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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.
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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
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Mula-Hussain L, Lum K, Alaslani O, Bebedjian R, Grimard L, Sinclair J, Dos Santos MP. Perimesencephalic subarachnoid hemorrhage as a rare delayed complication of radiation therapy in a patient with parotid basaloid squamous cell carcinoma. J Med Imaging Radiat Sci 2024; 55:354-359. [PMID: 38418293 DOI: 10.1016/j.jmir.2024.02.006] [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: 09/30/2023] [Revised: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
In this case report, we address a rare entity of parotid cancer: basaloid squamous cell carcinoma, which was surgically unresectable and had thus far only been treated with radiation therapy. Following twenty years of continuous remission, our patient presented with an acute perimesencephalic subarachnoid hemorrhage. The cause of the acute perimesencephalic subarachnoid hemorrhage was a delayed complication of radiation therapy.
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Affiliation(s)
- Layth Mula-Hussain
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Keanu Lum
- Department of Radiology, Radiation Oncology and Medical Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Ottawa, ON, Canada
| | - Ohoud Alaslani
- Department of Radiology, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Razmik Bebedjian
- Department of Medicine, Neurology Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Laval Grimard
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital; Ottawa, ON, Canada
| | - John Sinclair
- Department of Surgery, Neurosurgery Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Marlise P Dos Santos
- Department of Radiology, Radiation Oncology and Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Associate Professor of Radiology, University of Ottawa; Clinician Investigator, Neurosciences Program, Ottawa Hospital Research Institute; Scientist, Brain and Mind Research Institute; Ottawa ON, Canada.
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Kouka M, Waldner M, Guntinas-Lichius O. Multispectral optoacoustic tomography of benign parotid tumors in vivo: a prospective observational pilot study. Sci Rep 2024; 14:10597. [PMID: 38719924 PMCID: PMC11079028 DOI: 10.1038/s41598-024-61303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
Parotid lumps are a heterogeneous group of mainly benign but also malignant tumors. Preoperative imaging does not allow a differentiation between tumor types. Multispectral optoacoustic tomography (MSOT) may improve the preoperative diagnostics. In this first prospective pilot trial the ability of MSOT to discriminate between the two most frequent benign parotid tumors, pleomorphic adenoma (PA) and Warthin tumor (WT) as well as to normal parotid tissue was explored. Six wavelengths (700, 730, 760, 800, 850, 900 nm) and the parameters deoxygenated (HbR), oxygenated (HbO2), total hemoglobin (HbT), and saturation of hemoglobin (sO2) were analyzed. Ten patients with PA and fourteen with WT were included (12/12 female/male; median age: 51 years). For PA, the mean values for all measured wave lengths as well as for the hemoglobin parameters were different for the tumors compared to the healthy parotid (all p < 0.05). The mean MSOT parameters were all significantly higher (all p < 0.05) in the WT compared to healthy parotid gland except for HbT and sO2. Comparing both tumors directly, the mean values of MSOT parameters were not different between PA and WT (all p > 0.05). Differences were seen for the maximal MSOT parameters. The maximal tumor values for 900 nm, HbR, HbT, and sO2 were lower in PA than in WT (all p < 0.05). This preliminary MSOT parotid tumor imaging study showed clear differences for PA or WT compared to healthy parotid tissue. Some MSOT characteristics of PA and WT were different but needed to be explored in larger studies.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Maximilian Waldner
- Department of Medicine, University of Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Pannuto L, Soh JY, Duah-Asante K, Shaharan S, Ward J, Bisase BS, Norris P, Koshima I, Nduka C, Kannan RY. A Novel Approach to Facial Reanimation and Restoration Following Radical Parotidectomies. J Clin Med 2024; 13:2269. [PMID: 38673542 PMCID: PMC11051263 DOI: 10.3390/jcm13082269] [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: 01/21/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Parotidectomies are indicated for a variety of reasons. Regardless of the indication for surgery, facial reanimation may be required because of facial nerve sacrifice or iatrogenic damage. In these cases, facial restoration performed concurrently with ablative surgery is considered the gold standard, and delayed reanimation is usually not attempted. Methods: A retrospective review of all patients who underwent parotidectomies from 2009 to 2022 in a single institution was performed. Indications, surgical techniques, and outcomes of an algorithmic template were applied to these cases using the Sunnybrook, Terzis scores, and Smile Index. A comparison was made between immediate vs. late repairs. Results: Of a total of 90 patients who underwent parotidectomy, 17 (15.3%) had a radical parotidectomy, and 73 (84.7%) had a total or superficial parotidectomy. Among those who underwent complete removal of the gland and nerve sacrifice, eight patients (47.1%) had facial restoration. There were four patients each in the immediate (n = 4) and late repair (n = 4) groups. Surgical techniques ranged from cable grafts to vascularized cross facial nerve grafts (sural communicating nerve flap as per the Koshima procedure) and vascularized nerve flaps (chimeric vastus lateralis and anterolateral thigh flaps, and superficial circumflex perforator flap with lateral femoral cutaneous nerve). Conclusions: The algorithm between one technique and another should take into consideration age, comorbidities, soft tissue defects, presence of facial nerve branches for reinnervation, and donor site morbidity. While immediate facial nerve repair is ideal, there is still benefit in performing a delayed repair in this algorithm.
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Affiliation(s)
- Lucia Pannuto
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Jun Yi Soh
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Kwaku Duah-Asante
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Shazrinizam Shaharan
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Joseph Ward
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Brian S. Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (B.S.B.); (P.N.)
| | - Paul Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (B.S.B.); (P.N.)
| | - Isao Koshima
- Department of Plastic Surgery, Hiroshima University Hospital, Hiroshima 734-0037, Japan;
| | - Charles Nduka
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Ruben Yap Kannan
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
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Parmar R, Kalaria AN, Patel KA. Oncocytic Lesions of Salivary Glands: Morphological, Immunohistochemical, and Molecular Findings. Cureus 2024; 16:e59328. [PMID: 38817461 PMCID: PMC11137436 DOI: 10.7759/cureus.59328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
The fifth edition of the World Health Organization (WHO) classification introduces new diagnostic methods based on genetic alterations, providing insight into the molecular basis of lesions. As a result, the classification system has evolved, new entities have been introduced, and existing entities have been reclassified. Oncocytic lesions of salivary glands are a group of neoplastic conditions characterized by the presence of oncocytic cells. These lesions present a diagnostic challenge due to their overlapping histological features. Therefore, a comprehensive evaluation, including morphological, immunohistochemical, and molecular analysis, is crucial for accurate diagnosis and appropriate management. Accurate classification of salivary gland pathologies is essential for selecting the appropriate treatment methods and predicting outcomes. The introduction of new therapeutic approaches, such as targeted therapies for malignant salivary gland tumors, has improved patient outcomes. However, to effectively implement these therapies in clinical practice, a clear classification of lesions is necessary.
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Affiliation(s)
- Riddhi Parmar
- Department of Pathology, All India Institute of Medical Sciences, Rajkot, Rajkot, IND
| | - Amankumar N Kalaria
- Department of Pathology, Swaminarayan Institute of Medical Sciences & Research, Kalol, IND
| | - Keval A Patel
- Department of Pathology, Gujarat Medical Education & Research Society (GMERS) Medical College, Vadnagar, IND
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Beck-Broichsitter B, Heiland M, Guntinas-Lichius O. [Salivary Gland Tumors: Limitations of International Guidelines and Status of the planned AWMF-S3-Guideline]. Laryngorhinootologie 2024; 103:135-149. [PMID: 38320568 DOI: 10.1055/a-2150-2670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Primary salivary gland carcinomas are not among the common head and neck tumors. They are characterized by manifold different histological types. Clinically, malignant tumors often cannot be distinguished from benign tumors, so that in these cases malignancy is only established by histopathological diagnosis. These are all reasons why there are relatively few clinical trials on the diagnosis, therapy and follow-up of these tumors. This in turn has the consequence that often only recommendations with limited evidence can be made in clinical guidelines. The most important international guidelines are the National Comprehensive Cancer Network (NCCN) guideline of 2023, the American Society of Clinical Oncology (ASCO) guideline of 2021, the European Society for Medical Oncology (ESMO) guideline of 2022 and still the British National Multidisciplinary guideline of 2016. These 4 international guidelines with their strengths and limitations are presented and commented here. Against this background, the development of a first German S3 clinical guideline on salivary gland tumors is important and expected to be completed in 2023. For the first time in the German guideline program on oncology, benign and malignant tumors are presented together in order to comprehensively do justice to the special features of salivary gland tumors.
