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Locati LD, Ferrarotto R, Licitra L, Benazzo M, Preda L, Farina D, Gatta G, Lombardi D, Nicolai P, Vander Poorten V, Chua MLK, Vischioni B, Sanguineti G, Morbini P, Fonseca I, Sozzi D, Merlotti A, Orlandi E. Current management and future challenges in salivary glands cancer. Front Oncol 2023; 13:1264287. [PMID: 37795454 PMCID: PMC10546333 DOI: 10.3389/fonc.2023.1264287] [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: 07/20/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
Salivary gland cancers (SGCs) are rare, accounting for less than 5% of all malignancies of the head and neck region, and are morphologically heterogeneous. The diagnosis is mainly based on histology, with the complementary aid of molecular profiling, which is helpful in recognizing some poorly differentiated, borderline, or atypical lesions. Instrumental imaging defines the diagnosis, representing a remarkable tool in the treatment plan. Ultrasound and magnetic resonance are the most common procedures used to describe the primary tumour. The treatment of SGCs is multimodal and consists of surgery, radiotherapy, and systemic therapy; each treatment plan is, however, featured on the patient and disease's characteristics. On 24 June 2022, in the meeting "Current management and future challenges in salivary gland cancers" many experts in this field discussed the state of the art of SGCs research, the future challenges and developments. After the meeting, the same pool of experts maintained close contact to keep these data further updated in the conference proceedings presented here. This review collects the insights and suggestions that emerged from the discussion during and after the meeting per se.
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Affiliation(s)
- Laura D. Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Medical Oncology Unit, Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
| | - Renata Ferrarotto
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) National Cancer Institute, Milano, Italy
- University of Milan, Milano, Italy
| | - Marco Benazzo
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Preda
- Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Davide Farina
- Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Division of Radiology and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) National Cancer Institute, Milano, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Study, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Study, Padova, Italy
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospital of Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Melvin Lee Kiang Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Barbara Vischioni
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Roma, Italy
| | - Patrizia Morbini
- Unit of Pathology, Department of Molecular Medicine, University of Pavia, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Isabel Fonseca
- Anatomia Patológica, Instituto Português de Oncologia Francisco Gentil, University of Lisbon, Lisbon, Portugal
| | - Davide Sozzi
- Department of Medicine and Surgery, School of Medicine University of Milano-Bicocca, Monza, Italy
- Maxillofacial Surgery Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Gerardo dei Tintori, Monza, Italy
| | - Anna Merlotti
- Department of Radiation Oncology, Santa Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
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Shi L, Wu D, Yang X, Yan C, Huang P. Contrast-Enhanced Ultrasound and Strain Elastography for Differentiating Benign and Malignant Parotid Tumors. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:419-427. [PMID: 36731495 PMCID: PMC10629480 DOI: 10.1055/a-1866-4633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/21/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Preoperative differentiation between benign parotid tumors (BPT) and malignant parotid tumors (MPT) is crucial for treatment decisions. The purpose of this study was to investigate the benefits of combining contrast-enhanced ultrasound (CEUS) and strain elastography (SE) for preoperative differentiation between BPT and MPT. METHODS A total of 115 patients with BPT (n=72) or MPT (n=43) who underwent ultrasound (US), SE, and CEUS were enrolled. US and CEUS features and the elasticity score were evaluated. Receiver operating characteristic curve (ROC) analysis was used to assess the diagnostic performance of SE, CEUS, and SE + CEUS with respect to identifying MPT from BPT. RESULTS Solitary presentation, larger diameter, irregular shape, ill-defined margin, heterogeneous echogenicity, and calcification on US and higher elasticity score on SE had a significant association with malignancy. MPT also presented an unclear margin, larger size after enhancement, and "fast-in and fast-out" pattern on CEUS. The combination of SE and CEUS was effective for differentiating MPT from BPT (AUC: 0.88, 0.80-0.95), with a sensitivity of 86.0%, specificity of 88.9%, and accuracy of 87.8%, which were significantly higher than the values for SE (AUC: 0.75, 0.66-0.85) and CEUS (AUC: 0.82, 0.73-0.91) alone. CONCLUSION The combination of CEUS and SE is valuable for distinguishing MPT from BPT.
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Affiliation(s)
- Liuhong Shi
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Dingting Wu
- Nutrition Division, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
| | - Xu Yang
- Pathology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Caoxin Yan
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
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Karagozoglu KH, Mahraoui A, Bot JCJ, Cha S, Ho JPTF, Helder MN, Brand HS, Bartelink IH, Vissink A, Weisman GA, Jager DHJ. Intraoperative Visualization and Treatment of Salivary Gland Dysfunction in Sjögren's Syndrome Patients Using Contrast-Enhanced Ultrasound Sialendoscopy (CEUSS). J Clin Med 2023; 12:4152. [PMID: 37373845 DOI: 10.3390/jcm12124152] [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: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
In sialendoscopy, ducts are dilated and the salivary glands are irrigated with saline. Contrast-enhanced ultrasound sialendoscopy (CEUSS), using microbubbles, may facilitate the monitoring of irrigation solution penetration in the ductal system and parenchyma. It is imperative to test CEUSS for its safety and feasibility in Sjögren's syndrome (SS) patients. CEUSS was performed on 10 SS patients. The primary outcomes were safety, determined by the occurrence of (serious) adverse events ((S)AEs), and feasibility. The secondary outcomes were unstimulated and stimulated whole saliva (UWS and SWS) flow rates, xerostomia inventory (XI), clinical oral dryness score, pain, EULAR Sjögren's syndrome patient reported index (ESSPRI), and gland topographical alterations. CEUSS was technically feasible in all patients. Neither SAEs nor systemic reactions related to the procedure were observed. The main AEs were postoperative pain (two patients) and swelling (two patients). Eight weeks after CEUSS, the median UWS and SWS flow had increased significantly from 0.10 to 0.22 mL/min (p = 0.028) and 0.41 to 0.61 mL/min (p = 0.047), respectively. Sixteen weeks after CEUSS, the mean XI was reduced from 45.2 to 34.2 (p = 0.02). We conclude that CEUSS is a safe and feasible treatment for SS patients. It has the potential to increase salivary secretion and reduce xerostomia, but this needs further investigation.
