# Tobacco exposure linked to Warthin's tumor being the most common benign parotid neoplasm in Veterans: A retrospective cohort study

## TL;DR

This study found that Warthin's tumor is the most common benign parotid tumor in Veterans, especially among heavy smokers, and that FNA is a reliable diagnostic method.

## Contribution

The study identifies Warthin's tumor as the most common benign parotid neoplasm in Veterans, highlighting its strong association with tobacco use.

## Key findings

- Warthin's tumor was the most common benign parotid neoplasm (45%) in the Veteran population studied.
- Patients with Warthin's tumor were more likely to have over 10 pack-years of tobacco use compared to other groups.
- Fine-needle aspiration showed high concordance (87.5%) with surgical pathology, confirming its reliability as a diagnostic tool.

## Abstract

Parotid gland neoplasms account for a large proportion of benign salivary gland tumors, with pleomorphic adenomas (PA) being the most common in the civilian population, followed by Warthin's tumor (WT). However, the distinct risk profiles of Veterans significantly influence the incidence and prevalence of salivary gland neoplasms. We investigated the diagnostic and management algorithms for benign parotid gland neoplasms in Veterans.

Retrospective cohort study. Descriptive statistics were calculated using Microsoft Excel. Categorical variables were compared using chi square tests, and were reported with 95% confidence intervals, with statistical significance set at P < .05.

The study included 158 patients who underwent fine-needle aspiration (FNA) only, and 88 who had FNA followed by surgical intervention. Most patients were male (91%) and smokers (73%). WT was the most common overall (45%), followed by PA (16%). Patients with FNA or surgical pathology indicating WT were more likely to have a history of over 10 pack-years of tobacco use compared to those with lymphocytic tissue, cysts, or PA (58/68 [85.3%, 95% CI 76.9–93.7%] vs. 36/70 [51.4%, 95% CI 39.6–63.2%], P < .05; 39/46 [84.8%, 95% CI 74.4–95.2%] vs. 16/32 [50.0%, 95% CI 32.8–67.2%], P < .05). Concordance between FNA and final pathology was 87.5% (77/88; 95% CI, 80.6–94.4%). Surgical patients experienced low complication rates, with sialocele being the most common at 8% (7/88; 95% CI 2.3–13.6%).

Overall, WT was the most prevalent neoplasm and was strongly associated with heavy tobacco use. The high concordance between FNA and surgical pathology underscores the reliability of FNA as a diagnostic tool. These results support the use of FNA as a reliable tool that can guide patient counseling with greater confidence. Furthermore, the low complication rates observed post-surgery reinforce the safety of surgical management.