Controversial issues in core needle biopsy for diagnosing parotid neoplasms

Relevance. Accurate diagnosis of benign parotid gland tumors is a critical clinical task that requires an individualized approach to exclude potential malignant transformation. From this perspective, obtaining morphological results appears more reliable with core needle biopsy than with ultrasound-guided fine-needle aspiration cytology. The accuracy of the preoperative diagnosis directly determines the extent of surgical intervention and, in turn, significantly influences treatment outcomes and patient prognosis.

Materials and methods. The study analyzed diagnostic and treatment outcomes in 127 patients with benign parotid gland neoplasms treated at the I. P. Pavlov First Saint Petersburg State Medical University and the N. N. Burdenko Main Military Clinical Hospital. The methodology of ultrasound-guided core needle biopsy of parotid gland tumors is described. Diagnostic concordance and discordance between fine-needle aspiration biopsy and core needle biopsy were evaluated against final postoperative histopathological findings in the cohort of 127 patients.

Results. In 88 cases, concordance between fine-needle aspiration biopsy and postoperative histopathological examination was observed in 73% of cases, discordance in 18%, and non-diagnostic results in 9%. Among 46 patients who underwent preoperative core needle biopsy, diagnostic concordance with postoperative histology was achieved in 83% of cases, discordance in 11%, and non-diagnostic results in 6%.

Conclusion. The study highlights key limitations of conventional diagnostic approaches to benign parotid gland neoplasms and presents multicenter clinical experience with ultrasound-guided core needle biopsy as an alternative method for diagnostic confirmation. In addition, practical recommendations for clinicians on the performance of this biopsy technique are provided.

1. Harutyunyan G, Yaremenko A, Rybakova M, Kutukova S, Kazachkova K, Nutfullina G. A Comprehensive Approach to the Treatment of Patients with Primary Growth of Pleomorphic Adenoma of the Parotid Salivary Gland. Bulletin of Stomatology and Maxillofacial Surgery. 2025;21(3):116-122. https://doi.org/10.58240/1829006X-2025.3-116.

2. Bychkov D.V., Batoroev J.K., Vjazmin A.J. Problems of preoperative diagnostics of tumors of salivary glands. Sibirskij Medicinskij Zhurnal. 2011;6:33-36 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=17053506

3. Ziyoratsho I. Diagnostic significance of puncture and trepanobiopsy of salivary gland tumors under ultrasound control and its reliability in doubtful situations. Healthcare in Tajikistan. 2023;2(357):44–50 (In Russ.). https://doi.org/10.52888/0514-2515-2023-357-2-44-50

4. Yurmazov N.B., Markov N.V., Fialko P.N., Horoshko E.P. Selection of optimal method of pre-operative diagnostic of salivary gland tumor in maxillary-facial surgery clinic. Medicine in the Kuzbass. 2008;7(3):20-22 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=11669851

5. Izatulin VG, Gazal AS. Advanced puncture needle for the sampling of biopsy material of large salives. Siberian Medical Journal. 2017;2:18-20 (In Russ.). https://cyberleninka.ru/article/n/usovershenstvovannaya-punktsionnaya-igla-dlya-zabora-biopsiynogo-materiala-bolshih-slyunnyh-zhelez

6. Buckland JR, Manjaly G, Violaris N, Howlett DC. Ultrasound-guided cutting-needle biopsy of the parotid gland. J Laryngol Otol. 1999;113(11):988-992. https://doi.org/10.1017/s0022215100145785

7. Kim HJ, Kim JS, Ultrasound-guided core needle biopsy in salivary glands: А meta-analysis. Laryngoscope. 2018;128(1):118-125. https://doi.org/10.1002/lary.26764.

8. Howlett DC, Menezes LJ, Lewis K, Moody AB, Violaris N, Williams MD. Sonographically guided core biopsy of a parotid mass. AJR Am J Roentgenol. 2007;188(1):223-227. https://doi.org/10.2214/AJR.05.1549.

9. Song IH, Song JS, Sung CO, Roh J-L, Choi S-H, Nam SY, et al. Accuracy of core needle biopsy versus fine needle aspiration cytology for diagnosing salivary gland tumors. J Pathol Transl Med. 2015;49(2):136-143. https://doi.org/10.4132/jptm.2015.01.03.

10. Huang Y-C, Wu C-T, Lin G, Chuang W-Y, Yeow K-M, Wan Y-L, Сomparison of ultrasonographically guided fineneedle aspiration and core needle biopsy in the diagnosis of parotid masses. Journal of clinical ultrasound. 2012;40(4):189-194. https://doi.org/10.1002/jcu.20873