Malignancies in the parotid gland-preoperative management with the use of clinical examination, ultrasonography and core needle biopsy

Introduction Among head and neck tumors cancerous lesion in the parotid gland are rare. Multiple tumors entities have been described. To best guide surgical management of these lesions pre-operative determination of tumor dignity is therefore of utmost importance. The aim of this study is to refine the preoperative evaluation of parotid masses with the use of sonography and core needle biopsy.

Material and Methods We conducted a retrospective study between 2/14 and 9/19 including all patients referred to our institution for evaluation of a parotid mass. When malignancy was suspected based on initial clinical evaluation or sonographic findings, or when imaging findings were equivocal ultrasound-guided core needle biopsy was pursued. Core needle biopsy was also performed in all cases in which risk for general anesthesia was deemed prohibitive due to advanced age or comorbidities.

Results Among the 764 patients included in this study 156 malignant cases were identified. For diagnostic purposes a core needle biopsy was performed in 49 cases out of which 28 were diagnosed with malignancy. The most common malignant lesion was distant metastases of cutaneous squamous cell carcinoma. In 21 patients core needle biopsy established the diagnosis of a benign tumor entity and treatment in these cases could thereby be optimized.

Conclusion Ultrasound in combination with core needle biopsy can improve the determination of dignity preoperatively and guide treatment. Intraoperative decision making particularly need for facial nerve resection can be facilitated. Therefore, accurate preoperative histopathological evaluation of parotid lesions can reliably establish a diagnosis and optimize surgical approaches particularly in patients of advanced age or with significant comorbidities.

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Publication History

Article published online:
10 June 2020