Diagnostic Value of Fine-Needle Aspiration Biopsy in Major Salivary Gland Masses

Objective: To investigate the diagnostic efficacy and accuracy of fine-needle aspiration biopsy (FNAB) in solid and cystic tumors of the major salivary glands, examine the histopathologic distribution and malignancy rates of non-diagnostic cases, and investigate any significant difference between benign and malignant salivary gland tumors according to age and tumor size Methods: Age, sex, tumor location, side, tumor size, preoperative diagnosis of FNAB, and final histopathological diagnosis of 182 patients with major salivary gland mass were retrospectively evaluated. Each lesion is categorized as solid and cystic. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and FNAB accuracy were separately calculated for parotid gland tumors, submandibular gland tumors, solid, and cystic tumors. Results: Among the 182 performed FNABs, 153 were benign, 9 were malignant, and 20 were non-diagnostic. Malignancy was detected in 12.2% of the parotid gland, 25.9% of the submandibular gland, and 14.2% overall. Unlike the parotid gland, when the FNAB of the submandibular gland was non-diagnostic, the final histopathology was most likely to be malignant than benign. No difference was found in the risk of malignancy between the solid and cystic tumors (p=0.192). The sensitivity, specificity, PPV, NPV, and accuracy of the major salivary gland FNAB in this study were 42.1%, 99.3%, 88.8%, 92.8%, and 92.5%, respectively. Conclusion: In the context of a non-diagnostic FNAB, high suspicion especially for the submandibular gland tumors is warranted for otorhinolaryngologists. Based on low sensitivity values, FNAB of the major salivary glands is limited as the only diagnostic tool.