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Affiliation(s)
- K Hakki Karagozoglu
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, Noord-Holland, The Netherlands
| | - Anissa Mahraoui
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, Noord-Holland, The Netherlands
| | - Joseph C J Bot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands
| | - Seunghee Cha
- Department of Oral and Maxillofacial Diagnostic Sciences, Center for Orphaned Autoimmune Disorders, University of Florida, 1395 Center Drive, Gainesville, FL 32610, USA
| | - Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, Noord-Holland, The Netherlands
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, Noord-Holland, The Netherlands
| | - Henk S Brand
- Department of Oral Biochemistry, Academisch Centrum Tandheelkunde Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, Noord-Holland, The Netherlands
| | - Imke H Bartelink
- Department of Pharmacy, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1018 HV Amsterdam, Noord-Holland, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Groningen, The Netherlands
| | - Gary A Weisman
- Department of Biochemistry, Christopher S. Bond Life Sciences Center, University of Missouri, 1201 Rollins St, Columbia, MO 65211, USA
| | - Derk Hendrik Jan Jager
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, Noord-Holland, The Netherlands
- Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, De Boelelaan 1118, 1081 HV Amsterdam, Noord-Holland, The Netherlands
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Xia F, Zha X, Qin W, Wu H, Li Z, Li C. Histogram analysis of ultrasonographic images in the differentiation of benign and malignant parotid gland tumors. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00437-6. [PMID: 37258328 DOI: 10.1016/j.oooo.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/13/2023] [Accepted: 04/22/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We evaluated the diagnostic value of histogram analysis (HA) using ultrasonographic (US) images for differentiation among pleomorphic adenoma (PA), adenolymphoma (AL), and malignant tumors (MT) of the parotid gland. STUDY DESIGN Preoperative US images of 48 patients with PA, 39 patients with AL, and 17 patients with MT were retrospectively analyzed for gray-scale histograms. Nine first-order texture features derived from histograms of the tumors were compared. Area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic performance of texture features. The Youden index maximum exponent was used to calculate sensitivity and specificity. RESULTS Statistically significant differences were discovered in Mean and Skewness HA values between PA and AL (P<0.001), and in Mean values between AL and MT (P<0.001). However, comparison of PA and MT showed no statistically significant differences (P>0.01). Excellent discrimination was detected between PA and AL (AUC=0.802), and between AL and MT (AUC=0.822). The combination of Mean plus Skewness improved discrimination between PA and AL (AUC=0.823) with sensitivity values reaching 1.00. However, Mean plus Skewness applied to differentiate PA from AL and Mean values applied to distinguish AL and MT resulted in low specificity, indicating many false positive interpretations. CONCLUSIONS Histogram analysis is useful for differentiating PA from AL and AL from MT but not PA from MT.
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Affiliation(s)
- Feifei Xia
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China; School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Xiaoyu Zha
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Wenjuan Qin
- Department of Ultrasound, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Hui Wu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Zeying Li
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China; Department of Pathology, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang China
| | - Changxue Li
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China.
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Assessment of Parotid Gland Tumors by Means of Quantitative Multiparametric Ultrasound (mpUS). Diagnostics (Basel) 2022; 13:diagnostics13010012. [PMID: 36611304 PMCID: PMC9818404 DOI: 10.3390/diagnostics13010012] [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] [Received: 11/30/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The preoperative diagnostical differentiation of parotid gland tumor (PGT) is not always simple due to several different entities. B-mode-ultrasound (US) remains the imaging modality of choice, while histopathology serves as the gold standard for finalizing the diagnosis. We aimed to evaluate the use of multiparametric US (mpUS) in the assessment of PGT. METHODS We included 97 PGTs from 96 patients. A standardized mpUS protocol using B-mode-US, shear-wave elastography (SWE), and standardized contrast-enhanced ultrasound (CEUS) was performed prior to surgical intervention. SWE was assessed by real-time measurement conducting a minimum of five measurements, while quantitative CEUS parameters were assessed with a post-processing perfusion software. RESULTS SWE allowed differentiation between benign PGT (Warthin's Tumor (WT) paired with lymph nodes (LN) and pleomorphic adenoma (PA)), and WT and LN were softer compared to PA. WT showed lower velocities than squamous cell carcinoma (SCC): the most common malignant PGT. CEUS parameters showed significant group differences between WT and PA, WT and malignant lesions, WT and SCC, WT paired with LN versus PA, and WT paired with LN versus SCC. CONCLUSION MpUS seems to be beneficial in the assessment of PGT characterization, with benign PGT appearing to be softer in SWE than tumors with malignant tendencies. The quantitative CEUS parameter shows higher perfusion in WT than in PA, and malignant PGTs are less vascularized than WTs.
