability to resect all possible foci and to minimize the risk of second ipsilateral tumors.…”

Section: Parotidectomy I-iv (Total Parotidectomy)mentioning

confidence: 99%

“…Many authors follow this strategy but combine different extensions depending on the extent of the tumor. For example, Lee et al [33] in a recent series of 118 WTs treated with surgery, performed a partial parotidectomy in 43 cases. The rest were treated with a superficial parotidectomy (68 cases) or a total parotidectomy (7 cases).…”

Section: Parotidectomy II (Partial Lateral Parotidectomy)mentioning

confidence: 99%

Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

et al. 2021

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Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.

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Surgical treatment strategy in Warthin tumor of the parotid gland

Cited by 13 publications

References 11 publications

A multi‐institutional study of salivary gland cytopathology: Application of the Milan System for Reporting Salivary Gland Cytopathology in Japan

A multi‐institutional study of salivary gland cytopathology: Application of the Milan System for Reporting Salivary Gland Cytopathology in Japan

Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

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