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Chen Y, Huang N, Zheng Y, Wang F, Cao D, Chen T. Characterization of parotid gland tumors: Whole-tumor histogram analysis of diffusion weighted imaging, diffusion kurtosis imaging, and intravoxel incoherent motion - A pilot study. Eur J Radiol 2024; 170:111199. [PMID: 38104494 DOI: 10.1016/j.ejrad.2023.111199] [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: 08/13/2023] [Revised: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To investigate the diagnostic performance of histogram features of diffusion parameters in characterizating parotid gland tumors. METHOD From December 2018 to January 2023, patients who underwent diffusion weighted imaging (DWI), diffusion kurtosis imaging (DKI), and intravoxel incoherent motion (IVIM) were consecutively enrolled in this retrospective study. The histogram features of diffusion parameters, including apparent diffusion coefficient (ADC), diffusion coefficient (Dk), diffusion kurtosis (K), pure diffusion coefficient (D), pseudo-diffusion coefficient (DP), and perfusion fraction (FP) were analyzed. The Mann-Whitney U test was used for comparison between benign parotid gland tumors (BPGTs) and malignant parotid gland tumors (MPGTs). Receiver operating characteristic curve and logistic regression analysis were used to identify the differential diagnostic performance. The Spearman's correlation coefficient was used to analyze the correlation between diffusion parameters and Ki-67 labeling index. RESULTS For diffusion MRI, twenty-three histogram features of diffusion parameters showed significant differences between BPGTs and MPGTs (all P < 0.05). Compared with the DWI model, the IVIM model and combined model had better diagnostic specificity (58 %, 94 %, and 88 %, respectively; both corrected P < 0.001) and accuracy (64 %, 89 %, and 86 %, respectively; both corrected P = 0.006). The combined model was superior to the single DWI model with improved IDI (IDI improvement 0.25). Significant correlations were found between Ki-67 and ADCmean, Dkmean, Kmean, and Dmean (r = -0.57 to 0.53; all P < 0.05). CONCLUSIONS Whole-tumor histogram analysis of IVIM and combined diffusion model could further improve the diagnostic performance for differentiating BPGTs from MPGTs.
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Affiliation(s)
- Yu Chen
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Nan Huang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Yingyan Zheng
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Feng Wang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China.
| | - Tanhui Chen
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China.
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Mdletshe FB, Luvhengo TE, Masege D. The Usefulness of Fine Needle Aspiration Cytology in the Management of Parotid Gland Masses at a Tertiary Academic Hospital. Indian J Otolaryngol Head Neck Surg 2023; 75:3199-3204. [PMID: 38027536 PMCID: PMC10646002 DOI: 10.1007/s12070-023-03685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background Fine needle aspiration cytology (FNAC) is an integral part of the preoperative work-up of parotid tumours. Aim To determine the rate of concordance between FNAC and histology following parotidectomy. Methods A review of records of patients who had parotidectomy which was preceded FNAC was done. Data collected included patients' demography, presenting symptoms and clinical signs; cytology and post-operative histology results. Results Seventy-seven records were found and 14 were excluded. Forty-five (71%: 45/63) of the tumours were benign, 21% (13/63) malignant and 8% (5/63) inflammatory lesions. Forty-one (91.1%: 41/45) of the benign tumours had concordance between FNAC and final histology. Seven (63.6%: 7/11) of FNAC diagnosed malignancies were confirmed on histology. Conclusion Around 71% of parotid masses were benign. Painful masses are more likely to be malignant and FNAC is more reliable for the diagnosis of pleomorphic adenoma than rare benign and malignant tumours of the parotid gland.
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Affiliation(s)
- Fanelesibonge B Mdletshe
- Department of Otorhinolaryngology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 Republic of South Africa
| | - Thifhelimbilu E Luvhengo
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 Republic of South Africa
| | - Dipuo Masege
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Neurosciences, 1st Floor, Office 7, Friends of Baragwanath Building, , Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, PO Bertsham, Johannesburg, 2013 Republic of South Africa
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Abbate V, Barone S, Borriello G, Troise S, Bonavolontà P, Pacella D, Vaira LA, Turri-Zanoni M, Cuéllar CN, Califano L, Dell' Aversana Orabona G. Diagnostic performance of inflammatory biomarkers and cytological analysis in salivary gland tumors. Head Neck 2023; 45:3015-3023. [PMID: 37752706 DOI: 10.1002/hed.27528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the diagnostic performance of serum inflammatory biomarkers in salivary gland tumors with dubious results following cytological analysis. METHODS A retrospective analysis of 239 cases following surgery between January 2011 and June 2022 was performed. Receiver Operating Characteristic curves were drawn and areas under the curves were computed to evaluate the diagnostic performance of the inflammatory biomarkers (SII, SIRI, PLR, and NLR). Optimal cut-offs for each marker were determined by maximizing the Youden index. RESULTS Analysis showed that among the major biomarkers examined, SIRI performed an AUC of 0.77. The best SIRI cut-off was 0.94 with an accuracy of 79.9%. The accuracy, sensitivity, and specificity of cytological analysis were 77.8%, 59.6%, and 90.7% respectively. By combining SIRI with cytological analysis we demonstrated an increase in sensitivity to 82.8%. CONCLUSIONS Inflammatory biomarkers could be evaluated to support the diagnosis and treatment of salivary gland tumors in difficult cases.
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Affiliation(s)
- Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Simona Barone
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Gerardo Borriello
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Stefania Troise
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Paola Bonavolontà
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mario Turri-Zanoni
- ENT Unit, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo Via Guicciardini, Varese, Italy
| | - Carlos Navarro Cuéllar
- Division of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Dell' Aversana Orabona
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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Cheng PC, Chiang HHK. Diagnosis of Salivary Gland Tumors Using Transfer Learning with Fine-Tuning and Gradual Unfreezing. Diagnostics (Basel) 2023; 13:3333. [PMID: 37958229 PMCID: PMC10648910 DOI: 10.3390/diagnostics13213333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Ultrasound is the primary tool for evaluating salivary gland tumors (SGTs); however, tumor diagnosis currently relies on subjective features. This study aimed to establish an objective ultrasound diagnostic method using deep learning. We collected 446 benign and 223 malignant SGT ultrasound images in the training/validation set and 119 benign and 44 malignant SGT ultrasound images in the testing set. We trained convolutional neural network (CNN) models from scratch and employed transfer learning (TL) with fine-tuning and gradual unfreezing to classify malignant and benign SGTs. The diagnostic performances of these models were compared. By utilizing the pretrained ResNet50V2 with fine-tuning and gradual unfreezing, we achieved a 5-fold average validation accuracy of 0.920. The diagnostic performance on the testing set demonstrated an accuracy of 89.0%, a sensitivity of 81.8%, a specificity of 91.6%, a positive predictive value of 78.3%, and a negative predictive value of 93.2%. This performance surpasses that of other models in our study. The corresponding Grad-CAM visualizations were also presented to provide explanations for the diagnosis. This study presents an effective and objective ultrasound method for distinguishing between malignant and benign SGTs, which could assist in preoperative evaluation.
