Navigating Challenges in Parotid Tumors: Multi Centric Evaluation of Diagnostic Pitfalls and Post-parotidectomy Quality of Life

Parotid gland tumors represent a significant challenge due to their histological diversity and anatomical complexity. Accurate diagnosis and tailored surgical management are crucial for optimizing outcomes. This study evaluates the diagnostic performance of fine-needle aspiration cytology (FNAC) and investigates postoperative quality of life (QoL) in patients undergoing parotidectomy. A mixed-methods study was conducted over six years (January 2019 to December 2023) across four tertiary care centres in North India. The study included retrospective analyses of FNAC and histopathological outcomes, complemented by prospective evaluations of postoperative complications and QoL using the Parotidectomy Outcome Inventory-8 (POI-8). Statistical analyses assessed diagnostic accuracy and predictors of postoperative outcomes. Among 40 patients, FNAC showed moderate diagnostic performance with a sensitivity of 65.4%, specificity of 78.3%, and an AUC of 0.72. Diagnostic pitfalls were more pronounced in rare tumor subtypes. Superficial parotidectomy was the preferred surgical approach for benign lesions, resulting in fewer complications and better QoL scores than total parotidectomy (p < 0.001). Transient facial nerve paresis was observed in 67.5% of cases, with complete recovery in most patients within six months. FNAC remains a valuable diagnostic tool but has limitations, particularly for rare tumors. Combining FNAC with advanced diagnostics like imaging and molecular profiling can enhance accuracy. Superficial parotidectomy is associated with superior QoL outcomes, highlighting the importance of minimally invasive approaches. Further multicentric studies are warranted to refine diagnostic and surgical strategies.