Clinical decision making when cytology indicates a Warthin tumor

Abstract

Warthin tumor (WT) is a benign tumor usually affecting the parotid gland. The main diagnostic tool remains ultrasound combined with fine-needle aspiration cytology (FNAC). This study aims to examine how reliably FNAC indicates WT for clinical decision making regarding surgical versus conservative management. We included all patients who underwent FNAC from a parotid gland lesion between 2016 and 2018 at our institution, and whose FNAC revealed WT suspicion. The FNACs were divided into three groups based on the cytology report: certain, likely, and possible WT. The patients were divided into two groups based on having had either surgery or follow-up. We sent a questionnaire to patients who had not undergone surgery in order to obtain follow-up for a minimum of four years. Altogether, 135 FNAC samples, from 133 tumors and 125 patients, showed signs of WT. Of the 125 patients, 44 (35%) underwent surgery, and 81 (65%) were managed conservatively. Preoperative misdiagnosis in FNAC occurred in three (7%) surgically treated tumors. Their FNACs were reported as possible WTs, but histopathology revealed another benign lesion. In the conservatively treated group, two patients underwent surgery later during the follow-up. Cytological statements of WT were seldom false, and none were malignant. The majority of the patients were only followed-up and rarely required further treatment. A certain or likely diagnosis of WT in the FNAC report by an experienced head and neck pathologist is highly reliable in selecting patients for conservative surveillance.

Current Developments in Diagnosis of Salivary Gland Tumors: From Structure to Artificial Intelligence

“…This system has improved the communication of data between doctors of different specialties. However, FNA cytology accuracy is considered to be more reliable in the diagnostic of benign salivary gland tumors which pathologists encounter frequently, like pleomorphic adenomas and Warthin tumors [ 5 , 54 , 55 , 56 ].…”

“…The FNA cytologic diagnosis is invasive and limited by the quality of the sample and the experience of the cytopathologist in head and neck lesions. Furthermore, the FNA technique can be accompanied by complications such as spreading of tumor cells, local recurrence, risk of infection and haemorrhage at the needle puncture site and facial nerve injury [ 5 , 54 , 55 , 56 , 57 , 58 , 59 ]. It has been proposed that the MSRSGC malignant category be divided into low-grade and high-grade malignancy and a separate category be used for haematological malignancies [ 55 ].…”