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Contrast-Enhanced Ultrasound in the Differentiation between the Most Common Benign Parotid Gland Tumors: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11247360. [PMID: 36555976 PMCID: PMC9787854 DOI: 10.3390/jcm11247360] [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] [Received: 11/02/2022] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Recently, contrast-enhanced ultrasound (CEUS) has become a promising tool in distinguishing benign from malignant parotid gland tumors. However, its usefulness in differentiating various benign parotid tumors has not been determined so far. This study aimed to systematically review the literature to determine the utility of CEUS in the preoperative differentiation between pleomorphic adenomas (PAs) and Warthin's tumors (WTs) of the parotid gland. PubMed, Embase, and Cochrane were searched for English-language articles published until 21 July 2022. Fifteen studies were included. On CEUS examination, a significantly greater percentage of PAs displayed heterogeneous enhancement texture compared to WTs. Contrarily, the enhanced lesion size, the enhancement margin, and the presence of the enhancement rim did not differ significantly between the entities. Significantly longer normalized mean transit time (nMTT) and time to peak (TTP) were observed in PAs. Contrarily, the mean values of area under the curve (AUC) and time from peak to one half (TPH) were significantly higher for WTs. Due to the considerable overlap among the qualitative CEUS characteristics of PAs and WTs, the reproducible, investigator-independent quantitative CEUS measurements have a greater potential to distinguish PAs from WTs, which might influence the selection of an appropriate management strategy.
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Correlations between Contrast-Enhanced Ultrasound Imaging and Histopathological Results in Salivary Gland Lesions. Diagnostics (Basel) 2022; 12:diagnostics12112636. [DOI: 10.3390/diagnostics12112636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to search for correlations between contrast-enhanced ultrasound (CEUS) imaging and histopathological results in salivary gland lesions and to determine the accuracy of CEUS in the preoperative differentiation of salivary gland tumours according to postoperative histopathological results. The study included 54 consecutive patients with 63 salivary gland lesions who underwent CEUS examination prior to surgical treatment at the Department of Otolaryngology, Medical University of Łódź (Poland) in 2019–2022. The accuracy of CEUS in differential diagnostics of salivary gland lesions was later verified against final histological diagnosis. Among 63 salivary gland lesions, 26 were categorized as malignant or with malignant potential, and 37 were benign. There was a correlation between professional photographs of CEUS imaging and microscope slides containing postoperative specimens. A strong heterogeneous enhancement was observed mainly in benign lesions, with while weak heterogeneity mostly among the malignant or with malignant potential lesions. A pattern of contrast enhancement in specific structures reflected histopathological images. These results suggest that contrast-enhanced ultrasonography is a promising tool for the preoperative diagnostics of salivary gland lesions.
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Wang Y, Nie F, Wang P. Clinical Diagnostic Application of Contrast-Enhanced Ultrasound in Focal Lesions of the Salivary Glands. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2535-2546. [PMID: 35043446 DOI: 10.1002/jum.15943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/27/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate the clinical diagnostic value of contrast-enhanced ultrasound (CEUS) for focal benign and malignant lesions of the salivary glands, as well as for common benign lesions. METHODS A total of 91 patients with focal lesions of the salivary glands were included in this study. In this study, CEUS was used to study the differential diagnosis of focal benign and malignant lesions of the salivary gland and the most common benign tumors, that is, pleomorphic adenoma (PA) and adenolymphoma. RESULTS The differences between focal benign and malignant lesions in the salivary glands were statistically significant (P < .05) in terms of qualitative CEUS indicators, enhancement pattern, enhancement homogeneity, enhancement margin, and enhanced lesion size, whereas the differences were not statistically significant (P > .05) in terms of wash-in and wash-out pattern, enhancement degree. Blurred margins and increased size of the lesion after enhancement are two CEUS features independently associated with focal malignant lesions of the salivary gland. The differences between salivary gland PA and adenolymphoma were statistically significant (P < .05) in terms of wash-in pattern, enhancement degree, enhancement homogeneity, and enhancement pattern, but not in terms of wash-out pattern, enhancement margin, and enhanced lesion size (P > .05). CONCLUSIONS As an economical, convenient, and safe imaging method, CEUS has important clinical value in distinguishing benign and malignant salivary glands.
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Affiliation(s)
- Yanqing Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Peihua Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
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xia F, qin W, feng J, zhou X, sun E, xu J, li C. Differential diagnostic value of tumor morphology, long/short diameter ratio and ultrasound gray scale ratio for three parotid neoplasms. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:484-491. [DOI: 10.1016/j.oooo.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
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Welkoborsky HJ, Albers M, Küstermeyer J. Perfusion analysis of benign parotid gland tumors by contrast-enhanced ultrasonography (CEUS). Eur Arch Otorhinolaryngol 2022; 279:4137-4146. [PMID: 35230508 DOI: 10.1007/s00405-022-07303-z] [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: 09/13/2021] [Accepted: 02/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Diagnosis of parotid gland tumors is sometimes challenging due to their diversity and pleomorphic histological appearance. B-scan sonography along with color-coded duplex sonography is the gold standard in the diagnostic workup of these lesions, whereas histopathology is to date the gold standard for the final diagnosis. To date no single imaging technique provides the chance for an art-diagnosis with highly diagnostic accuracy. Contrast enhanced ultrasonography (CEUS) on the other hand provides information of the perfusion down to the capillary level. Currently there are only a few papers published with systematical examination of the perfusion in benign parotid gland tumors and its diagnostic significance. PATIENTS AND METHODS One hundred patients with a parotid gland tumor were examined. The examinations included conventional B-scan sonography, color-coded duplexsonography along with contrast enhanced ultrasonography (CEUS). B-scan sonographic parameters, i.e. echogenicity, shape, size, demarcation, and borders of a lesion along with vascularization estimated by color-coded-duplexsonography were analyzed. Analysis of quantitative CEUS parameters was performed using 8 regions of interest (ROI), which were standardized located throughout the entire tumors. The perfusion parameters were analyzed for particular tumor entities. Qualitative CEUS analysis with estimating the perfusion pattern was additionally performed. RESULTS Histological examination revealed benign tumors in 92 cases, with pleomorphic adenomas and Warthin´s tumors were the most frequent entities. Malignant conditions were found in 8 cases. CEUS revealed a centripetal perfusion pattern in malignant tumors significantly more frequently than in benign tumors. CEUS showed a significant heterogenic perfusion in all tumors, with a higher perfusion in the medial parts of the tumors and in some cases also in the center. Perfusion patterns of PA and WT were different. WT displayed centrifugal, centripetal, and central diffuse perfusion more often than PA, whereas in PA perfusion often was limited to the capsule or periphery. Oncocytoma had the highest perfusion values. Intraglandular cysts showed no intralesional perfusion. CONCLUSIONS CEUS analysis in different parts of benign tumors revealed a significant heterogeneity in tumor perfusion. Some perfusion pattern could be identified which might be characteristic for particular lesions. Based on this, the diagnostic accuracy of CEUS in the differential diagnosis of parotid gland tumors can be increased. In particular, the perfusion analysis within the tumors using ROIs located standardized throughout the entire tumor provides additional information which are important for the art diagnosis and in differentiation of tumor entity.
