1
|
He Y, Zheng B, Peng W, Chen Y, Yu L, Huang W, Qin G. An ultrasound-based ensemble machine learning model for the preoperative classification of pleomorphic adenoma and Warthin tumor in the parotid gland. Eur Radiol 2024; 34:6862-6876. [PMID: 38570381 DOI: 10.1007/s00330-024-10719-2] [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: 12/06/2023] [Revised: 02/24/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES The preoperative classification of pleomorphic adenomas (PMA) and Warthin tumors (WT) in the parotid gland plays an essential role in determining therapeutic strategies. This study aims to develop and validate an ultrasound-based ensemble machine learning (USEML) model, employing nonradiative and noninvasive features to differentiate PMA from WT. METHODS A total of 203 patients with histologically confirmed PMA or WT who underwent parotidectomy from two centers were enrolled. Clinical factors, ultrasound (US) features, and radiomic features were extracted to develop three types of machine learning model: clinical models, US models, and USEML models. The diagnostic performance of the USEML model, as well as that of physicians based on experience, was evaluated and validated using receiver operating characteristic (ROC) curves in internal and external validation cohorts. DeLong's test was used for comparisons of AUCs. SHAP values were also utilized to explain the classification model. RESULTS The USEML model achieved the highest AUC of 0.891 (95% CI, 0.774-0.961), surpassing the AUCs of both the US (0.847; 95% CI, 0.720-0.932) and clinical (0.814; 95% CI, 0.682-0.908) models. The USEML model also outperformed physicians in both internal and external validation datasets (both p < 0.05). The sensitivity, specificity, negative predictive value, and positive predictive value of the USEML model and physician experience were 89.3%/75.0%, 87.5%/54.2%, 87.5%/65.6%, and 89.3%/65.0%, respectively. CONCLUSIONS The USEML model, incorporating clinical factors, ultrasound factors, and radiomic features, demonstrated efficient performance in distinguishing PMA from WT in the parotid gland. CLINICAL RELEVANCE STATEMENT This study developed a machine learning model for preoperative diagnosis of pleomorphic adenoma and Warthin tumor in the parotid gland based on clinical, ultrasound, and radiomic features. Furthermore, it outperformed physicians in an external validation dataset, indicating its potential for clinical application. KEY POINTS • Differentiating pleomorphic adenoma (PMA) and Warthin tumor (WT) affects management decisions and is currently done by invasive biopsy. • Integration of US-radiomic, clinical, and ultrasound findings in a machine learning model results in improved diagnostic accuracy. • The ultrasound-based ensemble machine learning (USEML) model consistently outperforms physicians, suggesting its potential applicability in clinical settings.
Collapse
Affiliation(s)
- Yanping He
- Department of Medical Ultrasonics, The First People's Hospital of Foshan, No. 81, Lingnan Avenue North, Foshan, 528000, China
| | - Bowen Zheng
- Department of Radiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Weiwei Peng
- Department of Medical Ultrasonics, The First People's Hospital of Foshan, No. 81, Lingnan Avenue North, Foshan, 528000, China
| | - Yongyu Chen
- Department of Medical Ultrasonics, The First People's Hospital of Foshan, No. 81, Lingnan Avenue North, Foshan, 528000, China
| | - Lihui Yu
- Department of Medical Ultrasonics, The First People's Hospital of Foshan, No. 81, Lingnan Avenue North, Foshan, 528000, China
| | - Weijun Huang
- Department of Medical Ultrasonics, The First People's Hospital of Foshan, No. 81, Lingnan Avenue North, Foshan, 528000, China.
| | - Genggeng Qin
- Department of Radiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, China.
- Medical Imaging Center, Ganzhou People's Hospital, 16th Meiguan Avenue, Ganzhou, 34100, China.