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Affiliation(s)
- Ping-Chia Cheng
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City 22060, Taiwan
| | - Hui-Hua Kenny Chiang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
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11
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Xia F, Guo F, Liu Z, Zeng J, Ma X, Yu C, Li C. Enhanced CT combined with texture analysis for differential diagnosis of pleomorphic adenoma and adenolymphoma. BMC Med Imaging 2023; 23:169. [PMID: 37891554 PMCID: PMC10612226 DOI: 10.1186/s12880-023-01129-9] [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: 03/13/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE This study sought to evaluate the worth of the general characteristics of enhanced CT images and the histogram parameters of each stage in distinguishing pleomorphic adenoma (PA) and adenolymphoma (AL). METHODS The imaging features and histogram parameters of preoperative enhanced CT images in 20 patients with PA and 29 patients with AL were analyzed. Tumor morphology and histogram parameters of PA and AL were compared. Area under the curve (AUC), sensitivity, and subject operational feature specificity (ROC) analysis were used to determine the differential diagnostic effect of single-stage or multi-stage parameter combinations. RESULTS The difference in CT value and net enhancement value of arterial phase (AP) were significant (p < 0.05); Flat sweep phase (FSP), AP mean, percentiles, 10th, 50th, 90th, 99th and arterial period variance and venous phase (VP) kurtosis in the nine histogram parameters of each period (p < 0.05). An analysis of the ROC curve revealed a maximum area beneath the curve (AUC) in the 90th percentile of FSP for a single-parameter differential diagnosis to be 0.870. The diagnostic efficacy of the mean value of FSP + The 90th percentile of AP + Kurtosis of VP was the best in multi-parameter combination diagnosis, with an AUC of 0.925, and the sensitivity and specificity of 0.900 and 0.850, respectively. CONCLUSION The histogram analysis of enhanced CT images is valuable for the differentiation of PA and AL. Moreover, the combination of single-stage parameters or multi-stage parameters can improve the differential diagnosis efficiency.
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Affiliation(s)
- Feifei Xia
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Shihezi University, Shihezi, 832000, China
| | - Foqing Guo
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Shihezi University, Shihezi, 832000, China
| | - Zhe Liu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Shihezi University, Shihezi, 832000, China
| | - Jie Zeng
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Shihezi University, Shihezi, 832000, China
| | - Xuehua Ma
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Shihezi University, Shihezi, 832000, China
| | - Chongqing Yu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Shihezi University, Shihezi, 832000, China
| | - Changxue Li
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Shihezi University, Shihezi, 832000, China.
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Sauvage L, Calugaru V, Janoray G. [Radiotherapy of rare head and neck tumors]. Cancer Radiother 2023; 27:608-613. [PMID: 37596121 DOI: 10.1016/j.canrad.2023.06.020] [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: 05/13/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 08/20/2023]
Abstract
Management of head and neck tumors is complex because of multiple anatomical locations and histologies possibilities. Rare tumors must be managed in a specialized center and be registered in the French network of expertise on ENT Cancers (Refcor). Despite heterogeneous levels of evidence, radiotherapy plays an essential role in their treatment. Radiation therapy is generally indicated in the adjuvant setting, or in case of non-operability. Dose and target volumes depend on histology, location and extensions of the tumor, and the quality of the excision if applicable. We present here a review of the literature and available guidelines for the management by radiotherapy of rare upper aerodigestive tract tumors.
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Affiliation(s)
- L Sauvage
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - V Calugaru
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - G Janoray
- Clinique Pasteur, Atrium, 1, rue de la Petite-Vitesse, 31300 Toulouse, France
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13
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Novitskaya MG, DeRosa PA, Chen DT, Khalil A, Harfouch O, O’Connor EE, Schmalzle SA. Rapidly Enlarging Parotid Mass in a Person Living with HIV: A Case of Multiple Myeloma with Extramedullary Plasmacytoma. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e938431. [PMID: 37533236 PMCID: PMC10411289 DOI: 10.12659/ajcr.938431] [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: 09/19/2023] [Revised: 06/29/2023] [Accepted: 05/11/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The differential diagnosis for a parotid mass is broad, including infectious, autoimmune, and neoplastic etiologies. In people with HIV, regardless of viral suppression or immune status, neoplastic causes are more common. This report describes the evaluation of a woman with a large parotid mass, with an ultimate diagnosis of multiple myeloma with extramedullary plasmacytoma. CASE REPORT A 51-year-old woman with HIV infection presented with headache, weight loss, and right facial mass that was present for 5 years but more rapidly enlarging in the prior year. CD4 count was 234 cells/mL, and HIV RNA was 10 810 copies/mL. Physical examination was significant for a large deforming right-sided facial mass, decreased sensation in the V1 and V2 distributions, and right-sided ophthalmoplegia and ptosis. MRI and PET/CT scan confirmed a metabolically active large parotid mass with extension into the cavernous sinus. An IgG kappa monoclonal spike was present on serum protein electrophoresis. Incisional biopsy of the facial mass showed atypical lymphoid cells with plasmablastic and plasmacytic morphology with a high mitotic rate and proliferation index. She was diagnosed with R-ISS stage II IgG kappa multiple myeloma with extramedullary plasmacytoma, and initiated on chemotherapy, radiation, and antiretroviral therapy. CONCLUSIONS A rapidly enlarging parotid mass should prompt timely evaluation and biopsy for definitive diagnosis, particularly in immunocompromised patients, including people with HIV. Extramedullary plasmacytomas have a more aggressive disease process in people with HIV and are associated with high-risk multiple myeloma and progression, as seen in this patient.
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Affiliation(s)
| | - Peter A. DeRosa
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - David T. Chen
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ahmed Khalil
- Division of Hematology Oncology, Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Omar Harfouch
- Division of Infectious Disease, Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Erin E. O’Connor
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah A. Schmalzle
- Division of Infectious Disease, Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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14
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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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15
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Tu CH, Wang RT, Wang BS, Kuo CE, Wang EY, Tu CT, Yu WN. Neural network combining with clinical ultrasonography: A new approach for classification of salivary gland tumors. Head Neck 2023; 45:1885-1893. [PMID: 37222027 DOI: 10.1002/hed.27396] [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: 12/01/2022] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE Little information is available about deep learning methods used in ultrasound images of salivary gland tumors. We aimed to compare the accuracy of the ultrasound-trained model to computed tomography or magnetic resonance imaging trained model. MATERIALS AND METHODS Six hundred and thirty-eight patients were included in this retrospective study. There were 558 benign and 80 malignant salivary gland tumors. A total of 500 images (250 benign and 250 malignant) were acquired in the training and validation set, then 62 images (31 benign and 31 malignant) in the test set. Both machine learning and deep learning were used in our model. RESULTS The test accuracy, sensitivity, and specificity of our final model were 93.5%, 100%, and 87%, respectively. There were no over fitting in our model as the validation accuracy was similar with the test accuracy. CONCLUSIONS The sensitivity and specificity were comparable with current MRI and CT images using artificial intelligence.