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Affiliation(s)
- Hans J Welkoborsky
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Haltenhoffstr. 41, 30167, Hannover, Germany.
| | - Maria Albers
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Haltenhoffstr. 41, 30167, Hannover, Germany
| | - Julian Küstermeyer
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Haltenhoffstr. 41, 30167, Hannover, Germany
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Weimer JM, Rink M, Müller L, Arens C, Bozzato A, Künzel J. Sonografische Diagnostik im Kopf-Hals-Bereich – Teil 2: Transzervikale Sonografie. Laryngorhinootologie 2022; 101:156-175. [DOI: 10.1055/a-1667-8675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | - Julian Künzel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Regensburg
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Xu S, Luo J, Zhu C, Jiang J, Cheng H, Wang P, Hong J, Fang J, Pan J, Brown MA, Zhu X, Wang X. Performance Evaluation of Multiple Ultrasonographical Methods for the Detection of Primary Sjögren's Syndrome. Front Immunol 2021; 12:777322. [PMID: 34880870 PMCID: PMC8646092 DOI: 10.3389/fimmu.2021.777322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Major salivary gland ultrasonography (SGUS) is increasingly being recognized as having critical roles in differentiating primary Sjögren’s syndrome (pSS) from other connective tissue disorders. Contrast-enhanced ultrasonography (CEUS) has been reported to evaluate microvascularity of lesions in different tissues with objective angiographic index, eliminating the observer-dependent defect of ultrasonography. However, there are few relevant studies concentrating on the application of CEUS in the diagnosis and assessment for pSS, and their clinical utility prospect remains uncertain. In this study, a total of 227 eligible patients were enrolled, including 161 pSS and 66 non-pSS patients with comprehensive ultrasonographic evaluation of the parotid and submandibular glands, including grayscale ultrasonography, color Doppler sonography (CDS), and CEUS. Compared with non-pSS, pSS patients had significantly higher grayscale ultrasound (US) scores and CDS blood grades in the parotid gland and significantly higher grayscale US and CEUS scores in the submandibular glands. Diagnostic model combining ultrasonographic signatures, anti-SSA/Ro60, and keratoconjunctivitis sicca (KCS) tests showed a remarkable discrimination [mean area under the curve (AUC)0.963 in submandibular glands and 0.934 in parotid glands] for pSS, and the nomogram provided excellent prediction accuracy and good calibration in individualized prediction of pSS. A combination of multiple ultrasonographical examinations of the major salivary glands (SGs) is a promising technique that may be used as a practical alternative to minor SG biopsy in the detection of pSS.
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Affiliation(s)
- Shihao Xu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jing Luo
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chengwei Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiachun Jiang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui Cheng
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ping Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingwei Hong
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinxia Fang
- Department of Rheumatology, Taizhou Hospital of Zhejiang University, Linhai, China
| | - Jingjing Pan
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Matthew A Brown
- Department of Medicine, Guy's and St Thomas' Hospital NHS Trust and King's College London NIHR Biomedical Research Centre, London, United Kingdom
| | - Xiaochun Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaobing Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Grasso M, Fusconi M, Cialente F, de Soccio G, Ralli M, Minni A, Agolli G, de Vincentiis M, Remacle M, Petrone P, Di Maria D, D’Andrea V, Greco A. Rupture of the Pleomorphic Adenoma of the Parotid Gland: What to Know before, during and after Surgery. J Clin Med 2021; 10:jcm10225368. [PMID: 34830650 PMCID: PMC8624875 DOI: 10.3390/jcm10225368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: We assessed the cases of intraoperative spillage of primary pleomorphic adenomas (PPAs) of the parotid gland in the literature, comparing them with our own cases. We aim to explain how the surgeon should manage a spillage during surgery (i.e., how to avoid spreading the contents that are coming out of the tumor). We also aim to investigate whether or not spillage is linked to a higher rate of PPA recurrence. Methods: We collected surgical and pathological reports, taking data on capsular ruptures and the spillage of tumors. Results: Intraoperative tumor spillage and tumor rupture occurred in 34/202 cases. There were three recurrences after a mean of 3.7 years (mean follow-up duration: 10.3 years). One recurrence happened to a patient who had an intraoperative tumor spillage, and two more recurrences happened to patients who did not have spillage. Conclusion: We believe that the real number of the events of spillage is underestimated and underreported by surgeons. Capsular rupture must always be avoided, and secure resection margins must always be pursued, independent of the type of parotidectomy being performed. Features that increase the risk of recurrence are an intraoperative rupture and the presence of satellite nodules (as recorded in the pathologist’s report). In these cases, patients need a longer follow-up period.
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Affiliation(s)
- Michele Grasso
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (F.C.); (G.d.S.); (M.R.); (A.M.); (G.A.); (A.G.)
