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Clinical decision making when cytology indicates a Warthin tumor
Minna Sirviö1, Katri Aro2, Mira Naukkarinen2
1Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland. minna.m.sirvio@hus.fi.
Scientific Reports
|April 17, 2024
Summary
Fine-needle aspiration cytology (FNAC) reliably diagnoses Warthin tumor (WT) of the parotid gland. A certain or likely FNAC diagnosis allows for conservative management, avoiding unnecessary surgery for most patients.
Area of Science:
- Otolaryngology
- Pathology
- Oncology
Background:
- Warthin tumor (WT) is a common benign parotid gland neoplasm.
- Diagnosis typically involves ultrasound and fine-needle aspiration cytology (FNAC).
- Accurate FNAC is crucial for guiding surgical versus conservative management decisions.
Purpose of the Study:
- To evaluate the reliability of FNAC in diagnosing Warthin tumor.
- To assess the impact of FNAC results on clinical management strategies.
- To determine the rate of misdiagnosis and need for intervention in suspected WTs.
Main Methods:
- Retrospective analysis of parotid gland FNACs performed between 2016-2018.
- Categorization of FNAC results into 'certain', 'likely', and 'possible' Warthin tumor.
- Classification of patients into surgical and conservative management groups.
- Minimum four-year follow-up for conservatively managed patients.
Main Results:
- 135 FNAC samples from 125 patients showed signs of WT.
- 44% of patients underwent surgery, while 65% were managed conservatively.
- FNAC misdiagnosis occurred in 7% of surgically treated cases (reported as possible WT, histopathology confirmed other benign lesions).
- No malignant diagnoses were reported; FNAC for WT was seldom false.
Conclusions:
- A certain or likely Warthin tumor diagnosis via FNAC by an experienced head and neck pathologist is highly reliable.
- FNAC findings effectively guide the selection of patients for conservative surveillance.
- Most patients with suspected Warthin tumor can be managed conservatively with minimal need for further intervention.
