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OBJECTIVE: To evaluate the precision and utility of fine-needle aspiration (FNA) in differentiating between benign and malignant parotid tumours, and the implications of FNA results on management and outcomes. DESIGN: Retrospective case series. SETTING: Tertiary medical centre. PARTICIPANTS: All adults who underwent preoperative FNA, followed by postoperative histological examination, between 1986 and 2014. MAIN OUTCOME MEASURES: Differences in clinical management and outcomes of patients with parotid masses in light of FNA results. RESULTS: We analysed 505 samples from 485 patients. According to histopathological results, preoperative FNA successfully identified benign tumours in 89% of the cases (362/405) and only 59% of malignant tumours (59/100). Overall sensitivity and specificity of FNA in distinguishing between different subtypes of benign lesions were 80% and 99%, respectively, whereas positive predictive value (PPV) and negative predictive value (NPV) were 85% and 98%. Moreover, malignant lesions subtyping had high false-positive and false-negative rates with sensitivity, specificity, PPV and NPV of 44%, 100%, 75% and 99%, respectively. Additionally, when FNA falsely classified malignant tumours as benign, surgeries were inappropriately delayed and the durations of surgeries and hospitalisations were shorter, compared to true malignant FNA results. Interestingly, survival was not affected in falsely benign lesions that were mostly low-grade, conversely non-diagnostic FNA for malignant tumours resulted in decreased survival. CONCLUSIONS: Our findings highlight the limitations of FNA as a decision-making tool in preoperative evaluation of parotid masses. Clinicians should take into account that FNA is inaccurate for identifying specific subtypes of malignant lesions, which may eventually delay treatment and influence outcome.

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Parotid gland is an important major salivary gland connected to the oral cavity. Salivary gland tumours are infrequent around less than 3% of head and neck tumours. Parotid gland is the most common site for the occurrence of salivary tumors. They are heterogeneous group of neoplasm characterized by the varying histological features and clinical behaviour. In our study we have examined the role of FNAC for preoperative diagnostic and management. We have concluded that Fine needle aspiration cytology is advocated routinely to know the type and nature of the tumour as an important pre-operatively diagnostic work up. It helps in preoperative identification of type of tumour neoplastic or benign, preoperative counselling of patient, planning of management of tumour, and preparing the patient and the surgical team for the more extensive procedure generally required for a high grade malignancy.

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Following up on the Consensus Conference on high-grade malignant salivary gland tumours (HGMSGT) in adult patients in Brescia, Italia, in October 2014, we review the current imaging modalities for diagnosing and staging these rare tumours. The advantages of functional MR imaging techniques such as diffusion weighted imaging (DWI) and dynamic contrast-enhanced MR imaging (DCEMRI) in comparison with traditional MRI will be outlined. The limited role of (18)FDG-PET CT and fMRI will be addressed. Finally, in view of new experimental treatment options, we will discuss the role of imaging during follow-up.

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Interest in the knowledge of salivary gland tumours is highlighted. A sample of 315 cases, collected over a period of 25 years in a busy pathology centre, is analysed both on total and individual aspects of tumours. The findings are compared to earlier works on the subject and also with contemporary literature.