Clinical utility of frozen section examination of lymph nodes in the level 2 neck during surgical treatment of parotid gland lesions

Objectives: This study aims to report the frozen section examination (FSE) results of level 2 lymph nodes (LNs) during parotidectomies for parotid masses preoperatively diagnosed as a benign lesion and to evaluate the possible role of FSE in the diagnosis and treatment plan of these patients. Patients and Methods: The prospective study was conducted on patients who underwent parotidectomy with a preliminary diagnosis of a benign parotid lesion between May 2018 and June 2023. Among 120 patients who underwent parotidectomy, 30 patients (24.79%; 23 males, 7 females; mean age: 53.3±12.3 years; range, 22 to 79 years) who had FSE examination of level 2 LNs during parotidectomy were identified. The age, sex, fine-needle aspiration biopsy (FNAB), FSE, and final histopathology reports were evaluated from the patient records. All parotidectomies were performed by the same surgeon using the modified Blair incision, and level 2 LNs were harvested to ascertain the histopathological content through FSE during the surgery. Results: Twenty-five (83.3%) of the 30 patients had a preoperative FNAB, and it was compatible with the final histopathology in 20 (66.67%) patients. The most common parotid lesions were Warthin’s tumor (60%) and pleomorphic adenoma (36.67%), respectively. The FSE of all LNs was reported as reactive, and FSE did not alter the treatment plan in any patient. Conclusion: An LN metastasis detected with FSE may be utilized as an adjunctive diagnostic tool during parotidectomy to prevent the preoperative misdiagnosis of a high-grade malignancy as a benign parotid gland lesion. Although the present study did not demonstrate such a contribution to a false-negative preoperative diagnosis of primary malignancy, the absence of a metastatic LN disease may be an auxiliary finding to confirm the diagnosis of a benign gland disease.