- Correspondence:
| | - Massimo Fusconi
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (F.C.); (G.d.S.); (M.R.); (A.M.); (G.A.); (A.G.)
| | - Fabrizio Cialente
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (F.C.); (G.d.S.); (M.R.); (A.M.); (G.A.); (A.G.)
| | - Giulia de Soccio
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (F.C.); (G.d.S.); (M.R.); (A.M.); (G.A.); (A.G.)
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (F.C.); (G.d.S.); (M.R.); (A.M.); (G.A.); (A.G.)
| | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (F.C.); (G.d.S.); (M.R.); (A.M.); (G.A.); (A.G.)
| | - Griselda Agolli
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (F.C.); (G.d.S.); (M.R.); (A.M.); (G.A.); (A.G.)
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy;
| | - Marc Remacle
- Department of Otorhinolaryngology Head and Neck Surgery, CHL-Eich, Rue d’Eich 78, 1111 Luxembourg, Luxembourg;
| | - Paolo Petrone
- Department of Otolaryngology, Head and Neck Surgery, “Di Venere” Hospital, 70121 Bari, Italy;
| | - Domenico Di Maria
- Department of Otolaryngology, Head and Neck Surgery, “San Pio” Hospital, 82100 Benevento, Italy;
| | - Vito D’Andrea
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy;
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (F.C.); (G.d.S.); (M.R.); (A.M.); (G.A.); (A.G.)
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14
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[Perfusion analysis in parotid gland tumors using contrast-enhanced ultrasound (CEUS)]. HNO 2021; 70:51-59. [PMID: 34160626 DOI: 10.1007/s00106-021-01077-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The diagnosis of parotid gland tumors is challenging due to their rarity and heterogenity. Neither conventional ultrasound nor magnetic resonance imaging (MRI) nor computed tomography (CT) allow a reliable pretherapeutic diagnosis. In addition to conventional ultrasound, contrast-enhanced ultrasound (CEUS) enables a more detailed assessment of perfusion in parotid gland tumors, thereby improving evaluation of this tumor entity. Extensive studies with analysis of perfusion characteristics in different regions of interest (ROI) in parotid gland tumors are currently lacking. This study analysed and compared perfusion parameters in different intratumoral areas of malignant and benign parotid gland tumors using CEUS. MATERIALS AND METHODS A total of 100 patients with tumors in the parotid gland were examined using B‑mode sonography, colour Doppler sonography and CEUS. The parameters magnitude, echogenicity, demarcation, vascularisation and in particular perfusion characteristics were measured and analysed. Analysis of quantitative CEUS parameters was performed using a specific method for perfusion analysis with certain ROI, which were allocated in a standardized manner in the entire parotid gland tumors. The perfusion parameters were compared between intratumoral ROI in the tumors and between particular tumor entities. Qualitative CEUS analysis with an estimation of perfusion patterns was additionally performed. RESULTS Histologically benign tumors were found in 92 cases, and malignant tumors in eight cases. CEUS analysis of perfusion patterns revealed a centripetal perfusion pattern in malignant tumors significantly more frequently than in benign tumors. In the perfusion analysis of quantitative CEUS parameters, all tumors showed higher perfusion intensities in the peripheral ROI. In benign tumors, more differences in perfusion intensity between the intratumoral ROIs were detected compared to malignant tumors. CONCLUSION The perfusion parameters (centripetal perfusion pattern; area under the curve) evaluated in this study have the potential to improve pretherapeutic diagnostics of parotid gland tumors in terms of differentiation of tumor entity. Further studies with larger patient cohorts are required for subsequent investigation and validation of the diagnostic accuracy of particular parameters to detect perfusion patterns potentially specific to particular tumor entities.
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15
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Zhao Y, Jiang T, Lv K, Pan M, Wen Q, Huang P. Application of ultrasound and contrast-enhanced ultrasound to distinguish salivary focal inflammatory masses from malignant masses: A retrospective observational study. Clin Hemorheol Microcirc 2021; 79:423-434. [PMID: 34057139 DOI: 10.3233/ch-211151] [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: 12/12/2022]
Abstract
BACKGROUND The aim was to retrospectively analyze the ultrasonographic and clinical characteristics of focal inflammatory masses and malignant masses of salivary gland by using B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) for differential analysis. METHODS The features of US and CEUS were retrospectively analyzed for 19 cases of focal salivary inflammatory masses and 45 cases of malignant salivary masses. All cases were confirmed by pathohistological examination. RESULTS On B-mode US, the incidence of expansive growth patterns of malignant salivary masses (44.4%, 20/45) was significantly higher than that of focal salivary inflammatory masses (15.8%, 3/19) (p = 0.029). The rate of lymphadenopathy surrounding salivary glands of malignant salivary masses (42.2%, 19/45) was significantly higher than that of focal salivary inflammatory masses (15.8%, 3/19) (p = 0.042). On CEUS, clear enhancement margins were more common in malignant salivary masses (44.4%, 20/45) compared to focal salivary inflammatory masses (15.8%, 3/19) (p = 0.029); Rapid washout was more common in malignant salivary masses (82.2%, 37/45) than focal salivary inflammatory masses (31.6%, 6/19) (p < 0.001). Rapid washout on CEUS and craniocaudal diameter were independent predictive factors in differentiating salivary inflammatory masses and malignant masses according to binary logistic regression analysis. US and CEUS achieved a sensitivity of 80.0%, a specificity of 78.9%and an accuracy of 80.0%for discrimination between salivary inflammatory masses and malignant masses. CONCLUSION Therefore, a multimodal ultrasonographic pathway combining clinical manifestations, B-mode US and CEUS was needed to differentiate between salivary focal inflammatory masses and malignancies to avoid unnecessary biopsies.
