Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins.

Autor: Benchetrit L; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A., Torabi SJ; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A., Morse E; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A., Mehra S; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.; Yale Cancer Center, New Haven, Connecticut, U.S.A., Rahmati R; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.; Yale Cancer Center, New Haven, Connecticut, U.S.A., Osborn HA; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.; Yale Cancer Center, New Haven, Connecticut, U.S.A., Judson BL; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.; Yale Cancer Center, New Haven, Connecticut, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2020 Jun; Vol. 130 (6), pp. 1450-1458. Date of Electronic Publication: 2019 Aug 14.
DOI: 10.1002/lary.28224
Abstrakt: Objectives: Determine rate of preoperative biopsy in parotid malignancies, identify factors associated with its use, and its association with surgical margins.
Study Design: Retrospective cohort.
Setting: Commission on Cancer-Accredited Institutions.
Subjects and Methods: We included 5533 patients treated surgically for a parotid malignancy 2004-2014 in the National Cancer Database. Chi-squared tests, univariable, and multivariable logistic regressions were used to evaluate predictors of preoperative biopsy (defined as needle, aspiration, or incisional), and associate biopsy with surgical margins.
Results: Preoperative biopsy was utilized in 26.0% of patients. Biopsy was more likely in patients >60 years (odds ratio [OR]: 1.19, P = .035), advanced clinical T stage (vs. T1,T2 OR: 1.23, P = .009; T3 OR: 1.26, P = .026; T4A OR: 2.05, P < .001), advanced clinical N stage (vs. N0, N1: OR: 1.39, P = .013; N2/3: OR: 1.63, P < .001), in academic centers (OR: 1.18, P < .024), and in higher volume centers (vs. low, medium OR: 1.28, P = .002; high OR: 2.16, P < .001). Biopsy use increased over time (vs. 2004-2006, 2007-2010 OR: 1.20, P = .047; 2011-2014 OR: 1.39, P < .001). Biopsy was associated with a reduced risk of positive margins in patients with clinical T1 stage (OR: 0.70, P = .012), and younger than 61 (OR: 0.79, P = .036).
Conclusion: The national rate of preoperative biopsy in parotid malignancy is low at 26.0%, but has increased over time. Preoperative biopsy is associated with a reduced risk of positive margins in younger patients and those with early clinical stage, suggesting its increased use may improve surgical outcomes and decrease reoperation or adjuvant therapy in these subgroups of patients.
Level of Evidence: 3 Laryngoscope, 130:1450-1458, 2020.
(© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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