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Affiliation(s)
- Cheng-Hung Tu
- Department of Otorhinolaryngology - Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Rui-Teng Wang
- Department of Applied Mathematics, National Chung Hsing University, Taichung, Taiwan
| | - Bo-Sen Wang
- Department of Applied Mathematics, National Chung Hsing University, Taichung, Taiwan
| | - Chih-En Kuo
- Department of Applied Mathematics, National Chung Hsing University, Taichung, Taiwan
| | - En-Ying Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Ting Tu
- Department of Applied Mathematics, National Chung Hsing University, Taichung, Taiwan
| | - Wan-Nien Yu
- Department of Otorhinolaryngology - Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
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16
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Johnson F, Hofauer B, Wirth M, Wollenberg B, Stögbauer F, Notohamiprodjo S, Haller B, Reschke R, Knopf A, Strassen U. Novel Discovery of the Somatostatin Receptor (SSTR2) in Pleomorphic Adenomas via Immunohistochemical Analysis of Tumors of the Salivary Glands. Cancers (Basel) 2023; 15:3917. [PMID: 37568733 PMCID: PMC10417029 DOI: 10.3390/cancers15153917] [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: 06/01/2023] [Revised: 07/09/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Reliable preoperative diagnosis between salivary gland tumor entities is difficult. In this monocentric retrospective study, we examined the somatostatin receptor 2 (SSTR2) status of salivary gland tumors after salivary gland tumor resection via immunohistochemistry (IHC), and stains were compared in analogy to the HER2 mamma scale. A total of 42.3% of all pleomorphic adenoma (PA) tumors (42 of 99, 95% confidence interval 32.5-52.8%) demonstrated ≥20% of cells displaying the SSTR2 as compared to just 1% of all other tumors (1/160, 95% CI 0.02-3.4%). The other tumor was a neuroendocrine carcinoma. PA had a higher intensity of SSTR2 staining, with 90.9% staining ≥ an intensity of 2 (moderate). Tumors with an intensity of SSTR2 expression equal to or greater than 2 had an 89.9% likelihood of being a PA (95% CI: 82.2-95.0%, AUC: 0.928). Only one Warthin tumor demonstrated a 'strong' SSTR2 staining intensity. No Warthin tumor showed a percentage of cells staining for SSTR2 above ≥20%. This result demonstrates consistent and strong expression of SSTR2 in PAs as compared to Warthin tumors, which may allow physicians to utilize radioligand-somatostatin analog PET CT/MR imaging to diagnose the PA. SSTR2 positivity, if shown to be clinically relevant, may allow peptide receptor radionuclide therapy in the future.
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Affiliation(s)
- Felix Johnson
- Department of Otorhinolaryngology, University Clinic of Innsbruck, 6020 Innsbruck, Austria
| | - Benedikt Hofauer
- Department of Otorhinolaryngology, University Clinic of Innsbruck, 6020 Innsbruck, Austria
| | - Markus Wirth
- Department of Otorhinolaryngology, Technical University of Munich (TUM), 85354 Freising, Germany
| | - Barbara Wollenberg
- Department of Otorhinolaryngology, Technical University of Munich (TUM), 85354 Freising, Germany
| | - Fabian Stögbauer
- Institute of General and Surgical Pathology, TUM School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Susan Notohamiprodjo
- Department of Nuclear Medicine, Technical University of Munich (TUM), 85354 Freising, Germany
| | - Bernhard Haller
- Institut für KI und Informatik in der Medizin, 81675 München, Germany
| | - Robin Reschke
- Department of Dermatology and Venereology, Universitätsklinikum Hamburg-Eppendorf, Fleur Hiege Center for Skin Cancer Research, 20246 Hamburg, Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology, Head and Neck Surgery, Albert-Ludwigs-Universität Freiburg, 79085 Freiburg, Germany
| | - Ulrich Strassen
- Department of Otorhinolaryngology, Technical University of Munich (TUM), 85354 Freising, Germany
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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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18
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Deuss E, Schieder S, Lang S, Mattheis S, Guntinas-Lichius O, Meyer MF. [Results of a nationwide survey on the treatment of salivary gland diseases in German hospitals]. HNO 2023; 71:145-153. [PMID: 36512059 DOI: 10.1007/s00106-022-01247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Salivary gland diseases are an important part of the work of ENT physicians in hospitals. The treatment strategies depend, among other things, on the doctrine at the respective location. OBJECTIVE The aim of this questionnaire-based study was to assess the current diagnostic workup and therapeutic strategies for salivary gland diseases in German otorhinolaryngology departments. MATERIALS AND METHODS A survey was performed using a 25-question online questionnaire sent to all German otorhinolaryngology department directors. RESULTS The questionnaire was answered by 92 of 175 otorhinolaryngology departments (52.6%). In the diagnosis of salivary gland tumors, a dominance of sonography and MRI was shown. Fine- and core-needle aspiration were not performed by more than 50% of the clinics. The dominant technique for parotidectomy was under microscopic control (82%). In 99% of clinics, EMG was used during resection of the parotid gland for intraoperative monitoring of the facial nerve. There was a trend towards performing partial parotidectomies (85%), lateral parotidectomies (70%), and extracapsular dissections (57%) for benign tumors of the parotid gland. The treatment concepts for malignant tumors were inconsistent. CONCLUSION In particular, the treatment strategy and extent of surgery for benign and malignant salivary gland tumors differed depending on location. The choice of palliative (drug) therapy was also diverse. Prospective multicenter studies could help to develop evidence-based treatment strategies.
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Affiliation(s)
- Eric Deuss
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Saskia Schieder
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Stephan Lang
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Stefan Mattheis
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - Moritz Friedo Meyer
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Carta F, Bontempi M, De Seta D, Corrias S, Tatti M, Marrosu V, Mariani C, Gerosa C, Shetty SA, Atzeni M, Buckley C, Figus A, Puxeddu R. Survival in Patients with Primary Parotid Gland Carcinoma after Surgery—Results of a Single-Centre Study. Curr Oncol 2023; 30:2702-2714. [PMID: 36975417 PMCID: PMC10047368 DOI: 10.3390/curroncol30030204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
This study aims to analyse a single-centre cohort series of patients who underwent parotidectomy for primary malignant parotid tumours. A retrospective chart review of 64 consecutive patients treated from November 2010 to March 2022 was performed. Outcomes were analysed by Kaplan-Meier curves. Sixty-four patients with a primary parotid malignancy were included in the study, with one bilateral case in this cohort. Patients were classified as stage I–II in 39 cases and stage III–IV in 26 cases. The five-year overall survival (OS), disease-specific survival (DSS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 78.4%, 89%, 92.5%, and 87.1%, respectively. Univariate analysis showed that high-risk histology, stage IV disease, lymphovascular invasion, perineural invasion, node metastasis, skin involvement, facial nerve involvement, and positive or close margins were risk factors associated with poorer outcomes. At present, the best evidence suggests that radical surgery should be the standard approach, and adjuvant therapy, in terms of radiotherapy/chemoradiotherapy, is recommended in patients with risk factors.
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Affiliation(s)
- Filippo Carta
- Otorhinolaryngology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Mauro Bontempi
- Otorhinolaryngology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-07051096411
| | - Daniele De Seta
- Otorhinolaryngology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Simone Corrias
- Otorhinolaryngology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Melania Tatti
- Otorhinolaryngology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Valeria Marrosu
- Otorhinolaryngology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Cinzia Mariani
- Otorhinolaryngology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Clara Gerosa
- Pathology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | | | - Matteo Atzeni
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Christina Buckley
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Andrea Figus
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
| | - Roberto Puxeddu
- Otorhinolaryngology Unit, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09124 Cagliari, Italy
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Primary and Secondary Tumors of the Parotid Gland: Clinical Features and Prognosis. Cancers (Basel) 2023; 15:cancers15041293. [PMID: 36831634 PMCID: PMC9954225 DOI: 10.3390/cancers15041293] [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: 12/24/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Primary and secondary malignant tumors can affect the parotid gland. The aim of this retrospective study was to evaluate the clinical features and prognosis of malignant epithelial tumors of the parotid gland. In particular, a comparison between primary and secondary cancer and survival analyses were performed. Eighteen patients with primary cancer and fifteen with intraparotid metastasis from cutaneous squamous cell carcinoma were included. A chart review was performed to collect clinical data (age, sex, smoking, alcohol consumption, tumor stage, type of surgical procedure, complications, recurrence and death). The majority of primary tumors were early (T1-2 N0, 83%) with mucoepidermoid carcinoma being the most common (33%). Secondary tumors were mostly staged P2 (53%) and N0 (67%). Subjects with secondary tumors were older than those with primary cancer. Post-operative permanent facial palsy was observed in 5 patients (17%) with primary cancer and 9 (60%) with secondary tumors (p = 0.010). Two-year overall survival for primary and secondary parotid cancer was 76.58% and 43.51%, respectively (p = 0.048), while 2-year disease-free survival was 76.05% and 38.50%, respectively (p = 0.152). In conclusion, secondary cancer of the parotid gland has worse survival than primary tumors. In the future, the implementation of multimodality treatment of intraparotid metastases is necessary to improve oncologic outcomes.
