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Sirviö M, Aro K, Naukkarinen M, Mäkitie A, Tarkkanen J, Kelppe J, Atula T. Clinical decision making when cytology indicates a Warthin tumor. Sci Rep 2024; 14:8832. [PMID: 38632256 PMCID: PMC11023945 DOI: 10.1038/s41598-024-58892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Warthin tumor (WT) is a benign tumor usually affecting the parotid gland. The main diagnostic tool remains ultrasound combined with fine-needle aspiration cytology (FNAC). This study aims to examine how reliably FNAC indicates WT for clinical decision making regarding surgical versus conservative management. We included all patients who underwent FNAC from a parotid gland lesion between 2016 and 2018 at our institution, and whose FNAC revealed WT suspicion. The FNACs were divided into three groups based on the cytology report: certain, likely, and possible WT. The patients were divided into two groups based on having had either surgery or follow-up. We sent a questionnaire to patients who had not undergone surgery in order to obtain follow-up for a minimum of four years. Altogether, 135 FNAC samples, from 133 tumors and 125 patients, showed signs of WT. Of the 125 patients, 44 (35%) underwent surgery, and 81 (65%) were managed conservatively. Preoperative misdiagnosis in FNAC occurred in three (7%) surgically treated tumors. Their FNACs were reported as possible WTs, but histopathology revealed another benign lesion. In the conservatively treated group, two patients underwent surgery later during the follow-up. Cytological statements of WT were seldom false, and none were malignant. The majority of the patients were only followed-up and rarely required further treatment. A certain or likely diagnosis of WT in the FNAC report by an experienced head and neck pathologist is highly reliable in selecting patients for conservative surveillance.
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Affiliation(s)
- Minna Sirviö
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland.
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Mira Naukkarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Pathology, Helsinki University Hospital Diagnostic Center, Helsinki, Finland
| | - Jetta Kelppe
- Pathology, Helsinki University Hospital Diagnostic Center, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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HaLiMaiMaiTi N, Hong Y, Li M, Li H, Wang Y, Chen C, Lv X, Chen C. Classification of benign and malignant parotid tumors based on CT images combined with stack generalization model. Med Biol Eng Comput 2023; 61:3123-3135. [PMID: 37656333 DOI: 10.1007/s11517-023-02898-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/09/2023] [Indexed: 09/02/2023]
Abstract
Parotid tumors are among the most prevalent tumors in otolaryngology, and malignant parotid tumors are one of the main causes of facial paralysis in patients. Currently, the main diagnostic modality for parotid tumors is computed tomography, which relies mainly on the subjective judgment of clinicians and leads to practical problems such as high workloads. Therefore, to assist physicians in solving the preoperative classification problem, a stacked generalization model is proposed for the automated classification of parotid tumor images. A ResNet50 pretrained model is used for feature extraction. The first layer of the adopted stacked generalization model consists of multiple weak learners, and the results of the weak learners are integrated as input data in a meta-classifier in the second layer. The output results of the meta-classifier are the final classification results. The classification accuracy of the stacked generalization model reaches 91%. Comparing the classification results under different classifiers, the stacked generalization model used in this study can identify benign and malignant tumors in the parotid gland effectively, thus relieving physicians of tedious work pressure.
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Affiliation(s)
| | - Yue Hong
- People's Hospital of Xinjiang Uygur Autonomous Region, UrumqiXinjiang, 830001, China
| | - Min Li
- College of Information Science and Engineering, Xinjiang University, Urumqi, 830046, China
| | - Hongtao Li
- The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Yunling Wang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, China
| | - Chen Chen
- College of Information Science and Engineering, Xinjiang University, Urumqi, 830046, China
| | - Xiaoyi Lv
- College of Software, Xinjiang University, Urumqi, 830046, China.
- Key Laboratory of Software Engineering Technology, Xinjiang University, Urumqi, 830046, China.
- Key Laboratory of Signal Detection and Processing, Xinjiang University, Urumqi, 830046, China.
| | - Cheng Chen
- College of Software, Xinjiang University, Urumqi, 830046, China.
