Benign Tumors of Major Salivary Glands Workup
- Author: Fadi Chahin, MD; Chief Editor: John Geibel, MD, DSc, MSc, MA more...
Perform a white blood cell (WBC) count to investigate for any evidence of leukocytosis and shift that might indicate a possible infectious process or lymphoproliferative disease.
Imaging studies are most helpful in the diagnostic evaluation of salivary gland tumors (SGTs).[1, 9] Magnetic resonance imaging (MRI) is the most sensitive test for establishing the borders of soft-tissue tumor extension. In most circumstances, findings from computed tomography (CT) and MRI cannot reliably be used to differentiate benign from malignant disease. (See the images below.) In a study of 46 major SGTs, Aghaghazvini et al found that dynamic contrast-enhanced MRI had potential utility for differentiating SGTs preoperatively, specifically with regard to distinguishing between Warthin tumors and benign non-Warthin tumors.
Fine-needle aspiration biopsy (FNAB) may aid in the diagnosis of SGTs. The availability of an experienced cytologist is a prerequisite in this case. FNAB can be helpful in identifying nonneoplastic masses that respond to medication and in detecting lymphomas and metastatic masses. FNAB findings provide evidence for a preoperative diagnosis that is 70-80% accurate.
Core needle biopsy is an option in this setting. Song et al, in a study comparing FNAB (n=371) with ultrasound-guided core needle biopsy (n=228) in the evaluation of major SGTs, found core needle biopsy to be significantly more sensitive and to provide better tumor subtyping, especially for malignant lesions.
The final pathologic diagnosis is always established on the basis of findings from surgical excision.
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