Thank you for your very interesting comments concerning the article ‘Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours’ by Fakhry et al.

We know that, with the exception of a very few selected cases (patients in poor general health, very elderly patients, and some cases of Warthin’s tumour, for example), histological examination after parotidectomy is always necessary. We also know that almost a third of parotid tumours are malignant. The goal is thus to perform a preoperative assessment that is as accurate as possible, because the histological nature of the tumour determines the planning of the surgical procedure and its resulting consequences and complications. As the postoperative complication rate understandably increases with the degree of invasiveness of the surgical procedure, it is important to be able to characterize the tumour preoperatively in order to correctly inform the patient about the type of surgery that will be performed, the need for lymph node dissection, and the possibility of nerve sacrifice.

There is probably not a single assessment that would be better than all others, and none of them reaches a yield of 100%. Ultrasound is of course an accurate imaging modality that also allows FNAC or core needle biopsy, but, in our opinion, magnetic resonance imaging (MRI), comprising the use of new sequences (perfusion and diffusion-weighted sequences), has a very important place in the management of parotid masses. MRI allows the contours of the tumour, possible extensions into the deeper part of the gland, and the tumour size and position within the gland to be assessed precisely. Moreover, new sequences (perfusion and diffusion-weighted sequences) provide very important information regarding the likelihood of malignancy. FNAC provides cytological information. Core needle biopsy appears to be a very interesting technique that may further improve the preoperative assessment.