| |
Collapse
|
2
|
Tong HC, Ma S, Chen L, Meng X, Li YC, Li LY, Dong L, Zhang WL, Wildes T, Yang LH, Wang E. Warthin tumor concomitant with mantle cell lymphoma: a case report and review of literature. Diagn Pathol 2024; 19:114. [PMID: 39182117 PMCID: PMC11344329 DOI: 10.1186/s13000-024-01538-6] [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: 07/03/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024] Open
Abstract
RATIONALE Warthin tumor (WT) is the second most common benign tumor in salivary gland. It has a slow growth rate and most frequently occurs in the parotid gland. Most patients present with an incidental finding of a painless mass inferior/anterior to the ear. Besides the epithelial component of the tumor, WT is characteristically associated with lymphoid stroma that is considered benign. While there have been a few reports of malignant transformation of the lymphoid components in WT, cases of WT concomitant with mantle cell lymphoma (MCL) are extremely rare. To the best of our knowledge, two cases have been described in the English literature. Herein, we report a case of WT concomitant with MCL in a 70-year-old female patient, and emphasize the importance of careful examination of lymphoid stroma in WT so that concurrent lymphoma is not missed. PATIENT CONCERNS A 70-year-old Chinese woman with a 40-year history of cigarette smoking presented with a one year history of a right submaxillary mass with recent enlargement. DIAGNOSIS Cervical ultrasound (US) and computed tomography (CT) scans of the neck revealed a well-circumscribed mass in the right parotid with a maximum diameter of 3.1 cm. Surgical resection of the mass was performed. Histopathological examination revealed a characteristic double-layer of neoplastic epithelium with prominent lymphoid stroma, suggesting WT. In addition, morphology and immunohistochemistry studies confirmed the coexistence of MCL. Thereafter, the final diagnosis of this case was WT concomitant with MCL. INTERVENTIONS The patient was staged as stage I after clinical assessment. Due to the slow growth of parotid lesions, close observation was decided with periodic clinical and radiological monitoring. OUTCOMES Currently, the patient demonstrates a stable disease by clinical evaluation. LESSONS To the best of our knowledge, reported cases of WT concomitant with MCL are very rare. This case highlights the importance of a comprehensive assessment of the lymphoid stroma of WT to avoid missed diagnosis of a lymphoma component in a collision tumor.
Collapse
Affiliation(s)
- Hai-Chao Tong
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
- Department of Pathology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lan Chen
- Department of pathology, Datong County People's Hospital of Qinghai Province, Datong Hui and Tu Autonomous County, China
| | - Xiangyun Meng
- Department of pathology, Datong County People's Hospital of Qinghai Province, Datong Hui and Tu Autonomous County, China
| | - Ying-Chun Li
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Le-Yao Li
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Lingyun Dong
- Department of pathology, Yangzhou maternal and child health hospital, Yangzhou, Jiangsu province, China
| | - Wan-Lin Zhang
- Department of pathology, The Third Medical Centre, Chinese PLA General Hospital, Peking, China
| | - Tyler Wildes
- Department of Pathology, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Lian-He Yang
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China.
| | - Endi Wang
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
3
|
Gao T, Lin Y, Li W, Zhang Y, Li J. Prediction of malignant risk stratification model for parotid gland nodules based on clinical and conventional ultrasound features: construction and validation. Gland Surg 2024; 13:1229-1242. [PMID: 39175712 PMCID: PMC11336789 DOI: 10.21037/gs-24-119] [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: 04/11/2024] [Accepted: 07/10/2024] [Indexed: 08/24/2024]
Abstract
Background Ultrasound is widely used in the examination of the parotid gland, but no single ultrasound feature has demonstrated satisfactory diagnostic performance in predicting the nature of parotid nodules. Unlike the established and widely used grading systems for breast and thyroid nodules, a universally adopted and clinically accepted risk stratification system for malignancy in parotid gland nodules remains absent at present. This study aims to establish a malignant risk stratification model for parotid nodules by analyzing patients' clinical features and conventional ultrasound image characteristics. Methods In this study, clinical data and ultrasound images of 736 patients with parotid nodules were retrospectively analyzed. Pathological results served as the gold standard, and the patients were randomly divided into training and validation groups in a 7:3 ratio. Clinical and ultrasound features of parotid nodules in the training group were compared. Multifactor logistic regression analysis was employed to screen for risk factors of malignant nodules and quantify scores. The probability of malignant risk was assessed and classified into five grades (Grade 1, normal parotid; Grade 2, definitive benign; Grade 3, possibly benign; Grade 4, suspicious malignant; Grade 5, high probability of malignancy). The diagnostic performance of the model was assessed by using calibration curves, receiver operating characteristic curves, decision curves, and clinical impact curves. Results Facial symptoms, unclear margin, irregular shape, microcalcification, and abnormal cervical lymph nodes were independent risk factors for malignant parotid nodules. The area under the curve of the model was 0.850 [95% confidence interval (CI): 0.816-0.879] in the training group and 0.846 (95% CI: 0.791-0.891) in the validation group. Conclusions The malignancy risk stratification model based on clinical and ultrasound image features has a good differentiation between benign and malignant parotid nodules, which is helpful for diagnosis and guiding clinical treatment.
