Diagnostic Accuracy and Procedural Risks of Preoperative Biopsy in Parotid Lesions: A Single-Institution Study.

BACKGROUND: Cytologic evaluation guides surgical planning in parotidectomy. Fine-needle aspiration (FNA) and core needle biopsy (CNB) are commonly used, though diagnostic accuracy and oncologic safety vary. METHODS: Retrospective review of 89 patients undergoing parotidectomy between October 2022 and January 2025 was conducted. When multiple biopsies were performed, the most recent biopsy preceding surgery was analyzed. Cytology was compared with histopathology, and procedure-related complications were analyzed. RESULTS: Among 89 index biopsies (77 FNAs, 12 CNBs), concordance between cytology and histopathology was 96.5% (sensitivity 94.1%, specificity 97.5%). Capsule disruption occurred in 10.1% of cases (33.3% CNB, 6.5% FNA, p = 0.017). Tumor spillage, recurrence, and temporary facial nerve weakness were 5.6%, 2.2%, and 9.0%, respectively. CONCLUSIONS: Both ultrasound-guided FNA and CNB demonstrate high concordance for parotid lesions. FNA was associated with lower capsule disruption. Higher capsule disruption rates with CNB warrant further evaluation due to the small sample size.