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Affiliation(s)
- Yanan Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tao Jiang
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kun Lv
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Minqiang Pan
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qing Wen
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pintong Huang
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Maraghelli D, Pietragalla M, Cordopatri C, Nardi C, Peired AJ, Maggiore G, Colagrande S. Magnetic resonance imaging of salivary gland tumours: Key findings for imaging characterisation. Eur J Radiol 2021; 139:109716. [PMID: 33866123 DOI: 10.1016/j.ejrad.2021.109716] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 12/22/2022]
Abstract
Salivary gland tumours are rare, representing only 3% of all head and neck neoplasms, with the parotid gland being the most common site (80 %). The risk of malignancy is inversely proportional to the size of the gland: lesions arising in the sublingual or minor salivary glands are more likely to be malignant, whereas parotid gland neoplasms are mostly benign. Fine needle aspiration cytology and core needle biopsy are considered the most accurate modalities for the diagnosis of a salivary gland neoplasm; however, they are not always conclusive due to procedural sampling errors and for the presence of a cytological / histological overlap between benign and malignant tumours. Moreover, they cannot be easily performed for parotid deep portion localisation. The role of magnetic resonance imaging (MRI) is growing and advanced techniques (diffusion-weighted and dynamic contrast-enhanced perfusion-weighted imaging) can provide useful additional information for the assessment of salivary gland neoplasms. The aim of this review is to present the main MRI and clinical features of salivary gland tumours to improve their comprehensive evaluation and characterisation.
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Affiliation(s)
- Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
| | - Cesare Cordopatri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
| | - Anna Julie Peired
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
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AlAmari K, Zahlan AM, Albawardi E, Dababo M, Alotaibi NH. A case report of a rare nasopharyngeal myoepithelial dominant pleomorphic adenoma. Int J Surg Case Rep 2021; 82:105859. [PMID: 33839626 PMCID: PMC8055613 DOI: 10.1016/j.ijscr.2021.105859] [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: 03/10/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/17/2022] Open
Abstract
Majority of pleomorphic adenoma arise from the major salivary glands but tumors arising from the minor salivary glands have been reported as well. Pleomorphic adenoma presents most commonly in the third to the sixth decades of life Surgical excision is the mainstay of treatment in pleomorphic adenoma as they can grow to giant sizes if left untreated.
Introduction Pleomorphic adenoma is the most common benign salivary gland neoplasm. The majority of cases occur in the major salivary glands; however, they can also originate from the minor salivary glands. The nasopharynx is an uncommon site, but it has been reported in the literature. The characteristic difference of our report from the literature is the young age of our patient and his previous unremarkable medical or surgical history. The objective of this report is to present a case of salivary gland pleomorphic adenoma, discuss radiological and histopathological findings and treatment options. Case presentation Herein we report a case of a 25-year-old male patient presenting with a long-term history of snoring, mouth breathing, and progressive left nasal obstruction. After examining the patient and confirming the diagnosis, patient successfully underwent tumor resection using a combined transnasal/transoral endoscopic approach with no complications following surgery and significant improvement of the previously reported symptoms. Discussion Pleomorphic adenoma of the minor salivary glands can occur anywhere throughout the distribution sites of these glands such as: along the upper aerodigestive tract, parapharyngeal fat spaces, soft palate, the sinonasal, and nasopharyngeal areas. Conclusion The occurrence of pleomorphic adenoma in uncommon sites has been reported in the literature, and the nasopharynx is considered to be one of these uncommon sites. The mainstay of treatment for nasopharyngeal pleomorphic adenoma is surgical excision as they can grow to giant sizes if left untreated.
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Affiliation(s)
- Kholoud AlAmari
- Department of Otolaryngology-Head & Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | | | - Esam Albawardi
- Department of Otolaryngology-Head & Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed Dababo
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Naif H Alotaibi
- Department of Otolaryngology-Head & Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Stoia S, Băciuț G, Lenghel M, Badea R, Csutak C, Rusu GM, Băciuț M, Tamaș T, Boțan E, Armencea G, Bran S, Dinu C. Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review. Bosn J Basic Med Sci 2021; 21:19-32. [PMID: 32893758 PMCID: PMC7861630 DOI: 10.17305/bjbms.2020.5028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023] Open
Abstract
An accurate preoperative diagnosis of parotid tumors is essential for the selection and planning of surgical treatment. Various modern cross-sectional imaging and cytologic investigations can support the differential diagnosis of parotid tumors. The aim of this study was to achieve a comprehensive and updated review of modern imaging and cytologic investigations used in parotid tumor diagnosis, based on the latest literature data. This literature review could serve as a guide for clinicians in selecting different types of investigations for the preoperative differential diagnosis of parotid tumors. Magnetic resonance imaging (MRI) with its dynamic and advanced sequences is the first-line imaging investigation used in differentiating parotid tumors. Computed tomography (CT) and positron emission tomography (PET)-CT provide limited indications in differentiating parotid tumors. Fine needle aspiration biopsy and core needle biopsy can contribute with satisfactory results to the cytological diagnosis of parotid tumors. Dynamic MRI with its dynamic contrast-enhanced and diffusion-weighted sequences provides the best accuracy for the preoperative differential diagnosis of parotid tumors. CT allows the best evaluation of bone invasion, being useful when MRI cannot be performed, and PET-CT has value in the follow-up of cancer patients. The dual cytological and imaging approach is the safest method for an accurate differential diagnosis of parotid tumors.