Collapse
Affiliation(s)
- Tian Gao
- Department of Ultrasound, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yiqun Lin
- Department of Ultrasound, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenbao Li
- Department of Ultrasound, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junlai Li
- Department of Ultrasound, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
4
|
Yeom S, Lee DH, Lee JK, Lim SC. Growth rates over time of unoperated parotid benign tumors. Am J Otolaryngol 2024; 45:104183. [PMID: 38211399 DOI: 10.1016/j.amjoto.2023.104183] [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: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION The treatment of parotid benign tumor is in principle surgery, but observation may be necessary in some cases. The purpose of this study was to investigate the growth rates over time of unoperated parotid benign tumors. METHODS We retrospectively reviewed the medical records of 63 patients with unoperated parotid benign tumors diagnosed at our institution between January 2010 and December 2022. RESULTS Forty-nine of the 63 patients had a Warthin tumor and 13 patients had a pleomorphic adenoma. On average, the unoperated parotid benign tumors grew 0.02 cm in length and 0.4 cm3 in volume per year. Compared to pleomorphic adenomas, Warthin tumors were more predominant in male patients and in those with a smoking history and a longer duration of smoking history; patients with Warthin tumors were also followed up longer (p < 0.05). However, the length and volume growth rates of unoperated Warthin tumors and pleomorphic adenomas did not significantly differ. CONCLUSION Surgery is the standard treatment for parotid benign tumors. However, small benign parotid tumors identified during preoperative examination can be observed through close follow-up, taking into account the patient's medical and general condition.
Collapse
Affiliation(s)
- Sujung Yeom
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea.
| | - Joon Kyoo Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| |
Collapse
|
5
|
Wang Y, Wang L, Huang H, Ma J, Lin L, Liu L, Song Q, Liu A. Amide proton transfer-weighted magnetic resonance imaging for the differentiation of parotid gland tumors. Front Oncol 2023; 13:1223598. [PMID: 37664057 PMCID: PMC10471989 DOI: 10.3389/fonc.2023.1223598] [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: 05/16/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose To assess the usefulness of amide proton transfer-weighted (APTw) imaging in the differentiation of parotid gland tumors. Materials and methods Patients with parotid gland tumors who underwent APTw imaging were retrospectively enrolled and divided into groups according to pathology. Two radiologists evaluated the APTw image quality independently, and APTw images with quality score ≥3 were enrolled. The maximum and average values of APTw imaging for tumor lesions (APTmax and APTmean) were measured. The differences in APTmax and APTmean were compared between malignant tumors (MTs) and benign tumors (BTs), as well as between MTs and pleomorphic adenomas (PAs) and between MTs and Warthin tumors (WTs). Independent-samples t-test, Kruskal-Wallis H test, and receiver operating characteristic (ROC) curve analyses were used for statistical analysis. Results Seventy-three patients were included for image quality evaluation. In this study, 32/73 and 29/73 parotid tumors were scored as 4 and 3, respectively. After excluding lesions with quality score ≤2 (12/73), the APTmean and APTmax of MTs were 4.15% ± 1.33% and 7.43% ± 1.61%, higher than those of BTs 2.74% ± 1.04% and 5.25% ± 1.54%, respectively (p < 0.05). The areas under the ROC curve (AUCs) of the APTmean and APTmax for differentiation between MTs and BTs were 0.819 and 0.821, respectively. MTs indicated significantly higher APTmean and APTmax values than those of PAs (p < 0.05) and WTs (p < 0.05). The AUCs of the APTmean and APTmax for differentiation between MTs and PAs were 0.830 and 0.815 and between MTs and WTs were 0.847 and 0.920, respectively. Conclusion Most APTw images for parotid tumors had acceptable image quality for APTw value evaluation. Both APTmax and APTmean can be used to differentiate MTs from BTs and to differentiate MTs from subtype parotid gland tumors.