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21
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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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22
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Nair S, Aishwarya JG, Jain A, Pavithra V, Mohan S. Mini-Incision Parotidectomy-Our Technique. Indian J Otolaryngol Head Neck Surg 2022; 74:6174-6179. [PMID: 36742673 PMCID: PMC9895246 DOI: 10.1007/s12070-021-02882-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/18/2021] [Indexed: 02/07/2023] Open
Abstract
Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to improve the aesthetic outcome and at the same time for complete disease clearance with reduced complications. In this study, we evaluated the feasibility of our mini-incision parotidectomy technique along with the surgical and quality of life (QOL) outcomes. This prospective case series was conducted at Apollo Hospitals, Bangalore over a period of 2 years (June 2018-August 2020) and includes 20 patients. The surgical outcomes were assessed in terms of feasibility of mini-incision technique with respect to levels of parotid involved and functional outcomes in terms of presence or absence of complications like facial palsy (temporary or permanent), seroma and Frey's syndrome. Patient related quality of life (QOL) outcomes were assessed in terms of post-operative pain score, patient comfort score and cosmetic score by using numerical rating scale-11 (NRS-11). The mini-incision parotidectomy technique is feasible for lesions in all the parotid levels and conversion or lengthening of incision was not needed in any of the cases. 2(10%) patients had temporary facial palsy (House-Brackman grade III) which was recovered within 3 weeks after surgery. One patient (5%) with adenoid cystic carcinoma had permanent facial palsy. Out of 20 patients 2(10%) had seroma and 1(5%) patient presented with Frey's syndrome. Mean post-operative pain score at 0, 6 and 24 h were 4.8, 3.4 and 1.8 out of 10 respectively. Mean comfort score was 9 out of 10 and mean cosmetic score was 9.5 out of 10. Mini-incision parotidectomy technique can render improved functional as well as aesthetic outcomes after parotidectomy without compromising the surgical clearance of the disease process.
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Affiliation(s)
- Satish Nair
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - J. G. Aishwarya
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - Aditya Jain
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - V. Pavithra
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - Sneha Mohan
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
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Ghaloo SK, Qayyum MU, Shaikh OS, Faisal M, Keerio AA, Hussain RT. Carcinoma ex-pleomorphic adenoma of mandible: A case report and review of literature. Int J Surg Case Rep 2022; 100:107729. [PMID: 36274292 PMCID: PMC9596728 DOI: 10.1016/j.ijscr.2022.107729] [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: 09/10/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction and importance The most common benign neoplasm of major and minor salivary glands is pleomorphic adenoma (PA). Around 80 % of all parotid neoplasms are pleomorphic adenomas, while 44–68 % and 38–43 % tumors were pleomorphic adenomas of submandibular and minor salivary gland tumors. PA has been reported in a variety of anatomic locations including true intraosseous mandibular tumor, external ear canal, TMJ region, lacrimal gland, epiglottis, larynx and nasopharynx, breast, lung, esophagus, sinonasal and skull base and trachea. Pleomorphic adenoma has a tendency to transform into a number of malignancies; carcinoma ex-pleomorphic adenoma, carcinosarcoma or metastasizing pleomorphic adenoma. Pleomorphic adenomas most commonly transform into carcinoma ex-pleomorphic adenoma (CEPA). Case presentation A 30-year-old male presented with the primary complaint of a long-standing swelling at his right mandibular region for past 18 months. On intra oral examination, there was a non-healing alveolar socket of right lower 3rd molar tooth while rest of the dentition and mucosal surfaces were normal. On extra oral examination, mouth opening was adequate with intact lower border of the mandible and no palpable lymph nodes in the neck. Initial biopsy of lesion showed pleomorphic adenoma, but later the lesion came out to be carcinoma ex-pleomorphic adenoma, for which he underwent segmental mandibulectomy and free fibular flap. Clinical discussion The prevalence of CEPA transformation from pleomorphic adenoma is 1.5 % within the first 5 years of diagnosis, going up to 10 % after 15 years. The true rate of malignant transformation in recurrent pleomorphic adenoma is reported to be 3.3 %. We report a case of an intra-osseous carcinoma ex pleomorphic adenoma (CEPA) of the mandible. It is thought that ectopic entrapment of salivary tissue or developmentally included embryonic remnants of submandibular glands within recesses or lacunae of the mandibular bone could explain the intraosseous origin of a salivary gland tumor in the mandible. Since carcinoma ex pleomorphic adenoma (CEPA) arises from primary or recurrent pleomorphic adenoma, therefore it poses a diagnostic challenge for histopathologists. The radiographic picture of primary tumor/recurrence can mimic odontogenic cyst/tumor; therefore, a sinister disease process should always be kept in mind. In the post operative period, regular follow up is required to treat any recurrence. The recurrence rate for such disease has not been documented. Conclusion Intra osseous CEPA is a very rare tumor. Intra bony tumors which rapidly increase in size have signs and symptoms of nerve involvement and cause bony destruction should have a high suspicion of index of malignancy. Therefore, biopsy must be correlated with clinical and radiological features. Regular follow up is necessary to detect any recurrence promptly. Carcinoma expleomorphic adenoma is a salivary gland tumor that can rarely occur in unique sites like mandible. Pleomorphic adenoma can co-exist with carcinoma expleomorphic adenoma which may give different biopsy results. Clinical and radiological correlation with tissue diagnosis is important.
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Affiliation(s)
- Shayan Khalid Ghaloo
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan,Corresponding author at: Ruby Beach Apartments, Clifton Block 1, Karachi, Pakistan.
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Saravakos P, Kourtidis S, Hartwein J, Preyer S. Parotid Gland Tumors: A Multicenter Analysis of 1020 Cases. Increasing Incidence of Warthin's Tumor. Indian J Otolaryngol Head Neck Surg 2022; 74:2033-2040. [PMID: 36452806 PMCID: PMC9702007 DOI: 10.1007/s12070-020-01981-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: 06/11/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022] Open
Abstract
We assessed the frequency of the parotid gland tumor entities and correlated sex and age in different tumor types. Retrospective data were obtained from three major otorhinolaryngology clinics in Karlsruhe and Pforzheim, Germany within a 10-year period. In total, 1020 cases of parotidectomy for benign and malignant lesions were identified. We found 864 (84.7%) and 156 (15.3%) patients with benign and malignant tumors of the parotid gland, respectively. The most common benign parotid tumor was Warthin's tumor, followed by pleomorphic adenoma. The most common primary malignant tumor types were acinic cell carcinoma and mucoepidermoid carcinoma. Secondary malignant tumors of the parotid gland included lymphoma and metastatic, cutaneous squamous cell carcinoma. The frequency of Warthin's tumors was higher than that of pleomorphic adenomas. A large proportion of the malignant parotid tumors represent metastases from squamous cell carcinoma of the skin of the head and neck.
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Affiliation(s)
- Panagiotis Saravakos
- Department of Otorhinolaryngology, Head and Neck Surgery, ViDia Christliche Kliniken Karlsruhe, Diakonissenstrasse 28, 76199 Karlsruhe, Germany
| | - Savvas Kourtidis
- Department of Otorhinolaryngology, Head and Neck Surgery, ViDia Christliche Kliniken Karlsruhe, Diakonissenstrasse 28, 76199 Karlsruhe, Germany
| | - Joerg Hartwein
- Department of Otorhinolaryngology, Head and Neck Surgery, Siloah St. Trudpert Klinikum, Wilferdinger Straße 67, 75179 Pforzheim, Germany
| | - Serena Preyer
- Department of Otorhinolaryngology, Head and Neck Surgery, ViDia Christliche Kliniken Karlsruhe, Diakonissenstrasse 28, 76199 Karlsruhe, Germany
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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.
