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Costanzo R, Scalia G, Strigari L, Ippolito M, Paolini F, Brunasso L, Sciortino A, Iacopino DG, Maugeri R, Ferini G, Viola A, Zagardo V, Cosentino S, Umana GE. Nuclear medicine imaging modalities to detect incidentalomas and their impact on patient management: a systematic review. J Cancer Res Clin Oncol 2024; 150:368. [PMID: 39052066 PMCID: PMC11272692 DOI: 10.1007/s00432-024-05891-3] [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: 04/01/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE This systematic review aims to investigate the role of nuclear imaging techniques in detecting incidentalomas and their impact on patient management. METHODS Following PRISMA guidelines, a comprehensive literature search was conducted from February to May 2022. Studies in English involving patients undergoing nuclear medicine studies with incidental tumor findings were included. Data on imaging modalities, incidentaloma characteristics, management changes, and follow-up were extracted and analyzed. RESULTS Ninety-two studies involving 64.884 patients were included. Incidentalomas were detected in 611 cases (0.9%), with thyroid being the most common site. PET/CT with FDG and choline tracers showed the highest incidentaloma detection rates. Detection of incidentalomas led to a change in therapeutic strategy in 59% of cases. Various radiotracers demonstrated high sensitivity for incidentaloma detection, particularly in neuroendocrine tumors and prostate cancer. CONCLUSION Nuclear imaging techniques play a crucial role in detecting incidentalomas, leading to significant changes in patient management. The high sensitivity of these modalities highlights their potential in routine oncology follow-up protocols. Future directions may include enhancing spatial resolution and promoting theranostic approaches for improved patient care.
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Affiliation(s)
- Roberta Costanzo
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, Catania, Italy.
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Massimiliano Ippolito
- Department of Advanced Technologies, Nuclear Medicine and PET, Cannizzaro Hospital, Catania, Italy
| | - Federica Paolini
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Lara Brunasso
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Andrea Sciortino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit, REM Radioterapia Srl, Viagrande, Italy
| | - Anna Viola
- Radiation Oncology Unit, REM Radioterapia Srl, Viagrande, Italy
| | | | - Sebastiano Cosentino
- Department of Advanced Technologies, Nuclear Medicine and PET, Cannizzaro Hospital, Catania, Italy
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma and Gamma-Knife Center, Cannizzaro Hospital, Catania, Italy
- Department of Medicine and Surgery, Kore University of Enna, Enna, Italy
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Jung JH, Lee YS, Jung YH, Choi SH, Nam SY, Cho HJ, Kwon M. Incidentally found parotid gland lesion in 18F-FDG PET/CT for staging evaluation of patients with hepatocellular carcinoma: remote possibility of metastatic tumor or second primary salivary gland malignancy. BMC Surg 2024; 24:124. [PMID: 38658868 PMCID: PMC11040990 DOI: 10.1186/s12893-024-02422-2] [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: 01/19/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES We primarily aimed to evaluate whether parotid incidental lesion (PIL) in 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging evaluation of patients with hepatocellular carcinoma (HCC) would represent a possibility of extrahepatic metastasis or second primary malignancy (SPM). Additionally, we explored the incidence of PIL in HCC patients and examined any associated risk factors. METHODS We retrospectively analyzed patients with HCC who underwent 18F-FDG PET/CT at our institution from 2010 to 2022. The pathological findings of PILs in HCC patients were investigated for confirmatory identification of the risk of HCC metastasis or SPM in parotid gland. Healthy controls received 18F-FDG PET/CT for health screening were also enrolled to compare the incidence of PILs with HCC patients. Various parameters associated with patient demographics and characteristics of HCC were analyzed to find the related factors of PILs. RESULTS A total of 17,674 patients with HCC and 2,090 healthy individuals who had undergone 18F-FDG PET/CT scans were enrolled in the analyses. Among the 54 HCC patients who underwent pathological confirmation for PILs, benign primary parotid tumor was most commonly observed (n = 43 [79.6%]); however, no malignant lesions were detected, including HCC metastasis. The incidence of PILs was higher in patients diagnosed with HCC compared with the control group (485 [2.7%] vs. 23 [1.1%], p = 0.002). Analysis for the risk factors for PILs revealed that patient age, sex, and positive viral markers were significantly associated with the incidence of PILs in patients with HCC (all p < 0.001). CONCLUSIONS Our study demonstrates that PILs are more frequently identified in patients with HCC on 18F-FDG PET/CT. However, no malignant PIL, including extrahepatic metastasis of HCC, was identified. Therefore, the presence of PIL should not impede or delay the treatment process for patients with HCC. Additionally, we suggested that for future swift and straightforward differential diagnoses of PIL, the development of additional protocols within the PET/CT imaging could be beneficial.
