- Email: [email protected]
The need for surgical removal of parotid tumours
YIJOM-2907; No of Pages 1
Int. J. Oral Maxillofac. Surg. 2014; xxx: xxx–xxx http://dx.doi.org/10.1016/j.ijom.2014.04.016, available online at http://www.sciencedirect.com
Letter to the Editor The need for surgical removal of parotid tumours Dear Editor Thank you for the very interesting comments on the statistical methodology related to the article ‘‘Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours’’ by Fakhry et al.2 It is indeed a frequently encountered bias in studies evaluating the performance of FNAC. However, as the authors of the comments point out, this bias is valid only for studies where all tumours are not operated on. This is the case for example in thyroid tumours, which sometimes cannot be operated on when the preoperative evaluation indicates a benign tumour.1 This is not the case for parotid tumours. FNAC alone cannot be used to guide surgical management, and imaging – magnetic resonance imaging (MRI) in particular, with the use of new sequences (perfusion and diffusion-weighted sequences) – now has a very important place in the management of parotid masses in combination with FNAC. FNAC and MRI are important examinations that provide valuable information for the preoperative diagnostic work-up and together alert the surgeon to the possible presence of malignancy; however, in view of the considerable
0901-5027/000001+01
false-negative rate, FNAC and MRI cannot formally exclude malignancy and therefore cannot reliably reassure the surgeon and the patient.3 Moreover the majority of parotid tumours, both benign and malignant, are not homogeneous. Therefore careful analysis of the entire tumour specimen after surgery is required before a final diagnosis can be established. Finally, considering the high rate of malignancy in parotid tumours (26–32%), apart from a very few selected cases (patients in poor general health, or very old patients, for example), histological examination after parotidectomy is always necessary. Funding
None. Competing interests
None. Ethical approval
None. N. Fakhry* Service d’ORL et Chirurgie CervicoFaciale, Centre Hospitalier Universitaire La Timone, Marseille, France
*Address: Nicolas Fakhry, Assistance Publique – Hoˆpitaux de Marseille, Universite´ Aix – Marseille, Centre Hospitalier Universitaire La Timone, Service ORL et Chirurgie Cervico-Faciale, 264, rue Saint Pierre, 13385 Marseille cedex 05, France. Tel: +33 4 91 38 60 71; Fax: +33 4 91 38 77 57. E-mail address: [email protected] (N. Fakhry)
References 1. Baynes AL, Del Rio A, McLean C, Grodski S, Yeung MJ, Johnson WR, Serpell JW. Fine-needle aspiration of the thyroid: correlating suspicious cytology results with histological outcomes. Ann Surg Oncol 2014; 21:1653–8. 2. Fakhry N, Santini L, Lagier A, Dessi P, Giovanni A. Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours. Int J Oral Maxillofac Surg 2014. [Epub ahead of print]. 3. Fakhry N, Antonini F, Michel J, Penicaud M, Mancini J, Lagier A, Santini L, Turner F, Chrestian MA, Zanaret M, Dessi P, Giovanni A. Fine-needle aspiration cytology in the management of parotid masses: evaluation of 249 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2012;129:131–5.
# 2014 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons.
Please cite this article in press as: Fakhry N. The need for surgical removal of parotid tumours, Int J Oral Maxillofac Surg (2014), http:// dx.doi.org/10.1016/j.ijom.2014.04.016
Int. J. Oral Maxillofac. Surg. 2014; xxx: xxx–xxx http://dx.doi.org/10.1016/j.ijom.2014.04.016, available online at http://www.sciencedirect.com
Letter to the Editor The need for surgical removal of parotid tumours Dear Editor Thank you for the very interesting comments on the statistical methodology related to the article ‘‘Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours’’ by Fakhry et al.2 It is indeed a frequently encountered bias in studies evaluating the performance of FNAC. However, as the authors of the comments point out, this bias is valid only for studies where all tumours are not operated on. This is the case for example in thyroid tumours, which sometimes cannot be operated on when the preoperative evaluation indicates a benign tumour.1 This is not the case for parotid tumours. FNAC alone cannot be used to guide surgical management, and imaging – magnetic resonance imaging (MRI) in particular, with the use of new sequences (perfusion and diffusion-weighted sequences) – now has a very important place in the management of parotid masses in combination with FNAC. FNAC and MRI are important examinations that provide valuable information for the preoperative diagnostic work-up and together alert the surgeon to the possible presence of malignancy; however, in view of the considerable
0901-5027/000001+01
false-negative rate, FNAC and MRI cannot formally exclude malignancy and therefore cannot reliably reassure the surgeon and the patient.3 Moreover the majority of parotid tumours, both benign and malignant, are not homogeneous. Therefore careful analysis of the entire tumour specimen after surgery is required before a final diagnosis can be established. Finally, considering the high rate of malignancy in parotid tumours (26–32%), apart from a very few selected cases (patients in poor general health, or very old patients, for example), histological examination after parotidectomy is always necessary. Funding
None. Competing interests
None. Ethical approval
None. N. Fakhry* Service d’ORL et Chirurgie CervicoFaciale, Centre Hospitalier Universitaire La Timone, Marseille, France
*Address: Nicolas Fakhry, Assistance Publique – Hoˆpitaux de Marseille, Universite´ Aix – Marseille, Centre Hospitalier Universitaire La Timone, Service ORL et Chirurgie Cervico-Faciale, 264, rue Saint Pierre, 13385 Marseille cedex 05, France. Tel: +33 4 91 38 60 71; Fax: +33 4 91 38 77 57. E-mail address: [email protected] (N. Fakhry)
References 1. Baynes AL, Del Rio A, McLean C, Grodski S, Yeung MJ, Johnson WR, Serpell JW. Fine-needle aspiration of the thyroid: correlating suspicious cytology results with histological outcomes. Ann Surg Oncol 2014; 21:1653–8. 2. Fakhry N, Santini L, Lagier A, Dessi P, Giovanni A. Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours. Int J Oral Maxillofac Surg 2014. [Epub ahead of print]. 3. Fakhry N, Antonini F, Michel J, Penicaud M, Mancini J, Lagier A, Santini L, Turner F, Chrestian MA, Zanaret M, Dessi P, Giovanni A. Fine-needle aspiration cytology in the management of parotid masses: evaluation of 249 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2012;129:131–5.
# 2014 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons.
Please cite this article in press as: Fakhry N. The need for surgical removal of parotid tumours, Int J Oral Maxillofac Surg (2014), http:// dx.doi.org/10.1016/j.ijom.2014.04.016