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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
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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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Parotid gland incidentalomas: A single-institution experience. Am J Otolaryngol 2022; 43:103296. [PMID: 34894452 DOI: 10.1016/j.amjoto.2021.103296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Parotid gland incidentaloma (PGI) management has not been well characterized in the literature. This study assesses clinicopathologic features, initial evaluation, management, and outcomes of PGIs discovered on various imaging modalities. MATERIALS AND METHODS This is a retrospective case series from a single academic institution. The study cohort included 34 patients with parotid gland incidentalomas discovered between January 2009 and December 2019. RESULTS Parotid gland incidentalomas were most frequently identified on magnetic resonance imaging (16 patients, 47.1%). Most patients (26 patients, 76.5%) underwent further evaluation with subsequent imaging, most often magnetic resonance imaging (18 patients, 69.2%), and fine needle aspiration biopsy (33 patients, 97.1%). Most tumors were benign on fine needle aspiration biopsy (19 patients, 57.6%). Most cases (21 patients, 61.8%) were managed with observation without parotidectomy. Malignant findings on fine needle aspiration cytology were associated with increased likelihood of undergoing parotidectomy (25% vs 0%; p = 0.04). Among the patients who received a parotidectomy, most (8 patients, 61.5%) had benign findings on final histopathology. CONCLUSION Parotid gland incidentalomas were discovered across a diverse set of imaging modalities in our institution. Magnetic resonance imaging and fine needle aspiration were often performed for further evaluation. Most cases were found to be benign on fine needle aspiration and were managed with observation. These findings highlight the necessity of appropriate work-up for these tumors, and the need for shared decision making between the patient and the physician in selecting the appropriate treatment strategy.
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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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Fabiana A, Carlotta L, Dimitri R, Federico B, Valeria B, Federico B. Minimally invasive temporalis tendon transposition and upper lid lipofilling for immediate and secondary facial reanimation in patients treated for malignant tumors of the parotid gland. J Craniomaxillofac Surg 2022; 50:419-425. [DOI: 10.1016/j.jcms.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/21/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022] Open
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Luksic I, Mamic M, Suton P. Management of malignant submandibular gland tumors: A 30-year experience from a single center. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:302-309. [PMID: 35428601 DOI: 10.1016/j.oooo.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Owing to histologic heterogeneity, biological behavior, and rarity, recommendations for the treatment of malignant submandibular gland tumors (MSGT) are inconsistent. The aim of this study was to present a single-center experience in the treatment of MSGT with an emphasis on surgical treatment, including indication on elective neck dissection (END). STUDY DESIGN Twenty-four MSGT were primary surgically treated (gland excision with neck dissection). Their records were retrospectively collected and analyzed. RESULTS The most frequent histology was adenoid cystic carcinoma (41.6%), followed by mucoepidermoid carcinoma (25%) and carcinoma ex pleomorphic adenoma (16.7%). There were 18 elective and 6 therapeutic neck dissections. Histopathologic examination confirmed 29% (7/24) of positive neck dissection specimens. The Kaplan-Meier analysis presented rates of disease-specific survival, disease-free survival, and overall survival (OS) of 81%, 78%, and 52% at 5 years, respectively. Patients undergoing postoperative radiotherapy had significantly higher OS rates compared with patients treated with surgery alone (P = .0209). CONCLUSION Results of this study suggest that END has questionable benefit in early stage MSGT. Elective selective neck dissection levels I-III is recommended in high-grade and advanced stage MSGT without evidence of multilevel lymphadenopathy.
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Affiliation(s)
- Ivica Luksic
- University of Zagreb School of Medicine, Department of Maxillofacial and Oral Surgery, University Hospital Dubrava, Zagreb, Croatia.
| | - Matija Mamic
- University of Zagreb School of Medicine, Department of Maxillofacial and Oral Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Petar Suton
- Division of Radiation Oncology, Department of Radiotherapy and Medical Oncology, University Hospital for Tumors, University Hospital Center "Sisters of Mercy", Zagreb, Croatia
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Sultan Abdul Kader MI, Abdullah A, Mohamad Yunus MR, Jaafar MN, Kew TY. Preoperative Challenges in Managing Intraparotid Schwannoma. Cureus 2022; 14:e21392. [PMID: 35198300 PMCID: PMC8856645 DOI: 10.7759/cureus.21392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/05/2022] Open
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Zahran F, Refaey Y, Shaker O, Abdelwahab A, Abdelmoneim IM. Diagnostic accuracy of human transcriptional activator (Myb) expression by ELISA technique versus immunohistochemistry in detecting salivary gland carcinomas. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_139_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ştefănescu EH, Mogoantă CA, Căluianu EI, Predescu OI, Florou C, Chercotă V, Iovănescu G. Benign tumors of the superficial lobe of the parotid gland. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:563-567. [PMID: 36588495 PMCID: PMC9926149 DOI: 10.47162/rjme.63.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tumors of the parotid gland are a rare occurrence among head and neck tumors (only 3-8%), and the vast majority are benign. Most benign tumors of the parotid gland are pleomorphic adenoma (PA), followed by Warthin's tumor (WT) and they occur in the superficial lobe. The only reasonable treatment is considered to be total tumor removal, but the appropriate surgical approach remains a matter of controversy. Over time, it went from enucleation to superficial parotidectomy (SP) and then to extracapsular dissection (ECD). SP is often considered to be the "gold standard"; however, the risk of intraoperative damage to the facial nerve (FN) cannot be ignored. Lately, ECD - which does not expose the main trunk of the FN - has been regarded as a safe technique for the treatment of small benign parotid tumors. PATIENTS, MATERIALS AND METHODS The study retrospectively reviewed all parotidectomies for benign parotid tumors of the superficial lobe performed in the Department of ENT, Municipal Emergency Clinical Hospital, Timişoara, Romania, between January 2014 and December 2018. The following patient data were collected: age; sex; follow-up duration; extension of the resection; use of FN monitoring and lesion features, including position, pathology, and size. Preoperative investigation protocol included a computed tomography (CT) scan to assess the size and location of the tumor helping the treatment planning. The same surgical team performed both standard SP and ECD for the treatment of these tumors. All cases were confirmed as benign parotid tumors. Recurrences of any kind and tumors involving the deep lobe of the gland were excluded from the study. All patients underwent a macroscopically complete resection of the tumor. The main outcome was the postoperative complications in the two groups. Data regarding these complications were recorded on follow-up visits at one, six, 12 and 24 months. RESULTS Ninety-five patients with benign parotid tumors were operated by the same surgical team at the Department of ENT, Municipal Emergency Clinical Hospital, Timişoara, between January 2014 and December 2018 but only 89 (38 men and 51 women) met the follow-up criteria and were included in the study. Sixteen (18%) patients underwent ECD, and 73 (82%) patients underwent SP as a primary intervention. The mean lesion size for ECD group was 2.0±0.9 cm and 4.2±1.7 cm in the SP group, and it was statistically significant (p<0.05). As expected, the most common type of tumor was PA but the distribution between the groups was different: in the SP group, PA represents 83% (61∕73) of cases but only 44% (7∕16) of cases in the ECD group. Median follow-up time was comparable in the two groups - 33±8 months for the ECD group and 39±11 months for the SP group. There were also differences between the two groups regarding the postoperative complication rate. There were significantly more transient and permanent FN paralysis, transient and permanent great auricular nerve (GAN) dysfunctions and Frey's syndrome (FS) in the SP group. CONCLUSIONS A comparison between ECD and SP as surgical procedures for the treatment of benign tumors of the parotid seems inappropriate as their indications do not overlap. ECD showed similar effectiveness and fewer side effects than SP and can be considered the treatment of choice for small, superficial and/or marginal tumors located in the lateral lobe of the parotid gland.