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Affiliation(s)
- Jin Hyung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Seung-Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Hyo Jung Cho
- Department of Gastroenterology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
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Klug TE, Hillerup S, Dias AH, Gormsen LC, Kristensen PN. Incidental [18F]FDG-avid focuses in parotid glands on PET/CT. Acta Otolaryngol 2024; 144:147-152. [PMID: 38530196 DOI: 10.1080/00016489.2024.2328720] [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: 02/07/2024] [Accepted: 03/04/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND The number of unexpected focal [18F]FDG-avid findings (incidentalomas) within the parotid gland (PGI) continues to increase with the expanding use of PET/CT scanning. The prevalence of malignancy in PGIs is uncertain and appropriate management is unsettled. AIMS We aimed to explore the underlying pathologies associated with PGI. MATERIALS AND METHODS A retrospective review of all patients with parotid gland incidentaloma(s) treated at the Ear-Nose-Throat Department, Aarhus University Hospital, Denmark in the period 2012-2021, was performed. RESULTS In total, 94 patients with one (n = 86) or two (n = 8) PGI(s) were included. In patients with one PGI, 72 (84%) focuses were benign, two (2%) focuses were malignant (both malignant melanoma metastases), and 12 (14%) focuses were undiagnosed. In patients with two PGIs, all 12 lesions with pathological examinations were benign (4 PGIs were undiagnosed). The median SUVmax found in benign lesions was higher (12.0) compared to malignant lesions (5.5) (p = .043). CONCLUSIONS AND SIGNIFICANCE The prevalence of malignancy was low (2/94, 2.4%) in PGIs. Based on our findings, PGI in patients without a history of parotid malignancy, who undergo PET/CT scanning for reasons other than head and neck cancer (including malignant melanoma), may be managed similarly to patients with asymptomatic parotid gland tumors.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- Aarhus University, Aarhus, Denmark
| | - Sara Hillerup
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- Aarhus University, Aarhus, Denmark
| | - André Henrique Dias
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Christian Gormsen
- Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Nørgaard Kristensen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Miladinovic D, Trautman J, Yabe T. A Cautionary Tale: A Case Report Describing a Benign Parotid Oncocytoma Diagnosed as Metastatic Squamous Cell Carcinoma on Fine Needle Aspirate. Cureus 2023; 15:e50853. [PMID: 38249277 PMCID: PMC10798819 DOI: 10.7759/cureus.50853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Parotid oncocytoma is a rare salivary gland tumour. Management does not require surgical intervention if diagnosed on a preoperative biopsy. A 64-year-old man presented with a parotid mass diagnosed as mcSCC on fine-needle aspiration cytology (FNAC). Surgical histopathology following parotidectomy demonstrated an oncocytoma of the parotid gland. Parotid oncocytomas are rare; therefore, diagnosis can be difficult. An MRI, CT, and US-guided biopsy are required for diagnosis. Ultrasound-guided core biopsy (UGSB) is more sensitive and specific when compared to FNAC for diagnosing malignant tumours. Diagnoses of benign salivary gland tumours on biopsy remain challenging. The aim of this article is to highlight the difficulty of diagnosing salivary gland tumours. We further aim to outline the contributing features that lead to this misdiagnosis and suggest steps to circumvent it in the future. This report describes the challenges in diagnosing salivary gland tumours and outlines the contributing features of this misdiagnosis. We add to the literature an additional case of a parotid oncocytoma.