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He SN, Lu RC, Zhou JL, Wang B, Bi GL, Wu KH. Semiquantitative magnetic resonance imaging parameters for differentiating parotid pleomorphic adenoma from Warthin tumor. Quant Imaging Med Surg 2023; 13:6152-6163. [PMID: 37711827 PMCID: PMC10498251 DOI: 10.21037/qims-22-1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/19/2023] [Indexed: 09/16/2023]
Abstract
Background Accurately distinguishing between pleomorphic adenoma (PA) and Warthin tumor (WT) is beneficial for their respective management. Preoperative magnetic resonance imaging (MRI) can provide valuable information due to its excellent soft tissue contrast. This study explored the value of semiquantitative contrast-enhanced MRI parameters in the differential diagnosis of PA and WT. Methods Data from 106 patients, 62 with PA and 44 with WT (confirmed by histopathology) were retrospectively and consecutively analyzed. The tumor-to-spinal cord contrast ratios (TSc-CR) based on the mean, maximum, and minimum signal intensity (T1-mean TSc-CR, T1-max TSc-CR, and T1-min TSc-CR, respectively) in the early and delayed phases were calculated on contrast-enhanced T1-weighted images as semiquantitative parameters, and then compared between PA and WT. Receiver operating characteristic (ROC) curve analysis and areas under the curve (AUCs) were used to determine the performance of these parameters in the differential diagnosis of PA from WT. Results Except T1-min TSc-CR in the early phase, all semiquantitative MRI parameters differed significantly between PA and WT (all P<0.05). T1-max TSc-CR showed higher sensitivity {70.45% [95% confidence interval (CI): 0.548-0.832]} and specificity [70.97% (95% CI: 0.581-0.818)] and had a higher AUC [0.707 (95% CI: 0.610-0.791)] in the early phase when using a cutoff value of 1.89. T1-max TSc-CR showed higher sensitivity [88.64% (95% CI: 0.754-0.962)], specificity [72.58% (95% CI: 0.598-0.831)], and AUC [0.854 (95% CI: 0.772-0.915)] in the delayed phase when using a cutoff value of 2.33. The sensitivity, specificity, and AUC were improved to 90.91% (95% CI: 0.783-0.975), 93.55% (95% CI: 0.843-0.982), and 0.960 (95% CI: 0.903-0.988), respectively, after combination of all semiquantitative parameters in the early and delayed phases. The two radiologists had excellent interobserver agreement on TSc-CRs [all interclass correlation coefficient (ICC) >0.75]. Conclusions Semiquantitative parameters using TSc-CR are valuable in distinguishing PA from WT, and a combination of these parameters can improve the differential diagnostic efficiency.
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Affiliation(s)
- Shao-Nan He
- Magnetic Resonance Imaging Department, the First People’s Hospital of Yunnan Province, Kunming, China
- Magnetic Resonance Imaging Department, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Ren-Cai Lu
- PET-CT Center, the First People’s Hospital of Yunnan Province, Kunming, China
| | - Jia-Long Zhou
- Magnetic Resonance Imaging Department, the First People’s Hospital of Yunnan Province, Kunming, China
- Magnetic Resonance Imaging Department, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Bo Wang
- Magnetic Resonance Imaging Department, the First People’s Hospital of Yunnan Province, Kunming, China
- Magnetic Resonance Imaging Department, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Guo-Li Bi
- Magnetic Resonance Imaging Department, the First People’s Hospital of Yunnan Province, Kunming, China
- Magnetic Resonance Imaging Department, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Kun-Hua Wu
- Magnetic Resonance Imaging Department, the First People’s Hospital of Yunnan Province, Kunming, China
- Magnetic Resonance Imaging Department, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Sethi HK, Fundakowski CE. Minimally invasive retroauricular approach parotidectomy: A pictorial essay. Head Neck 2023; 45:1060-1064. [PMID: 36808673 DOI: 10.1002/hed.27306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/16/2023] [Indexed: 02/22/2023] Open
Abstract
The surgical approach to a parotid neoplasm has traditionally been taught through a modified-Blair incision. This approach results in a visible scar in the preauricular, retromandibular, and upper neck skin. Various modifications have been undertaken which aim to improve cosmesis either by decreasing overall incision length and/or relocation of the incision to the hairline via what is commonly described as a "facelift approach". We describe a novel minimally invasive parotidectomy approach which utilizes a single retroauricular incision. This approach eliminates both the preauricular scar as well as the extended incision in the hairline and additional skin flap elevation which accompanies it. Sixteen patients underwent parotidectomy using this minimally invasive incision and the excellent clinical outcomes are reviewed. The minimally invasive retroauricular approach to parotidectomy provides excellent exposure with no visible incision/scar in appropriately selected patients.
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Affiliation(s)
- Harleen K Sethi
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Cancer Center at Abington-Jefferson Health, Willow Grove, Pennsylvania, USA.,Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Cancer Center at Abington-Jefferson Health, Willow Grove, Pennsylvania, USA.,Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Baohong W, Jing Z, Zanxia Z, kun F, Liang L, eryuan G, Yong Z, Fei H, Jingliang C, Jinxia Z. T2 mapping and readout segmentation of long variable echo-train diffusion-weighted imaging for the differentiation of parotid gland tumors. Eur J Radiol 2022; 151:110265. [DOI: 10.1016/j.ejrad.2022.110265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/27/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
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