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Affiliation(s)
- Eugen Horaţiu Ştefănescu
- Department of ENT, Department of Nursing Surgery, University of Medicine and Pharmacy of Craiova, Romania; ;
| | | | - Elena Irina Căluianu
- Department of Nursing Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Octavian Ion Predescu
- Department of Nursing, Faculty of Nursing, Târgu Jiu Subsidiary, Titu Maiorescu University, Bucharest, Romania
| | - Charoula Florou
- Department of Forensic Medicine, General University Hospital of Larissa, Greece
| | - Vlad Chercotă
- Department of Ophthalmology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Gheorghe Iovănescu
- Department of ENT, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
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Clinicopathological characteristics and outcomes of 23 patients with secretory carcinoma of major salivary glands. Sci Rep 2021; 11:22639. [PMID: 34811395 PMCID: PMC8609010 DOI: 10.1038/s41598-021-01970-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
This retrospective study investigated the clinicopathological characteristics of secretory carcinoma of salivary glands (SCSG) in 23 patients with histopathologically confirmed SCSG between January 2010 and December 2020. In total, 13 males and 10 females (ratio, 1.3:1) aged 10 − 69 years (median, 45 years) were enrolled in this study; the average disease duration was 2.44 years (0.25–20 years). Twenty-one patients (91.3%) had SCSG in the parotid gland, and two (8.7%) in the submandibular gland. All patients had single nodules of diameters 0.8–4.8 cm (average 2.6 cm); five with lymph node metastases, and two with distant metastases. Immunohistochemically, tumors stained positive for S-100, mammaglobin, CK7, GATA3 and pan-Trk, and negative for DOG1, P63, and calponin, with Ki-67 positivity from 1 to 50%. ETV6 gene rearrangement was confirmed in 15 patients. All patients underwent oncological resection, four had radioactive particles implanted postoperatively, one received chemotherapy, and seven underwent chemoradiotherapy. Six patients had regional recurrences, two distant metastases, and one died before the last follow-up. SCSGs are typically indolent, with a low locoregional recurrence rate and excellent survival. Prognosis is correlated to clinical stage, pathological grade, and surgical procedures.
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Roh JL. Selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for deep lobe parotid pleomorphic adenoma. Oral Dis 2021; 29:188-194. [PMID: 34739166 DOI: 10.1111/odi.14069] [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] [Received: 07/28/2021] [Revised: 10/08/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Deep lobe parotid tumour is commonly removed with the covering superficial lobe of parotid gland. Total or subtotal parotidectomy leads to an increase in surgical morbidity. This study evaluated recurrence and function after selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for pleomorphic adenoma. MATERIALS AND METHODS Twenty-eight patients with deep lobe parotid pleomorphic adenomas underwent selective deep lobe parotidectomy with preservation of the superficial lobe and the facial lobe via Roh's incision. Each patient was evaluated with any complications, cosmetic and salivary functions and local recurrence. RESULTS Superficial lobe-preserving surgery via Roh's incision was successfully applied to all patients without injury to the facial nerve and the Stensen's duct for a median operation time of 65 min. Facial nerve paralysis was found only temporarily in 9 (32%) patients, and other complications were minimal. None of the patients had postoperative Frey's syndrome. Salivary secretory function in the operated side was well preserved. No recurrence was found in the patients for a median follow-up of 94 months. CONCLUSIONS Selective deep lobe parotidectomy via Roh's incision is a reliable option of treatment for deep lobe parotid pleomorphic adenoma.
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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
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Saripalli RRK, Alluri LSC, Jakkula A, Yadavilli SS. Extracapsular Dissection for Small Benign Tumors of Parotid Gland: A Case Report on Contemporary Technique. Cureus 2021; 13:e17007. [PMID: 34540408 PMCID: PMC8423323 DOI: 10.7759/cureus.17007] [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] [Accepted: 08/08/2021] [Indexed: 11/30/2022] Open
Abstract
Salivary gland tumor looms as painless enlarging mass which may embrace in both major or minor glands. Pleomorphic adenoma (PA) accord about 40-70% of all salivary gland tumors, where Warthin tumor, basal cell adenoma (BCA), adenoid cystic carcinoma (ACC), and sebaceous tumors have a strong predilection for major salivary gland. However, polymorphous low-grade adenocarcinoma (PLGA) has a marked predilection for the minor salivary gland. We present a case of PA in a 26-year-old male patient that has been successfully managed by extracapsular dissection (ECD) without any post-operative complications.
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Affiliation(s)
| | | | - Ananthnag Jakkula
- Department of Oral and Maxillofacial Surgery, GSL Dental College & Hospital, Rajahmundry, IND
| | - Sai Sarat Yadavilli
- Department of Oral and Maxillofacial Surgery, St. Joseph Dental College, Eluru, IND
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Roch M, Mauvais O, Vergez S, Brenet E, Lindas P, Toussaint B, Nguyen DT, Gauchotte G, Rumeau C, Gallet P. Is Revision Surgery Necessary for Patients With High Risk of Recurrence After Parotidectomy? A Multicenter Retrospective Study. Ann Otol Rhinol Laryngol 2021; 131:782-790. [PMID: 34496666 DOI: 10.1177/00034894211045269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Close margin is a frequent situation after parotidectomy. The need for systematic prophylactic revision surgery is a question that arises regularly for malignant tumors, as it exposes to a high risk of facial palsy, while oncological benefits are unclear. STUDY DESIGN retrospective study. SETTING Multicentric. SUBJECTS AND METHODS We included all patients operated for systematic revision surgery in case of close margins after parotidectomy for a malignant tumor and analyzed the rate of tumor residue and its risk factors. RESULTS A tumor residue was identified in 43.5% of 23 cases, but none in case of initial complete excision with supra-millimetric margins. Invaded lymph nodes were identified in 6 cases, but none in case of low-grade tumors. CONCLUSIONS Systematic revision seems mandatory in case of infra-millimetric margins and high-grade tumors or positive lymph node; further studies are needed to confirm whether it can be spared for T1-T2/N0 low-grade tumors, with close margins but complete initial excision.
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Affiliation(s)
- Médarine Roch
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Olivier Mauvais
- ENT Department, Regional University Hospital of Besancon, Besancon, France
| | - Sebastien Vergez
- ENT Department, Regional University Hospital of Toulouse, Toulouse, France
| | - Esteban Brenet
- ENT Department, Regional University Hospital of Reims, Reims, France
| | - Pierre Lindas
- ENT Department, Robert Schuman Hospital, Metz, France
| | - Bruno Toussaint
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Duc Trung Nguyen
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | | | - Cécile Rumeau
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Patrice Gallet
- ENT Department, Regional University Hospital of Nancy, Nancy, France
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Iyer J, Hariharan A, Cao UMN, Mai CTT, Wang A, Khayambashi P, Nguyen BH, Safi L, Tran SD. An Overview on the Histogenesis and Morphogenesis of Salivary Gland Neoplasms and Evolving Diagnostic Approaches. Cancers (Basel) 2021; 13:cancers13153910. [PMID: 34359811 PMCID: PMC8345412 DOI: 10.3390/cancers13153910] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Diagnosing salivary gland neoplasms (SGN) remain a challenge, given their underlying biological nature and overlapping features. Evolving techniques in molecular pathology have uncovered genetic mutations resulting in these tumors. This review delves into the molecular etiopatho-genesis of SGN, highlighting advanced diagnostic protocols that may facilitate the identification and therapy of a variety of SGN. Abstract Salivary gland neoplasms (SGN) remain a diagnostic dilemma due to their heterogenic complex behavior. Their diverse histomorphological appearance is attributed to the underlying cellular mechanisms and differentiation into various histopathological subtypes with overlapping fea-tures. Diagnostic tools such as fine needle aspiration biopsy, computerized tomography, magnetic resonance imaging, and positron emission tomography help evaluate the structure and assess the staging of SGN. Advances in molecular pathology have uncovered genetic patterns and oncogenes by immunohistochemistry, fluorescent in situ hybridization, and next–generation sequencing, that may potentially contribute to innovating diagnostic approaches in identifying various SGN. Surgical resection is the principal treatment for most SGN. Other modalities such as radiotherapy, chemotherapy, targeted therapy (agents like tyrosine kinase inhibitors, monoclonal antibodies, and proteasome inhibitors), and potential hormone therapy may be applied, depending on the clinical behaviors, histopathologic grading, tumor stage and location, and the extent of tissue invasion. This review delves into the molecular pathways of salivary gland tumorigenesis, highlighting recent diagnostic protocols that may facilitate the identification and management of SGN.
