Role of fine needle aspiration biopsy in the diagnosis of pleomorphic adenoma

Objective. The aim of the present study is to assess the reliability of fine needle aspiration biopsy (FNAB), an acknowledged diagnostic tool for head and neck lumps, in the diagnosis of pleomorphic adenoma (PA), a common benign salivary tumour. Methods. We retrieved the FNABs performed at the Otolaryngology Division of a referral centre from September 2017 to September 2023. FNABs were ultrasound (US) guided and followed by rapid on-site evaluation (ROSE). Before surgery, cytological findings were integrated with clinical information to obtain a multiparametric diagnosis (MD). Results. Of 633 FNAB reports, 413 involved major salivary glands. Among these, 214 patients underwent surgery, and final histopathology confirmed PA in 76 cases. FNAB and multiparametric evaluation yielded specificities of 97% each, and sensitivities of 89.5% and 93.4%, respectively. Conclusions. US-guided FNAB, performed by head and neck surgeons, associated with ROSE, performed by anatomical pathologist, and MD, is highly reliable for diagnosing PA, thus improving clinical management and prioritisation of cases for surgery. This is particularly relevant considering that PA, even if benign, has a significant rate of malignant transformation and multifocal recurrences, creating notable concerns under both an oncological and functional (facial nerve sparing) points of view.