We thank Mandalia et al for their interest in our work on the management of parotid malignancy and for their contribution to debate on this difficult issue. We would urge caution, however, in direct comparisons of our published data on fine needle aspiration (FNA) with the published series on ultrasound guided core biopsy (USCB) cited in their comment. It is important to distinguish our retrospective examination of resected malignant tumours from data concerning the entire spectrum of parotid lumps (neoplastic and other), including those for which surgery did not form part of the management. Our study design was able to highlight limitations of cytological assessment in the diagnosis of malignant salivary gland tumours. Despite this, FNA was predictive of malignancy in 18 of 22 patients (81.8%).
The well documented risks of seeding disease (particularly pleomorphic adenoma) to the skin with large gauge core biopsy needles may well be mitigated by newer USCB techniques. Nevertheless, any needle that breaches the capsule, including during FNA,1 risks seeding the disease. Identifying such morbidity depends on careful follow-up, which is necessarily poor for the majority of parotid lumps. In addition, it is not clear that USCB is any less operator dependent than FNA.
The choice of preoperative investigations balances the potential diagnostic benefit against the costs and risks of the procedure. Accordingly, there may be a role for USCB in salivary gland tumours but the value of less intrusive FNA cannot be dismissed, especially when cytology expertise is available.
References
- 1.Supriya M, Denholm S, Palmer T. Seeding of tumor cells after fine needle aspiration cytology in benign parotid tumor: a case report and literature review. Laryngoscope. 2008;118:263–265. doi: 10.1097/MLG.0b013e318158f718. [DOI] [PubMed] [Google Scholar]