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Affiliation(s)
| | | | - Takako Yabe
- General Surgery, Wollongong Hospital, Wollongong, AUS
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McQueen A, Al-Zuhir N, Ali T. Incidentalomas in the head & neck. Br J Radiol 2023; 96:20220164. [PMID: 36317814 PMCID: PMC9975523 DOI: 10.1259/bjr.20220164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Incidental findings (IFs) in the head & neck are a frequent challenge to the reporting radiologist. A combination of complex anatomy, widely varied imaging techniques and the high prevalence of benign pathology, makes safe and appropriate management of head & neck IFs problematic. The non-head & neck radiologist is unlikely to have prior personal experience of the relevant specialties or current involvement with the pertinent multidisciplinary teams, creating unfamiliarity with both the clinical aspects of head & neck disease and the value of examination techniques. This triumvirate of complex anatomy, pathology and imaging creates the perfect environment for excessive investigation and overdiagnosis. In this article, the most frequently encountered and clinically relevant head & neck IFs are summarised. To reflect daily clinical practice, we will firstly consider anatomic abnormalities identified on cross-sectional imaging and ultrasound, followed by a review of PET-CT incidental findings.
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Affiliation(s)
- Andrew McQueen
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Naail Al-Zuhir
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Tamir Ali
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Parotid gland incidentalomas: A single-institution experience. Am J Otolaryngol 2022; 43:103296. [PMID: 34894452 DOI: 10.1016/j.amjoto.2021.103296] [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: 07/01/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Parotid gland incidentaloma (PGI) management has not been well characterized in the literature. This study assesses clinicopathologic features, initial evaluation, management, and outcomes of PGIs discovered on various imaging modalities. MATERIALS AND METHODS This is a retrospective case series from a single academic institution. The study cohort included 34 patients with parotid gland incidentalomas discovered between January 2009 and December 2019. RESULTS Parotid gland incidentalomas were most frequently identified on magnetic resonance imaging (16 patients, 47.1%). Most patients (26 patients, 76.5%) underwent further evaluation with subsequent imaging, most often magnetic resonance imaging (18 patients, 69.2%), and fine needle aspiration biopsy (33 patients, 97.1%). Most tumors were benign on fine needle aspiration biopsy (19 patients, 57.6%). Most cases (21 patients, 61.8%) were managed with observation without parotidectomy. Malignant findings on fine needle aspiration cytology were associated with increased likelihood of undergoing parotidectomy (25% vs 0%; p = 0.04). Among the patients who received a parotidectomy, most (8 patients, 61.5%) had benign findings on final histopathology. CONCLUSION Parotid gland incidentalomas were discovered across a diverse set of imaging modalities in our institution. Magnetic resonance imaging and fine needle aspiration were often performed for further evaluation. Most cases were found to be benign on fine needle aspiration and were managed with observation. These findings highlight the necessity of appropriate work-up for these tumors, and the need for shared decision making between the patient and the physician in selecting the appropriate treatment strategy.
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Broski SM, Johnson DR, Packard AT, Hunt CH. 18F-fluorodeoxyglucose PET/Computed Tomography. PET Clin 2022; 17:249-263. [DOI: 10.1016/j.cpet.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Soputro NA, Asairinachan A, Prasad J. Parotid gland metastasis of lung adenocarcinoma identified on surveillance 18F-FDG PET/CT. BMJ Case Rep 2022; 15:15/1/e246779. [PMID: 35039365 PMCID: PMC8768488 DOI: 10.1136/bcr-2021-246779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 79-year-old man with a previous history of primary bilateral pulmonary adenocarcinomas was found to have a new parotid lesion on oncological surveillance imaging, raising the possibility of metastatic disease. Biopsy of the lesion confirmed metastatic deposit from primary lung adenocarcinoma. Following multidisciplinary discussions, the patient underwent a left parotidectomy where clear resection margins and preservation of facial nerve function were achieved.
