Comprehensive Comparison of Ultrasound-Guided Fine Needle Aspiration and Core Needle Biopsy for Parotid Gland Masses

Saturday, October 11, 2025

9:42 AM - 9:48 AM EDT

Location: 127

Disclosure(s):

Lisa E. Chionis, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Andrew D.P Prince, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Mark E. Prince, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: This study primarily aims to compare diagnostic accuracy and safety of ultrasound-guided fine needle aspiration cytology (FNAC) and ultrasound-guided core needle biopsy (CNB) for parotid neoplasms and malignancies. We secondarily evaluate underreported factors including delays to surgery, unnecessary surgery, operator training level, and accuracy based on tumor type.

Methods: This is a retrospective cohort study of 485 patients who underwent parotidectomy at the University of Michigan (UMMC) with final pathology available between 10/2017 and 9/2022. Comparisons were made using standard statistical methods, with P<.05 indicating statistical significance.

Results: A total of 490 FNAC and 87 CNB were included. 317 biopsies were performed at UMMC vs 259 at outside hospitals (OSH). No statistical difference in patient demographics was observed. For detecting pathology-proven neoplasms, CNB was more sensitive (93.9% vs 83.6%, P=.017) than FNAC, but not more specific. For detecting pathology-proven malignancies, CNB was more sensitive (76.9% vs 52.8%, p=.007) and more specific than FNAC (91.7% vs 76.5%, p=.014). Inconclusive biopsy results were higher in FNAC than CNB (20.4% vs 4.7%, P< .001). CNB demonstrated 64.4% tissue-specific diagnostic accuracy, compared to 47.1% for FNAC (P=.003). CNB had an accuracy of 70.3% at UMMC (P=0.003) and 59.0% at OSH (P=.073), compared to FNAC accuracy of 50.6% and 45.7%, respectively. FNA led to 23 unnecessary surgeries vs 1 for CNB. There was no difference in the rate of complications or delays to surgery between FNAC and CNB. Operator training level and specialty, number of passes, and needle gauge made no difference in diagnostic accuracy for FNAC or CNB.

Conclusions: CNB outperforms FNAC in detection and characterization of parotid neoplasms and malignancies. CNB has lower inconclusive results, leads to less unnecessary surgery, and has a similar risk profile to FNAC for selected patients. CNB and FNAC obtained at experienced tertiary care centers are more accurate. CNB should be the diagnostic method of choice for selected patients presenting with a parotid gland mass.

Presenting Author(s)

Lisa E. Chionis, MD

Resident
Kaiser Permanente Oakland
Oakland, CA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

NB

Nicholas A. Bunda, MHS

Medical Student
University of Toledo College of Medicine
Grand Rapids, MI, United States

Disclosure information not submitted.

Co-Author(s)

NB

Nicholas A. Bunda, MHS

Medical Student
University of Toledo College of Medicine
Grand Rapids, MI, United States

Disclosure information not submitted.

Presenting Author(s)

AP

Andrew D.P Prince, MD

Otolaryngology Resident
University of Michigan
Ann Arbor, Michigan, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

AP

Andrew D.P Prince, MD

Otolaryngology Resident
University of Michigan
Ann Arbor, Michigan, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
KO

Kimberly A. Oslin, MD

Resident
Henry Ford
Royal Oak, MI, United States

Disclosure information not submitted.
JS

Joshua D. Smith, MD

Resident
University of Pittsburgh Otolaryngology
Ann Arbor, MI, United States

Disclosure information not submitted.
EH

Emma Hershey, MD

Dartmouth University, United States

Disclosure information not submitted.
MA

Michael Allevato, PhD

University of Michigan, United States

Disclosure information not submitted.
Steven B. Chinn, MD

Associate Professor
University of Pittsburgh Medical Center
Pittsburgh, PA, United States

Disclosure information not submitted.

Senior Author(s)

Mark E. Prince, MD

Professor and Chair
University of Michigan
Ann Arbor, MI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.