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Affiliation(s)
- Sebastian Stoia
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Grigore Băciuț
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Manuela Lenghel
- Department of Radiology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Badea
- Department of Medical Imaging, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology, Cluj-Napoca, Romania
| | - Csaba Csutak
- Department of Radiology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgeta Mihaela Rusu
- Department of Radiology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Băciuț
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tiberiu Tamaș
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Emil Boțan
- Department of Pathology, Emergency County Hospital, Cluj-Napoca, Romania
| | - Gabriel Armencea
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simion Bran
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Martino M, Fodor D, Fresilli D, Guiban O, Rubini A, Cassoni A, Ralli M, De Vincentiis C, Arduini F, Celletti I, Pacini P, Polti G, Polito E, Greco A, Valentini V, Sorrenti S, D'Andrea V, Masciocchi C, Barile A, Cantisani V. Narrative review of multiparametric ultrasound in parotid gland evaluation. Gland Surg 2020; 9:2295-2311. [PMID: 33447581 DOI: 10.21037/gs-20-530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Disorders affecting parotid gland represent a heterogeneous group comprising congenital, inflammatory and neoplastic diseases which show a focal or diffuse pattern of appearance. The differentiation of neoplastic from non-neoplastic conditions of parotid glands is pivotal for the diagnostic imaging. Frequently there is evidence of overlapping between the clinical and the imaging appearance of the various pathologies. The parotid gland is also often object of study with the combination of different techniques [ultrasound-computed tomography-magnetic resonance imaging (US-CT-MRI), ex.]. Compared to other dominant methods of medical imaging, US has several advantages providing images in real-time at lower cost, and without harmful use of ionizing radiation and of contrast enhancement. B-mode US, and the microvascular pattern color Doppler are usually used as first step evaluation of parotid lesions. Elastography and contrast-enhanced US (CEUS) has opened further possible perspectives to improve the differentiation between benign and malignant parotid lesions. The characterization of the parotid tumors plays a crucial role for their treatment planning and for the prediction of possible surgical complications. We present, here an updated review of the most recurrent pathologies of parotid gland focusing on the diagnostic power of multiparametric US including CEUS and ultrasound elastography (USE); limitations, advantages and the main key-points will be presented.
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Affiliation(s)
- Milvia Martino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Olga Guiban
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | | | - Andrea Cassoni
- Department of Maxillofacial Surgery, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Federico Arduini
- Department of Radiology, Ospedale Santa Maria del Carmine, Rovereto, Italy
| | - Ilaria Celletti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Giorgia Polti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Valentino Valentini
- Department of Maxillofacial Surgery, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
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20
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Karagozoglu KH, Helder M, Bot J, Kamp O, Forouzanfar T, Brand HS, Cha S, Weisman G, Bartelink I, Vissink A, Jager DHJ. Intraoperative visualisation and treatment of salivary glands in Sjögren's syndrome by contrast-enhanced ultrasound sialendoscopy (CEUSS): protocol for a phase I single-centre, single-arm, exploratory study. BMJ Open 2020; 10:e033542. [PMID: 32998913 PMCID: PMC7528357 DOI: 10.1136/bmjopen-2019-033542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION We established a promising sialendoscopic treatment for in vivo enhancement of salivation in salivary glands affected by Sjögren's syndrome (SS). In this technique, the ducts of the salivary glands are irrigated with saline and steroids. This allows for dilatation of ductal strictures and removal of debris. Unfortunately, it is not possible to assess the delivery and penetration of saline or medications in the ductal system and parenchyma. To address this problem, we will conduct contrast-enhanced ultrasound sialendoscopy (CEUSS) using sulphur hexafluoride microbubbles. To the best of our knowledge, microbubbles have never been used for the treatment of salivary glands in SS. It is, therefore, imperative to test this application for its safety and feasibility. METHODS AND ANALYSIS A single-arm phase I study will be performed in 10 SS patients. Under local anaesthesia, ultrasound (US) guided infusion of the parotid and submandibular glands with microbubbles will be performed. Continuous US imaging will be used to visualise the glands, including the location of strictures and occlusions. Main outcomes will be the evaluation of safety and technical feasibility of the experimental treatment. Secondary outcomes will consist of determinations of unstimulated whole mouth saliva flow, stimulated whole mouth saliva flow, stimulated parotid saliva flow, clinical oral dryness, reported pain, xerostomia, disease activity, salivary cytokine profiles and clinical SS symptoms. Finally, salivary gland topographical alterations will be evaluated by US. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Medical Ethics Committee of the Amsterdam University Medical Centre, Amsterdam, The Netherlands (NL68283.029.19). data will be presented at national and international conferences and published in a peer-reviewed journal. The study will be implemented and reported in line with the Standard Protocol Items: Recommendations for Interventional Trials' statement. TRIAL REGISTRATION NUMBERS The Netherlands Trial Register: NL7731, MREC Trial Register: NL68283.029.19; Pre-results.
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Affiliation(s)
- K Hakki Karagozoglu
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam University Medical Center (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco Helder
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam University Medical Center (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joseph Bot
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center (Amsterdam UMC, Location VUmc), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Otto Kamp
- Department of Cardiology, Amsterdam University Medical Center (Amsterdam UMC, Location VUmc), Amsterdam, The Netherlands
| | - Tim Forouzanfar
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam University Medical Center (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Seunghee Cha
- Department of Oral and Maxillofacial Diagnostic Sciences, Division of Oral Medicine, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Gary Weisman
- Department of Biochemistry, MU Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Imke Bartelink
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center (Amsterdam UMC, Location VUmc), Amsterdam, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Derk Hendrik Jan Jager
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam University Medical Center (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Tuma J. [CME Sonography 92: Nodes on the Neck]. PRAXIS 2020; 109:763-770. [PMID: 32752966 DOI: 10.1024/1661-8157/a003545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CME Sonography 92: Nodes on the Neck Abstract. Nodules on the neck can be discovered accidentally when looking in the mirror, or due to pain that may be acute or gradual. The clinical examination is helpful to estimate the localization or to assign the nodule to a specific organ and assess its consistency and mobility. A sonography is very helpful in most cases as there are typical findings related to the thyroid gland, findings based on lymph nodes, changes in the tonsils, vessels and salivary glands. In some cases, the ultrasound must be supplemented by fine needle puncture.
