Signs and symptoms of malignant parotid tumours: an objective assessment

Abstract

Background: The clinical features that may be associated with malignancy in parotid tumours are well known. Classical teaching dictates caution in their presence but this raises a false alarm in many cases. Formal studies looking at these features are few. The aim of this article was to study quantitatively those features that provide a better prediction of malignancy.

Methods: Clinical records of 186 consecutive patients treated for parotid tumours over a 12-year period were reviewed. Presence of suspicious clinical features and the final histology in each patient were noted.

Results: The overall pick-up rate for malignancy, based on clinical features alone, was around 30%. Palpable cervical lymph nodes, facial nerve palsy, deep fixation and rapid enlargement of the tumour were significant parameters indicative of malignancy (p = 0.000 for all 4 parameters, chi-squared test). The risk of malignancy increased when multiple parameters were present together at the same time.

Conclusion: Clinical features remained the most important single modality identifying malignancy in patients with parotid tumours. The logistic regression model allowed for simple clinical prediction of malignancy with improved sensitivity and much better specificity.