ArticleOral radiology2026
Parotid pleomorphic adenoma: can a biopsy be omitted in the setting of a characteristic MRI?
Article in Oral radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivePleomorphic adenoma (PA) is the most common benign parotid tumour. Magnetic resonance imaging (MRI) and fine-needle aspiration cytology (FNAC) are routinely used during preoperative work up. However, there is insufficient evidence to support the use of MRI alone to diagnose a PA. This paper aims to evaluate the diagnostic performance of MRI and FNAC in the diagnosis of PA and develop an MRI assessment tool to potentially reduce an invasive biopsy.
methodsA retrospective cohort study was conducted in 155 patients with histopathologically confirmed parotid tumours with preoperative MRI and/or FNAC between 2015 and 2020. Two experienced head and neck radiologists, both with over 20 years' experience, blinded to final histopathology, evaluated 100 MRIs. Diagnostic values for detecting PA with MRI and FNAC were evaluated. An MRI assessment tool was developed based on clinical criteria and MRI characteristics typical for a PA.
resultsThe sensitivity, specificity, positive predictive value (PPV), negative predictive value, (NPV) and diagnostic accuracy for predicting PA were 93%, 97%, 96%, 94% and 95% (Area under ROC curve (AUC) 0.95) for FNAC and 95%, 90%, 86%, 96% and 92% (AUC 0.93) for MRI respectively. There was no statistically significant difference between MRI and FNAC for diagnosing PA with regards to sensitivity (p = 0.628), specificity (p = 0.162) or overall accuracy (p = 0.361).
conclusionMRI is a noninvasive imaging technique that can predict PA with similar sensitivity, specificity and diagnostic accuracy compared with FNAC. The PA MRI assessment tool aims to assist in surgical management decisions, while potentially reducing the need for an invasive biopsy.
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