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Affiliation(s)
| | | | - Jessica Prasad
- Otolaryngology, Head and Neck, Footscray Hospital, Footscray, Victoria, Australia
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Incidental uptake of fluorodeoxyglucose in the Waldeyer's ring and risk of oropharyngeal malignancy. Eur Arch Otorhinolaryngol 2021; 279:2657-2664. [PMID: 34570264 PMCID: PMC8986689 DOI: 10.1007/s00405-021-07089-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/12/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE Fluorodeoxyglucose (FDG) positron emission tomography (PET) is increasingly used to diagnose and stage malignancy. The aim of this article is to investigate the significance of incidental FDG uptake in the Waldeyer's ring and to assess its value in predicting clinically occult oropharyngeal malignancy. METHODS All FDG-PET/CT scans performed in Imperial College NHS Foundation Trust, UK between January 2012 and November 2018 were included. Patients with known or suspected oropharyngeal malignancy or lymphoma were excluded. Minimum follow-up was 12 months. RESULTS A total of 724 scans revealed oropharyngeal uptake of FDG. Of these, 102 were included in the study. Most patients (62.1%) were scanned as part of staging for other malignancies. Oropharyngeal FDG uptake was asymmetrical in 57.3% of the cases. Uptake was more common in the tonsils (56.3%), followed by the tongue base (31.1%) and both sites (12.6%). In 41.7% of reports, appearance was described as likely physiological; however, 52.4% of reports advised direct visualisation, clinical correlation or ENT opinion. Only 24.3% (25/102) of patients were referred and seen by ENT, 14.6% (15/102) of which had an interval PET scan and 8.7% (9/102) proceeded to tissue diagnosis. There was one oropharyngeal cancer identified and one unexpected metastasis from esophageal cancer. CONCLUSION Incidental uptake on PET/CT in the oropharynx is common. However, malignancy is rare (1.9%) and, when present, is associated with high SUVmax and asymmetrical uptake. Imaging results must be correlated clinically. These patients should be seen by an ENT specialist yet most may not require further investigations.
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Abstract
OBJECTIVE Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management. METHODS A literature search was performed on 25 August 2020 using the keywords 'incidentaloma', 'incidental finding', 'parotid', 'parotid gland', 'salivary gland' and 'head and neck'. Articles were reviewed by two authors before their inclusion. RESULTS Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy. CONCLUSION If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.
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Ringel B, Kraus D. Observation Rather than Surgery for Benign Parotid Tumors: Why, When, and How. Otolaryngol Clin North Am 2021; 54:593-604. [PMID: 34024486 DOI: 10.1016/j.otc.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surgery is the preferred treatment of benign parotid lesions, but it carries a risk of complications. Therefore, the approach toward the surgery of these lesions should seek to avoid complications. There are no guidelines or recommendations for when not to operate. Integration of comorbidities and other factors shift the scales from surgery toward observation in a small subset of patients presenting with parotid tumors. When observation is chosen, the patient should be followed frequently and cautiously, and the surgeon should be prepared to change strategy to surgical excision if in doubt.
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Affiliation(s)
- Barak Ringel
- The Department of Otolaryngology-Head & Neck Surgery, Lenox Hill Hospital / Northwell Health, 130 East 77th Street - Black Hall 10th Floor, New York, NY 10075, USA
| | - Dennis Kraus
- The Department of Otolaryngology-Head & Neck Surgery, Lenox Hill Hospital / Northwell Health, 130 East 77th Street - Black Hall 10th Floor, New York, NY 10075, USA.
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Diagnostic and Prognostic Utility of 18F-FDG PET/CT in Recurrent Salivary Gland Cancers. AJR Am J Roentgenol 2021; 216:1344-1356. [PMID: 33826358 DOI: 10.2214/ajr.20.23259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE. The role of 18F-FDG PET/CT in the evaluation of recurrent salivary gland tumors remains poorly defined. We investigated the diagnostic and prognostic utility of PET in this setting. MATERIALS AND METHODS. A total of 146 patients with recurrent salivary gland cancer were treated at our institution between January 2002 and December 2015. Patients who underwent FDG PET/CT and conventional imaging (CT or MRI) within 3 months of recurrence (n = 78) were included in this retrospective analysis. On FDG PET/CT, we measured the SUVmax, total body metabolic tumor volume of all lesions, and total lesion glycolysis of all lesions to determine the intensity and extent of FDG-avid disease. We assessed the correlation of FDG PET/CT findings with clinicopathologic features, progression-free survival, and overall survival. RESULTS. FDG PET/CT was positive for recurrence in 74 of 78 patients (94.9%) and falsely negative in four patients (5.1%). In comparison with conventional imaging, FDG PET/CT performed for restaging detected additional recurrent lesions in 14 patients (17.9%). The median SUVmax was 7.4, the median total body metabolic tumor volume was 30.1 cm3, and median total lesion glycolysis was 97.3 g/mL × cm3. Sixty-six patients had progressive disease, and 54 died. Univariate and multivariate Cox hazards analysis identified pathologic risk group (p = .04), total body metabolic tumor volume (p < .001), and total lesion glycolysis (p < .001) as independent prognostic factors for progression-free survival and identified age (p = .05), total body metabolic tumor volume (p < .001), and total lesion glycolysis (p < .001) as independent prognostic factors for overall survival. CONCLUSION. In patients with recurrent salivary gland cancer, FDG PET/CT is useful as a single test for defining the extent of disease and providing prognostic information, which may help in selecting appropriate treatment strategies.