Collapse
Affiliation(s)
- Yihua Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lijun Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haitao Huang
- Department of Stomatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Juntao Ma
- Department of Stomatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liangjie Lin
- Clinical and Technical Support, Philips Healthcare, Beijing, China
| | - Lin Liu
- Department of Stomatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ailian Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
6
|
陈 杨, 张 萌, 张 勤, 曹 蜀, 刘 建. [Application of modified facelift incision in parotid gland surgery]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:940-943. [PMID: 36543403 PMCID: PMC10128275 DOI: 10.13201/j.issn.2096-7993.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Indexed: 12/24/2022]
Abstract
Objective:To explore the safety and aesthetic effect of modified facelift incision in parotidectomy for benign parotid tumors. Methods:By prospective study, 63 patients with benign parotid tumor were randomly divided into experimental group and control group. The experimental group underwent modified facelift incision(MFI), while the control group underwent Blair incision(BI). The operation time, bleeding volume, total postoperative drainage, length of postoperative hospital stay, postoperative complications and aesthetic satisfaction of the two groups were counted and evaluated. Results:There were no statistically significant differences in the operative time, bleeding volume, total postoperative drainage, length of postoperative hospital stay, postoperative complications between the two group(P>0.05). In terms of aesthetic satisfaction, the experimental group was significantly better than the control group, and the difference between the two groups was statistically significant(P<0.05). Conclusion:Compared with the BI, the MFI has the same safety and higher aesthetic satisfaction, which has positive significance in cosmetology.
Collapse
Affiliation(s)
- 杨 陈
- 成都中医药大学医学与生命科学学院(成都, 610032)School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - 萌 张
- 德阳市人民医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Deyang People's Hospital
| | - 勤修 张
- 成都中医药大学附属医院耳鼻咽喉科Department of Otolaryngology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - 蜀炜 曹
- 德阳市人民医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Deyang People's Hospital
| | - 建敏 刘
- 德阳市人民医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Deyang People's Hospital
| |
Collapse
|
7
|
Roh JL. Function-preserving surgery via single transverse cervical incision for Warthin's tumor in the parotid gland. Head Neck 2022; 44:1335-1341. [PMID: 35243713 DOI: 10.1002/hed.27027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This study evaluated functional and disease control outcomes after gland-preserving surgery via a single transverse cervical incision for Warthin's tumor of the parotid gland. METHODS One-hundred eleven patients with Warthin's tumor underwent the preservation of most normal parotid tissues and the facial nerve combined with the en-bloc resection of tumors. Postoperative complications, subjective satisfaction, salivary function, and metachronous tumor were assessed in each patient. RESULTS No patients had an extension to modified Blair or periauricular incision with the median operation time of 32 min. Temporary and permanent paralysis of the facial nerve was 5 (4.0%) and none of 125 tumor resection sides, respectively. Postoperative complications were minimal. The secretory functions between the affected and unaffected glands did not differ. One patient had metachronous tumor for a median follow-up of 72 months. CONCLUSION Functional gland-preserving surgery via single transverse cervical incision can safely treat Warthin's tumor in the parotid gland.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
8
|
Higuchi K, Urano M, Akiba J, Nogami M, Hirata Y, Zukeran Y, Moriyoshi K, Tada Y, Fukushima M, Obayashi M, Sakamoto S, Kuraoka K, Kira K, Kawahara A, Kato T, Tanigawa M, Nakaguro M, Yamamoto H, Nagao T. A multi-institutional study of salivary gland cytopathology: Application of the Milan System for Reporting Salivary Gland Cytopathology in Japan. Cancer Cytopathol 2021; 130:30-40. [PMID: 34478237 PMCID: PMC9290724 DOI: 10.1002/cncy.22505] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022]
Abstract
Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a risk‐stratification reporting system that was introduced in 2018. The objective of this multi‐institutional study was to evaluate the utility of the MSRSGC in Japan. Methods In total, 1608 fine‐needle aspiration samples with matching histologic diagnoses were retrieved from 12 large institutions in Japan. The diagnostic categories of the MSRSGC were assigned prospectively or retrospectively, and the results were compared with the histologic diagnoses. Results The cases were classified as follows: nondiagnostic, 18.1%; non‐neoplastic, 4.1%; atypia of undetermined significance, 11.5%; neoplasm‐benign, 43.7%; salivary gland neoplasm of uncertain malignant potential, 9.6%; suspicious for malignancy, 3.6%; and malignant, 9.4%. The risk of neoplasm and the risk of malignancy in each MSRSGC category were as follows: nondiagnostic, 72.9% and 13.4%, respectively; non‐neoplastic, 15.2% and 9.1%, respectively; atypia of undetermined significance, 77.9% and 24.9%, respectively; neoplasm‐benign, 99% and 1.8%, respectively; salivary gland neoplasm of uncertain malignant potential, 94.8% and 37%, respectively; suspicious for malignancy, 100% and 89.7%, respectively; and malignant, 100% and 99.3%, respectively. The accuracy of the MSRSGC for diagnosing neoplasms was 97.8%, and its accuracy for diagnosing malignancy was 97.3%. Institutions that used Romanowsky‐stained preparations had lower nondiagnostic rates and lower risks of neoplasm and malignancy in the non‐neoplastic category. Conclusions The MSRSGC is useful for risk stratification and quality control. Widespread use of the MSRSGC would improve the accuracy of salivary gland cytology and lead to better patient care in Japan. This is the first multi‐institutional study of a large‐scale application of the Milan System for Reporting Salivary Gland Cytopathology in Japan. It demonstrates the usefulness of the Milan system in the diagnosis of salivary gland lesions and for the quality control of salivary gland cytology results.
