Ji Jeong-Yeon, Cha Wonjae, Jung Young Ho, Ahn Soon-Hyun, Jeong Woo-Jin
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2025 Feb;18(1):57-63. doi: 10.21053/ceo.2024.00227. Epub 2024 Dec 2.
Salivary gland tumors present a diagnostic challenge, with preoperative false-negative results frequently leading to an unexpected diagnosis of malignancy after parotidectomy. This study was conducted to explore the clinical utility of preoperative core needle biopsy (CNB) in diagnosing malignancies before primary parotidectomy and to assess the prognostic implications of CNB for parotid gland cancers.
This retrospective cohort study included 615 patients who underwent preoperative CNB and parotidectomy for primary parotid tumors from 2003 to 2023 at a tertiary referral hospital. Among these patients, 102 who were diagnosed with primary parotid malignancy following parotidectomy were examined regarding survival outcomes. Disease-free survival (DFS) and predictive factors were assessed through univariable and multivariable analyses. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CNB were determined. These metrics were then compared to those of a separate cohort of 547 patients who underwent ultrasound-guided fine needle aspiration (FNA) and parotidectomy within the same timeframe.
In the CNB group, the 5-year predicted DFS was 86.9% (95% CI, 79.2%-95.3%). Multivariable analysis identified male sex (hazard ratio [HR], 8.48; 95% CI, 1.05-68.76) and a CNB finding of malignancy (HR, 8.20; 95% CI, 1.01-66.15) as factors significantly associated with decreased DFS. CNB demonstrated significantly higher sensitivity (89.0%; 95% CI, 81.2%-94.4%) and NPV (97.6%; 95% CI, 95.7%-98.8%) compared to FNA, which had a sensitivity of 45.2% (95% CI, 33.5%-57.3%) and an NPV of 90.8% (95% CI, 87.7%-93.3%).
Preoperative CNB may be predictive of parotid cancer prognosis. Patients receiving a diagnosis of malignancy on preoperative CNB demonstrated a worse prognosis compared to those with a "less-than-malignant" diagnosis. Additionally, CNB exhibited higher sensitivity than FNA in identifying malignancies of the parotid gland.
唾液腺肿瘤的诊断具有挑战性，术前假阴性结果常常导致腮腺切除术后意外诊断为恶性肿瘤。本研究旨在探讨术前粗针穿刺活检（CNB）在原发性腮腺切除术前诊断恶性肿瘤的临床实用性，并评估CNB对腮腺癌的预后影响。
这项回顾性队列研究纳入了2003年至2023年在一家三级转诊医院因原发性腮腺肿瘤接受术前CNB和腮腺切除术的615例患者。在这些患者中，对102例腮腺切除术后被诊断为原发性腮腺恶性肿瘤的患者进行了生存结局检查。通过单变量和多变量分析评估无病生存期（DFS）和预测因素。确定了CNB的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性。然后将这些指标与同一时间段内接受超声引导下细针穿刺抽吸（FNA）和腮腺切除术的547例患者组成的另一队列的指标进行比较。
在CNB组中，5年预测DFS为86.9%（95%CI，79.2%-95.3%）。多变量分析确定男性（风险比[HR]，8.48；95%CI，1.05-68.76）和CNB发现为恶性（HR，8.20；95%CI，1.01-66.15）是与DFS降低显著相关的因素。与FNA相比，CNB显示出显著更高的敏感性（89.0%；95%CI，81.2%-94.4%）和NPV（97.6%；95%CI，95.7%-98.8%），FNA的敏感性为45.2%（95%CI，33.5%-57.3%），NPV为90.8%（95%CI，87.7%-93.3%）。
术前CNB可能预测腮腺癌预后。术前CNB诊断为恶性的患者与诊断为“恶性程度较低”的患者相比，预后较差。此外，CNB在识别腮腺恶性肿瘤方面比FNA表现出更高的敏感性。
