Improving cytological diagnosis and surgical management of parotid adenolymphoma

Background: The role of fine-needle aspiration cytology (FNAC) in the diagnosis and management of discrete parotid swellings remains controversial. Controlled enucleation can be appropriate with accurate preoperative diagnosis. This study (1985-1995) reviewed the role of FNAC in the diagnosis and surgical management of adenolymphoma. Methods: Review of cytological smears by two observers concentrated on the features of infarction and squamoid metaplasia, Sensitivity, interobserver and intraobserver variation were evaluated statistically in a two-run 'blinded' analysis of 80 cytological slides from a variety of lesions, Results: Of 222 epithelial neoplasms of the parotid, 33 were adenolymphomas, FNAC was performed before operation in 32, producing 34 slides, and a correct cytological diagnosis was made in 21 patients. Retrospective review of the 34 slides, to examine specific features of squamoid metaplasia and infarction, improved diagnostic accuracy. The reliability and reproducibility of cytodiagnosis was confirmed by analysis of interobserver and intraobserver agreement. The sensitivity was high (0.76-0.88). Controlled enucleation was performed in 12 patients and superficial parotidectomy in 11. There were no tumour recurrences. Conclusion: Attention to the features of squamoid metaplasia and infarction improves cytological diagnosis and directs appropriate surgical management.