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Vergez S, Fakhry N, Cartier C, Kennel T, Courtade-Saidi M, Uro-Coste E, Varoquaux A, Righini CA, Malard O, Mogultay P, Thariat J, Tronche S, Garrel R, Chevalier D. Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part I: Primary treatment of pleomorphic adenoma. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:269-274. [PMID: 33060032 DOI: 10.1016/j.anorl.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The authors present the guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) for the diagnosis and treatment of pleomorphic adenoma (PA) of the salivary glands. METHOD A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted based on the articles retrieved and the workgroup members' individual experience. Guidelines were graded A, B, C or expert opinion by decreasing level of evidence. RESULTS In clinically suspected salivary gland PA, MRI should be performed, including head and neck lymph node levels. Fine needle aspiration cytology is particularly recommended for tumours difficult to characterise by MRI. Frozen section biopsy should be performed to confirm diagnosis and adapt the surgical procedure in case of intraoperative findings of malignancy. Complete resection of the parotid PA should be performed en bloc, including margins, when feasible according to tumour location, while respecting the facial nerve. Enucleation (resection only in contact with the tumour) is not recommended. For the accessory salivary and submandibular glands, complete en bloc resection should be performed.
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Affiliation(s)
- S Vergez
- Service d'ORL et de chirurgie de la face et du cou, hôpital Larrey, institut universitaire du cancer de Toulouse Oncopole, CHU de Toulouse, Toulouse, France.
| | - N Fakhry
- Service d'ORL et chirurgie de la face et du cou, hôpital de la conception, AP-HM, Aix-Marseille Université, Marseille, France
| | - C Cartier
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - T Kennel
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - M Courtade-Saidi
- Service d'anatomie et cytologie pathologiques, institut universitaire du cancer de Toulouse Oncopole, INSERM CRCT-Équipe 11, Toulouse, France
| | - E Uro-Coste
- Service d'anatomie et cytologie pathologiques, institut universitaire du cancer de Toulouse Oncopole, INSERM CRCT-Équipe 11, Toulouse, France
| | - A Varoquaux
- Service de radiologie, hôpital de la conception, AP-HM, Marseille; AMU, Faculté de Médecine Timone CNRS-Centre for Magnetic Resonance in Biology and Medicine, Marseille, France
| | - C-A Righini
- Service d'ORL et de chirurgie de la face et du cou, CHU de Grenoble Alpes (CHUGA), Grenoble, France
| | - O Malard
- Service d'ORL et de chirurgie de la face et du cou, CHU Hôtel Dieu, Nantes, France
| | - P Mogultay
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, Caen; Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie Université, Caen, France
| | - S Tronche
- Société française d'ORL et chirurgie cervico-faciale, Strasbourg, France
| | - R Garrel
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - D Chevalier
- Service d'ORL et de chirurgie de la face et du cou, CHU de Lille, Lille, France
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Üstün F, Taştekin E, Taş A, Altun GD. The Clinical Significance of Incidental Parotid Uptake in a PET/CT Study: A Diagnostic Algorithm. Curr Med Imaging 2020; 15:326-333. [PMID: 31989884 DOI: 10.2174/1573405614666171213160244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/28/2017] [Accepted: 12/02/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients diagnosed with cancer do not have sufficient clinical data for the management of incidental parotid lesions. We aimed to reveal the importance of randomized parotid lesions encountered during oncologic F-18 fluorodeoxyglucose positron emission tomography (FDG PET/CT) imaging in our clinical practice and the diagnostic algorithm of such lesions. METHODS We performed a database search of PET/CT records generated from 2009 to 2015 for "parotid" in reports of patients who underwent PET/CT examination for a known malignancy elsewhere, or cancer screening. RESULTS Incidental parotid FDG uptake on PET/CT had a prevalence of 1.1%. The incidence of parotid metastasis in our series was 36.4%, and 75% of them had malign melanoma metastasis. Of the 11 cases, 5 were of Warthin tumours, and Warthin tumours showed stronger GLUT1 expression than metastatic parotid lesions. CONCLUSION In patients with malignancy elsewhere, focal involvement of FDG by the parotid gland, especially if malignant melanoma or SCC is absent, should not be considered a metastatic disease without histopathologic confirmation. If parotid disease would change the patient's treatment plan and disease stage, the parotid lesion should be evaluated by additional methods, such as fine needle aspiration biopsy.