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Affiliation(s)
- Jan Tuma
- Ultrasound Learning Center (ULC) der European Federation of Ultrasound in Medicine and Biology (EFSUMB) am Institut für Allgemeine Innere Medizin und Nephrologie, Klinik Hirslanden, Zürich
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Rubini A, Guiban O, Cantisani V, D'Ambrosio F. Multiparametric ultrasound evaluation of parotid gland tumors: B-mode and color Doppler in comparison and in combination with contrast-enhanced ultrasound and elastography. A case report of a misleading diagnosis. J Ultrasound 2020; 24:337-341. [PMID: 32378165 DOI: 10.1007/s40477-020-00469-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023] Open
Abstract
Preoperative characterization of parotid gland tumors using imaging or cytological examination (fine-needle aspiration cytology) has a strong clinical and therapeutic impact, but it is often difficult due to the tumors' histological heterogeneity. The recent introduction of contrast-enhanced ultrasound (CEUS) and elastography, in the context of multiparametric ultrasound evaluation, contributed to improving the preoperative diagnosis of many diseases affecting the liver, breast, and thyroid, as well as other organs. However, limited evidence is available on the use and the diagnostic power of these techniques in parotid gland neoplasms. In this paper, we present a case of a parotid lesion that highlights the importance of a complete workup using multiparametric ultrasound evaluation, including CEUS and elastography, to identify malignant tumors of the parotid gland.
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Affiliation(s)
- Antonello Rubini
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Rome, Italy.
| | - Olga Guiban
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Vito Cantisani
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Ferdinando D'Ambrosio
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Rome, Italy
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Hoffman HT, Pagedar NA. Ultrasound-Guided Salivary Gland Techniques and Interpretations. Atlas Oral Maxillofac Surg Clin North Am 2019; 26:119-132. [PMID: 30077320 DOI: 10.1016/j.cxom.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Henry T Hoffman
- Department of Otolaryngology, University of Iowa, University of Iowa Hospital, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Nitin A Pagedar
- Department of Otolaryngology, University of Iowa, University of Iowa Hospital, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Yan F, Song Z, Du M, Klibanov AL. Ultrasound molecular imaging for differentiation of benign and malignant tumors in patients. Quant Imaging Med Surg 2018; 8:1078-1083. [PMID: 30701161 DOI: 10.21037/qims.2018.12.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Fei Yan
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Zhuqing Song
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Meng Du
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Alexander L Klibanov
- Cardiovascular Division and Robert M. Berne Cardiovascular Imaging Center, University of Virginia, Charlottesville, VA, 22908, USA
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Scattergood S, Moore S, Prior A, Yusuf GT, Sidhu PS. Percutaneous drainage of a parotid gland abscess under contrast-enhanced ultrasound guidance: A case report. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:182-186. [PMID: 30147743 DOI: 10.1177/1742271x18766705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/23/2018] [Indexed: 11/16/2022]
Abstract
A parotid gland abscess is uncommon and if not responding to conservative management, requires surgical intervention. However, surgery is invasive with the risk of complicating facial nerve damage and possible poor cosmetic outcome. We present a case of a parotid gland abscess in association with an underlying Warthin's tumour requiring percutaneous drainage, as patient co-morbidity precluded a safe surgical approach. Percutaneous drainage was aided by a contrast-enhanced ultrasound examination, which permitted delineation of the fluid aspects of the collection from the underlying tumour and allowed successful percutaneous ultrasound-guided aspiration without complication.
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Affiliation(s)
- Sean Scattergood
- Department of Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen Moore
- Department of Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Prior
- Department of Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Gibran T Yusuf
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
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Rzepakowska A, Osuch-Wójcikiewicz E, Sobol M, Cruz R, Sielska-Badurek E, Niemczyk K. The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice. Eur Arch Otorhinolaryngol 2017; 274:3231-3240. [PMID: 28612315 PMCID: PMC5500678 DOI: 10.1007/s00405-017-4636-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/07/2017] [Indexed: 11/10/2022]
Abstract
The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). Seventy-two consecutive parotid gland tumors were analysed with high-resolution ultrasonography (12 MHz) with color Doppler imagining. The histopathological diagnosis was confirmed after parotidectomy for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for the US were established. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. Area under the curve (AUC) was calculated for each parameter considered. The analysed material included 27 MA, 26 PA, 1 basal cell adenoma, 8 inflammatory conditions, and 10 malignant neoplasms. The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The predictive values were: PPV 66.8% and NPV 93.6%. Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. The predictive values were: PPV 50% and NPV 68.8%, respectively. For distinguishing malignant from benign tumors, the highest AUC values noted were for heterogeneity and vascularization (0.8 and 0.743, respectively). The AUC values were the highest for hypoechogenicity and vascularization in separating PA from MA (0.718 and 0.685, respectively).
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Affiliation(s)
- Anna Rzepakowska
- Department of Otolaryngology, Warsaw Medical University, ul. Banacha 1a, 02-097, Warsaw, Poland.
| | - Ewa Osuch-Wójcikiewicz
- Department of Otolaryngology, Warsaw Medical University, ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Maria Sobol
- Biophysics and Human Physiology Department, Warsaw Medical University, Warsaw, Poland
| | - Raul Cruz
- Otolaryngology Department, Kaiser Permanente Medical Center, Oakland, USA
| | - Ewelina Sielska-Badurek
- Department of Otolaryngology, Warsaw Medical University, ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology, Warsaw Medical University, ul. Banacha 1a, 02-097, Warsaw, Poland
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