Collapse
Affiliation(s)
- Kayoko Higuchi
- Department of Surgical Pathology, Okinawa Kyodo Hospital, Naha, Japan
| | - Makoto Urano
- Department of Diagnostic Pathology, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Miwako Nogami
- Division of Diagnostic Pathology, Kyushu University Hospital, Fukuoka, Japan
| | - Yukiya Hirata
- Department of Pathology, University of the Ryukyus Hospital, Nishihara, Japan
| | - Yoko Zukeran
- Department of Pathology, University of the Ryukyus Hospital, Nishihara, Japan
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, Kyoto Medical Center, Kyoto, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Mana Fukushima
- Department of Surgical Pathology, Ehime University Hospital, Toon, Japan
| | - Mariko Obayashi
- Department of Diagnostic Pathology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Shinnichi Sakamoto
- Department of Diagnostic Pathology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Kazuya Kuraoka
- Department of Diagnostic Pathology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Kana Kira
- Department of Diagnostic Pathology, Kochi University Hospital, Nangoku, Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Taku Kato
- Department of Pathology, Naritatomisato Tokushukai Hospital, Tomisato, Japan
| | - Maki Tanigawa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hidetaka Yamamoto
- Division of Diagnostic Pathology, Kyushu University Hospital, Fukuoka, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
9
|
Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland. Diagnostics (Basel) 2021; 11:diagnostics11081467. [PMID: 34441400 PMCID: PMC8391156 DOI: 10.3390/diagnostics11081467] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.
Collapse
|
10
|
Hirata Y, Higuchi K, Tamashiro K, Koja K, Yasutomi Y, Matsuzaki A, Yoshimi N. Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution. Acta Cytol 2020; 65:123-131. [PMID: 33113539 DOI: 10.1159/000510990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a recently published evidence-based categorization system for salivary gland fine-needle aspiration (FNA). We applied MSRSGC to Japanese cases and evaluated its utility. STUDY DESIGN A total of 480 FNA cases were reviewed. We recategorized each case into one of the MSRSGC categories. The risk of neoplasm (RON) and the risk of malignancy (ROM) for each diagnostic category in MSRSGC, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for malignancy and for neoplasms were calculated for cases with histological follow-up. In addition, the overall ROM (O-ROM) was calculated for all FNA cases. RESULTS RON, ROM, and O-ROM rates were as follows - non-diagnostic: 51.3, 5.1, and 1.0%; non-neoplastic: 0, 0, and 0%; atypia of undetermined significance: 83.9, 12.9, and 7.3%; neoplasm, benign: 100, 0, and 0%; salivary gland neoplasm of uncertain malignant potential: 100, 32.1, and 23.7%; suspicious for malignancy: 100, 85.7, and 60%; and malignant: 100, 100, 81.8%. The sensitivity, specificity, and accuracy with (without) indeterminate cases for malignancy were 65 (100), 99 (99), 92% (99%) and PPV and NPV were 96 and 100%, respectively, and those for neoplasms were 84 (100), 100 (100), 85% (100%), and PPV and NPV were 100 and 100%, respectively. CONCLUSIONS The MSRSGC is useful for stratification of ROM and for promoting the performance of salivary gland FNA. The MSRSGC could be easily introduced in Japan and may improve the Japanese salivary gland FNA status.