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Affiliation(s)
- Funda Üstün
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Ebru Taştekin
- Department of Pathology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Abdullah Taş
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Gülay Durmuş Altun
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
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Abstract
The salivary glands are host to a variety of benign and malignant tumors, as well as tumor-like conditions. Due to the variable FDG avidity of these lesions on positron emission tomography (PET) imaging, as well as the complex embryology and physiology that affect normal FDG uptake, FDG PET imaging of salivary gland pathology can prove challenging for head and neck imagers. We provide a practical guide for PET imaging of salivary gland tumors, detailing important additional diagnostic considerations, such as perineural tumor spread and intraparotid nodal metastases that are unique subsets related to salivary gland malignancy.
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Affiliation(s)
- Cody R Larson
- University of Utah Health Sciences Center, Salt Lake City, UT
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16
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Tzelnick S, Bernstine H, Domachevsky L, Soudry E. Clinical Implications of Incidental Sinonasal Positive FDG Uptake on PET-CT. Otolaryngol Head Neck Surg 2019; 160:729-733. [DOI: 10.1177/0194599818821862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) has been increasingly used in the past decade. Incidental FDG-avid findings are encountered in these studies, several of which with clinical significance. However, the significance of incidental FDG-avid sinonasal findings has not been studied to date. Study Design Retrospective cohort study. Setting A single tertiary medical center. Materials and Methods The medical records were reviewed of patients with incidental sinonasal positive FDG uptake between 2007 and 2016 who referred for further otolaryngological diagnostic workup. Results A total of 26 patients were identified, all of whom underwent a diagnostic surgical procedure. Histopathology revealed chronic inflammation (n = 12, 46.1%), malignancy (n = 7, 26.9%), inverted papilloma (n = 4, 15.5%), and fungal infections (n = 3, 11.5%). A unilateral maxillary sinus with FDG uptake was documented for 16 (61.5%) patients. CT evidence of bilateral disease and mucosal or sinus wall thickening correlated with inflammatory disease. Conclusions Incidental lesions with positive FDG uptake in the sinonasal cavities are at a high risk (40%) of being neoplastic. A diagnostic biopsy is advocated in these cases.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Ethan Soudry
- Department of Otolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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A Review of Salivary Gland Malignancies: Common Histologic Types, Anatomic Considerations, and Imaging Strategies. Neuroimaging Clin N Am 2018; 28:171-182. [PMID: 29622112 DOI: 10.1016/j.nic.2018.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Major and minor salivary gland malignancies come in various shapes and sizes. They can present as palpable masses or can be detected incidentally when imaging patients for other indications. A complete evaluation of salivary gland malignancies requires knowledge of the anatomy and various routes of spread of neoplasias. Computed tomography (CT) and MR imaging are complementary tools in this respect and offer useful information to the proceduralist. Advanced imaging (diffusion-weighted imaging and PET-CT) and other modalities (eg, ultrasound) help with characterization, although biopsy or excision is often needed for definitive tissue diagnosis.
