Management for Warthin Tumor of the Parotid Gland: Surgery or Observation. A 21-Year Retrospective Study of 387 Cases
Management for Warthin Tumor of the Parotid Gland: Surgery or Observation. A 21-Year Retrospective Study of 387 Cases
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DOI：
10.1177/01455613221080927
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发表时间：
2022-04-08
影响因子：
1.3
通讯作者：
Tochizawa, Takeshi
中科院分区：
文献类型：
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作者：
Nishimura, Hiromi;Kawata, Ryo;Tochizawa, Takeshi
目的探讨Warthin瘤的临床特点、诊断和治疗，探讨观察治疗的可行性。方法回顾性分析1999年9月至2021年4月间收治的1167例腮腺良性肿瘤患者的临床资料。其中WT 387例，多形性腺瘤668例。我们通过症状/体征、细针穿刺细胞学（FNAC）、影像学检查（如超声和磁共振成像）和锝-99 m高锝酸盐（Tc-99 m）放射成像评估WT的术前诊断。统计分析中使用Fisher精确检验和Mann-Whitney U检验。结果手术治疗Warthin瘤238例，随访149例。238例患者在手术后的最终病理检查中被诊断为WT。其中，172例（72.3%）患者术前FNAC确定为良性组织学类型;在这172例患者中，170例（71.4%）患者在最终病理学中被正确诊断为WT。对69例经病理或FNAC确诊的WT患者术前行~（99）Tc显像，阳性率为75.4%。结论结合FNAC和Tc-99 m核素显像，并结合临床表现，大多数病例可确诊WT。特别是，WT在老年人中更常见，生长更缓慢，并且不太可能是恶性的。因此，如果WT可以在术前诊断，且诊断正确率高，则它可能是通过随访而无需手术来管理患者的准确有效的方法。
Purpose This study investigated the characteristics, diagnosis, and treatment of Warthin tumors (WTs) to explore the possibility of managing patients by observation. Methods We reviewed the records of 1167 patients with benign parotid tumors who were seen in our department between September 1999 and April 2021. Among them, 387 cases were WT and 668 cases were pleomorphic adenoma. We evaluated preoperative diagnoses of WT by symptoms/signs, fine-needle aspiration cytology (FNAC), imaging, such as ultrasonography and magnetic resonance imaging, and technetium-99m pertechnetate (Tc-99m) scintigraphy. Fisher's exact test and the Mann-Whitney U test were used in statistical analyses. Results Warthin tumors were treated by surgery in 238 cases and follow-up in 149 cases. The 238 patients were diagnosed as WT at the final pathology after surgery. Among them, 172 patients (72.3%) were determined as benign histological type by preoperative FNAC; in these 172 patients, 170 (71.4%) were correctly diagnosed as WT in the final pathology. Preoperative Tc-99m scintigraphy was performed in 69 patients diagnosed with WT by final pathology or FNAC, and the positive rate of Tc-99m scintigraphy in WT was 75.4%. Conclusions Combining FNAC and Tc-99m scintigraphy, as well as considering clinical findings, enables the diagnosis of WT in most cases. In particular, WT is more common in the elderly, grows more slowly, and is less likely to be malignant. Therefore, if WT can be diagnosed preoperatively with a high rate of correct diagnosis, it could be an accurate and effective means of managing patients through follow-up without surgery.