Collapse
Affiliation(s)
- Yukiya Hirata
- Department of Pathology, University of the Ryukyus Hospital, Okinawa, Japan,
| | - Kayoko Higuchi
- Department of Surgical Pathology, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Koichi Tamashiro
- Department of Diagnostic Pathology, Okinawa Chubu Hospital, Okinawa, Japan
| | - Keisuke Koja
- Department of Diagnostic Pathology, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yuiko Yasutomi
- Department of Diagnostic Pathology, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Akiko Matsuzaki
- Department of Diagnostic Pathology, Urasoe General Hospital, Okinawa, Japan
| | - Naoki Yoshimi
- Department of Diagnostic Pathology, Okinawa Red Cross Hospital, Okinawa, Japan
| |
Collapse
|
11
|
Zahran M, Alsedra S, Cope D, Youssef A. The Role of FNAC in the Diagnosis and Management of Warthin Tumour: Analysis of 74 Cases. Int Arch Otorhinolaryngol 2020; 25:e379-e382. [PMID: 34377171 PMCID: PMC8321636 DOI: 10.1055/s-0040-1715148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/21/2020] [Indexed: 10/26/2022] Open
Abstract
Introduction After pleomorphic adenoma, Warthin tumor gets its popularity as the second most common benign neoplasm of the parotid gland. Fine-needle aspiration cytology (FNAC) is the most cost-effective and minimally-invasive way to determine the histological character of a parotid gland tumor. Objective To determine the accuracy of FNAC in the diagnosis of Warthin Tumour. Methods A retrospective study conducted between 2014 and 2018. Out of 243 FNACs performed for parotid lesions, a histopathological correlation was established in 74 cases to reveal the accuracy of FNAC in the diagnosis of Warthin tumor. Results A total of 243 FNACs of parotid lesions were performed, and a histopathological correlation was established in 74 (30.4%) cases. Later on, we confirmed that 16 (21.6%) out of these 74 patients had cases of Warthin tumor. In total, 15 (20.3%) out of those 74 cases were confirmed as Warthin tumors on the initial cytology, which revealed a true positive concordance between the cytology and the final histological diagnosis; 55/74 (74%) were true negative results; on the other hand, 1/74 (1.4%) was a false negative, and 3/74 (4.1%) were false positive results. The sensitivity of the FNAC in the diagnosis of Warthin tumor was of 93%, while the specificity was of 94.8%, and the accuracy, of 94.6%. Conclusion In the present study, FNAC had a high diagnostic accuracy, reaching 94%.
Collapse
Affiliation(s)
| | | | - Daron Cope
- Department of Otolaryngology-Head and Neck Surgery, NSW Health, North Sydney, New South Wales, Australia
| | | |
Collapse
|
12
|
Tunç O, Gönüldaş B, Arslanhan Y, Kanlıkama M. Change in Warthin's tumor incidence: a 20-year joinpoint trend analysis. Eur Arch Otorhinolaryngol 2020; 277:3431-3434. [PMID: 32472159 DOI: 10.1007/s00405-020-06081-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The incidence of Warthin's tumor (WT) has increased worldwide. In this study, we aimed to evaluate the incidence of WT in our hospital, which provides health care for an extremely large population. METHODS We retrospectively evaluated 573 patients, comprising 345 males and 228 females, who all experienced parotid tumor for the past 20 years. Patients with WT that were operated in the last 20 years were evaluated according to the number of patients per year to determine the annual WT increase trend. RESULTS In the distribution of WT over the years of surgery, the ratio of WT to all tumors irregularly changed. Furthermore, the total number of parotidectomies per year increased in time. We investigated whether WT had any increasing trend over the years. The annual percentage change (APC) of WT was calculated, and according to the segmented regression analysis, the APC was insignificant (APC = 4.3, 95% CI = - 3.6-12.9, P = 0.300). CONCLUSION The incidence of WT has increased across the world. However, in our study, no significant APC was observed according to the segmented regression analysis.
Collapse
Affiliation(s)
- Orhan Tunç
- Department of Otorhinolaryngology, Gaziantep University, Gaziantep, Turkey.
| | | | - Yusuf Arslanhan
- Department of Otorhinolaryngology, Gaziantep University, Gaziantep, Turkey
| | - Muzaffer Kanlıkama
- Department of Otorhinolaryngology, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|