Does routine preoperative imaging of parotid tumours affect surgical management decision making?

OBJECTIVE: To determine whether preoperative radiologic imaging of parotid tumours would alter the surgical approach to complete eradication of the parotid tumours.

METHODS: A retrospective chart review of 173 patients with parotid tumours who underwent removal of parotid tumours at Mount Sinai Hospital in Toronto, Ontario, from 2000 to 2002. Each patient presented with a single, unilateral parotid tumour. Ninety-eight patients underwent preoperative radiologic imaging prior to definitive surgeries. The remaining 75 patients did not undergo preoperative imaging before surgery.

RESULTS: Our study had shown that patients with superficial lobe parotid tumours did not require preoperative imaging as it did not affect the surgical management approach. On the contrary, for patients with parotid tumours clinically involving the deep lobe or parapharyngeal space, preoperative imaging often provides important additional information that may alter the surgical approach to eradication of parotid tumours. Moreover, patients with histopathologically benign tumours did not seem to benefit from preoperative imaging. On the other hand, patients with histopathologically malignant parotid tumours benefited from preoperative imaging as the additional information often altered the surgical management decision.

CONCLUSION: Preoperative imaging should not be routinely ordered to investigate patients with parotid tumours. Patients with either deep parotid tumours or clinically suspicious tumours of malignancy would benefit from a preoperative radiologic investigation. The additional information from imaging may affect the surgical management decision.