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18
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Kato H, Fujimoto K, Matsuo M, Mizuta K, Aoki M. Usefulness of diffusion-weighted MR imaging for differentiating between Warthin’s tumor and oncocytoma of the parotid gland. Jpn J Radiol 2017; 35:78-85. [DOI: 10.1007/s11604-016-0608-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/27/2016] [Indexed: 12/27/2022]
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Is There a Role for PET/CT Parameters to Characterize Benign, Malignant, and Metastatic Parotid Tumors? AJR Am J Roentgenol 2016; 207:635-40. [PMID: 27276388 DOI: 10.2214/ajr.15.15590] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Assessment of benign and malignant lesions of the parotid gland, including metastatic lesions, is challenging with current imaging methods. Fluorine-18 FDG PET/CT is a noninvasive imaging modality that provides both anatomic and metabolic information. Semiquantitative data obtained from PET/CT, also known as PET/CT parameters, are maximum, mean, or peak standardized uptake values (SUVs); metabolic tumor volume; total lesion glycolysis; standardized added metabolic activity; and normalized standardized added metabolic activity. Our aim was to determine whether FDG PET/CT parameters can differentiate benign, malignant, and metastatic parotid tumors. MATERIALS AND METHODS Thirty-four patients with parotid neoplasms underwent PET/CT before parotidectomy; maximum SUV, mean SUV, peak SUV, total lesion glycolysis, metabolic tumor volume, standardized added metabolic activity, and normalized standardized added metabolic activity were calculated on a dedicated workstation. Univariate analyses were performed. A ROC analysis was used to determine the ability of PET/CT parameters to predict pathologically proven benign, malignant, and metastatic parotid gland neoplasms. RESULTS Fourteen patients had a benign or malignant primary parotid tumor. Twenty had metastases to the parotid gland. When the specificity was set to at least 85% for each parameter to identify cut points, the corresponding sensitivities ranged from 15% to 40%. Assessment of benign versus malignant lesions of parotid tumors, as well as metastasis from squamous cell carcinoma versus other metastatic causes, revealed that none of the PET/CT parameters has enough power to differentiate among these groups. CONCLUSION PET/CT parameters, including total lesion glycolysis, metabolic tumor volume, standardized added metabolic activity, and normalized standardized added metabolic activity, are not able to differentiate benign from malignant parotid tumors, primary parotid tumors from metastasis, or metastasis from squamous cell carcinoma and nonsquamous cell carcinoma metastasis.
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20
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Focal fluorine-18 fluorodeoxyglucose-avid parotid findings in patients with lung cancer: prevalence and characteristics. Nucl Med Commun 2016; 37:969-74. [PMID: 27218431 DOI: 10.1097/mnm.0000000000000543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Correct interpretation of incidental tumors is important to plan an appropriate treatment. We assessed the incidence and imaging characteristics of fluorine-18 fluorodeoxyglucose (F-FDG)-avid focal parotid findings (FPFs) in patients with lung cancer. PATIENTS AND METHODS FPFs in PET-computed tomography reports of cancer patients were searched. Those with known parotid malignancies, lymphoma, and diffuse F-FDG uptake in the entire parotid gland were not included in the analysis. RESULTS FPFs were detected in 38/3120 cancer patients (1.23%), observed as a soft tissue mass with a mean diameter 1.6±0.5 cm (range 0.8-2.7 cm) and a mean maximum standardized uptake value of 7.7±3.7 (range 2.5-17.8). FPFs were observed in 23/604 (3.8%) patients with lung cancer, compared with 6/1366 (0.4%) with breast cancer and 5/842 (0.6%) with gastrointestinal malignancies. We assessed FPFs appearances in 23 patients with lung cancer (18 men, mean age 72.8±9.2); 20 (87%) were current or past smokers. There was no correlation between the stage or histopathological type of the lung cancer and the prevalence of parotid lesions. In four patients with histopathology, no malignancy was detected. For an additional 11 patients with available imaging and clinical follow-up (mean follow-up 15.5±13.5 months, range 3-42 months), FPFs were consistent with benign lesions. CONCLUSION FPFs were more prevalent among patients with lung cancer than in patients with other malignancies. As F-FDG avidity was moderate to high, FPFs may mimic distant metastases. It is important to consider FPFs in the interpretation of a focal parotid lesion as misinterpretation may result in denial of appropriate therapy.
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21
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Kuan EC, Mallen-St. Clair J, St. John MA. Evaluation of Parotid Lesions. Otolaryngol Clin North Am 2016; 49:313-25. [DOI: 10.1016/j.otc.2015.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Diagnostic value of metabolic heterogeneity as a reliable parameter for differentiating malignant parotid gland tumors. Ann Nucl Med 2016; 30:346-54. [PMID: 26897010 DOI: 10.1007/s12149-016-1068-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Exact classifying between malignant and benign tumors in the parotid gland is important because the cancer has relatively poor prognosis. There have been several studies that F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) can differentiate between malignant and benign parotid gland tumors. However, the role of FDG PET is still controversial because many benign parotid gland tumors, such as Warthin's tumor and pleomorphic adenoma, show high FDG uptake. We hypothesized that metabolic heterogeneity would differentiate malignant parotid tumors because tumoral heterogeneity is an important characteristic in the malignancies. METHODS From January 2010 to April 2015, we retrospectively reviewed the 46 patients who showed FDG uptake at the parotid gland. To differentiate malignant parotid gland tumors, we obtained maximum SUV and mean SUV. Metabolic tumor volume and total lesion glycolysis were measured as metabolic volumetric parameters. We also included heterogeneity parameters of FDG PET such as heterogeneity factor (HF) and the coefficient of variation for all patients. RESULTS There was significant difference of HF between malignant (-0.30 ± 0.25; range -0.937 to -0.084) and benign parotid gland tumors (-0.06 ± 0.05; range -0.291 to -0.012; p < 0.0001). In receiver operating characteristic analysis, when ≤-0.084 was used as the cut-off value for HF, the sensitivity and specificity were 100 % (95 % CI 81.5-100) and 89.2 % (95 % CI 71.8-97.7), respectively. HF showed the highest area under the curve of 0.947 among the parameters. In logistic regression analysis, the HF was the most powerful factor for differentiation of the parotid gland tumors (p = 0.002). CONCLUSIONS Our results suggest that HF can be utilized as a reliable and non-invasive method for differentiation of malignant and benign parotid gland tumors.
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23
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Mabray MC, Behr SC, Naeger DM, Flavell RR, Glastonbury CM. Predictors of pathologic outcome of focal FDG uptake in the parotid gland identified on whole-body FDG PET imaging. Clin Imaging 2015; 39:1073-9. [PMID: 26324219 DOI: 10.1016/j.clinimag.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose was to test whether patient's primary malignancy type and presence of F-18-fluorodeoxyglucose (FDG)-avid cervical lymph node(s) are predictors of pathologic outcome of incidental focal FDG-avid parotid lesions. BASIC PROCEDURES A retrospective cohort study of pathologically proven incidental cases was performed. MAIN FINDINGS Focal parotid FDG uptake in the setting of head and neck cancer/melanoma [odds ratio (OR)=24.6, P<.01], lymphoma (OR=7.2, P=.02), or FDG-avid cervical lymph node(s) (OR=3.6, P=.07) has a higher odds of representing metastases. No malignant primary parotid tumors were incidentally discovered. PRINCIPAL CONCLUSIONS In patients with head and neck cancer/melanoma, lymphoma, or FDG-avid cervical lymph node(s), there were higher odds that focal parotid FDG uptake was a metastasis.
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Affiliation(s)
- Marc C Mabray
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143.
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - David M Naeger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - Christine M Glastonbury
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
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24
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Britt CJ, Stein AP, Patel PN, Harari PM, Hartig GK. Incidental Parotid Neoplasms. Otolaryngol Head Neck Surg 2015; 153:566-8. [DOI: 10.1177/0194599815586764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
Abstract
Objective To better characterize parotid masses incidentally identified on imaging. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods Medical records were reviewed for 771 patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013. Patients were stratified into 2 groups: those with tumors identified solely on imaging (parotid incidentalomas [PIs]) and those with palpable masses, pain, facial nerve dysfunction, or other reasons their mass was identified (nonincidentals [NIs]). A χ2 test was employed to compare the prevalence of malignancy in PIs compared with NIs. Trend analysis was performed to determine the prevalence of PIs over the 20-year period. Results Of the 771 patients, 67 (8.7%) had their mass discovered incidentally on imaging (PIs). There was a significant difference in the rate of malignancy in the NI (32.7%) compared with the PI group (6.0%) ( P < .01). During the 1994 to 2003 time period, 4.0% of all parotoidectomies performed were for PIs, while during the second decade (2004-2013), this proportion increased to 10.2%. This represents a 155.0% increase in the percentage of parotidectomies carried out for PIs between these 2 periods. Conclusion In this study, the rate of malignancy in PIs was significantly lower than the rate of malignancy in patients with NIs. The occurrence of PIs has increased over time and now represents greater than 10.0% of all parotidectomies performed at the University of Wisconsin. This information is important to consider when consenting a patient for resection of a PI.
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Affiliation(s)
- Christopher J. Britt
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew P. Stein
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Priyesh N. Patel
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Paul M. Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gregory K. Hartig
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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25
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The diagnosis of parotid lesions. Eur Radiol 2015; 25:3025-6. [DOI: 10.1007/s00330-015-3713-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/03/2015] [Accepted: 03/08/2015] [Indexed: 11/27/2022]
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