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Affiliation(s)
- Janaki Iyer
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (J.I.); (A.H.); (U.M.N.C.); (C.T.T.M.); (A.W.); (P.K.); (L.S.)
| | - Arvind Hariharan
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (J.I.); (A.H.); (U.M.N.C.); (C.T.T.M.); (A.W.); (P.K.); (L.S.)
| | - Uyen Minh Nha Cao
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (J.I.); (A.H.); (U.M.N.C.); (C.T.T.M.); (A.W.); (P.K.); (L.S.)
- Department of Orthodontics, Faculty of Dentistry, Ho Chi Minh University of Medicine and Pharmacy, Ho Chi Minh City 700000, Vietnam
| | - Crystal To Tam Mai
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (J.I.); (A.H.); (U.M.N.C.); (C.T.T.M.); (A.W.); (P.K.); (L.S.)
| | - Athena Wang
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (J.I.); (A.H.); (U.M.N.C.); (C.T.T.M.); (A.W.); (P.K.); (L.S.)
| | - Parisa Khayambashi
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (J.I.); (A.H.); (U.M.N.C.); (C.T.T.M.); (A.W.); (P.K.); (L.S.)
| | | | - Lydia Safi
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (J.I.); (A.H.); (U.M.N.C.); (C.T.T.M.); (A.W.); (P.K.); (L.S.)
| | - Simon D. Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC H3A 0C7, Canada; (J.I.); (A.H.); (U.M.N.C.); (C.T.T.M.); (A.W.); (P.K.); (L.S.)
- Correspondence:
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The impact of radical parotidectomy with immediate facial nerve reconstruction: a quality-of-life measure. The Journal of Laryngology & Otology 2021; 135:804-809. [PMID: 34315553 DOI: 10.1017/s0022215121001857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Immediate facial nerve reconstruction is the standard of care following radical parotidectomy; however, quality of life comparisons with those undergoing limited superficial parotidectomy without facial nerve sacrifice is lacking. METHOD Patients who underwent parotidectomy were contacted to determine quality of life using the University of Washington Quality of Life and Parotidectomy Specific Quality of Life questionnaires. A total of 29 patients (15 in the radical parotidectomy and 14 in the limited superficial parotidectomy groups) completed and returned questionnaires. RESULTS Using the University of Washington Quality of Life Questionnaire, similar quality of life was noted in both groups, with the radical parotidectomy group having significantly worse speech and taste scores. Using the Parotidectomy Specific Quality of Life Questionnaire, the radical parotidectomy group reported significantly worse speech, eye symptoms and eating issues. CONCLUSION Those undergoing radical parotidectomy with reconstruction had comparable overall quality of life with the limited superficial parotidectomy group. The Parotidectomy Specific Quality of Life Questionnaire better identified subtle quality of life complaints. Eye and oral symptoms remain problematic, necessitating better rehabilitation and more focused reconstructive efforts.
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Abstract
OBJECTIVE Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management. METHODS A literature search was performed on 25 August 2020 using the keywords 'incidentaloma', 'incidental finding', 'parotid', 'parotid gland', 'salivary gland' and 'head and neck'. Articles were reviewed by two authors before their inclusion. RESULTS Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy. CONCLUSION If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.
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Abdelgalil A. Imaging of the Parotid Impostors. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kligerman MP, Jin M, Ayoub N, Megwalu UC. Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults. JAMA Otolaryngol Head Neck Surg 2021; 146:1027-1034. [PMID: 32970111 DOI: 10.1001/jamaoto.2020.2944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is no consensus regarding optimal management of pleomorphic adenoma in adults. Objectives To compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age. Design and Setting This decision analytical model was performed from November 21, 2019, to June 15, 2020, using a Markov model. Model variables and ranges were selected based on a literature review. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each algorithm, either upfront elective parotidectomy or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis using variable ranges was then performed 5 times with patients in the model assigned a starting age of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would be associated with the model results. Main Outcomes and Measures Model outcomes were measured with quality-adjusted life-years (QALYs). Results In the study models, the age thresholds at which observation became more beneficial than parotidectomy were 88.5 years for patients with superficial lobe tumors (5.37 QALYs in favor of parotidectomy below this age, and 5.37 QALYs in favor of observation above this age) and 83.4 years for patients with deep lobe tumors (7.51 QALYs in favor of surgery below this age, and 7.51 QALYs in favor of observation above this age). There was no significant difference in outcomes between parotidectomy and observation among patients aged 70 to 80 years. Conclusions and Relevance This study suggests that the outcomes associated with parotidectomy and observation are similar at 70 years or older among patients with pleomorphic adenoma and that observation may be the favorable treatment in that age group.
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Affiliation(s)
- Maxwell P Kligerman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael Jin
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Noel Ayoub
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Thielker J, Wahdan A, Buentzel J, Kaftan H, Boeger D, Mueller AH, Wittig A, Schultze-Mosgau S, Ernst T, Guntinas-Lichius O. Long-Term Facial Nerve Outcome in Primary Parotid Cancer Surgery: A Population-Based Analysis. Laryngoscope 2021; 131:2694-2700. [PMID: 34050959 DOI: 10.1002/lary.29666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine immediate postoperative and long-term facial nerve dysfunction after parotid cancer surgery, risk factors, and the role of facial reanimation surgery. STUDY DESIGN Population-based long-term analysis for all new primary parotid carcinoma cases in Thuringia from 1996 to 2019. METHODS Data of the cancer registries of Thuringia, a federal state in Germany, were analyzed in combination with hospital-based data on facial function. RESULTS About 477 patients (42.3% women; median age: 68 years) were included. It was observed that 6.7% had a preoperative facial nerve dysfunction, 11.7% received a radical parotidectomy, that is, that 5% had a normal preoperative facial function but needed radical surgery because of intraoperative detection of tumor infiltration into the facial nerve. About 10.2% received facial nerve reconstruction surgery. Immediate postoperative facial nerve dysfunction in the other patients was observed in 34.4% of the patients. Advanced T classification (odds ratio [OR] = 2.140; confidence interval [CI] = 1.268-3.611; P = .004) and neck dissection (OR = 2.012; CI = 1.027-3.940; P = .041) were independent risk factors for immediate postoperative facial nerve dysfunction. In addition, 22.0% showed no recovery during follow-up. Advanced T classification (OR = 2.177; CI = 1.147-4.133; P = .017) and postoperative radiotherapy (OR = 2.695; CI = 1.244-5.841; P = .012) were independent risk factors for permanent postoperative facial nerve dysfunction. CONCLUSION Patients with primary parotid cancer are at high risk for long-term facial nerve dysfunction. It seems that the possibilities of facial reanimation surgery needs to be utilized even more effectively. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Ali Wahdan
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Suedharzklinikum Nordhausen, Nordhausen, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Andreas H Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, Jena, Germany
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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Advanced Statistical Analysis of 3D Kinect Data: A Comparison of the Classification Methods. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This paper focuses on the statistical analysis of mimetic muscle rehabilitation after head and neck surgery causing facial paresis in patients after head and neck surgery. Our work deals with an evaluation problem of mimetic muscle rehabilitation that is observed by a Kinect stereo-vision camera. After a specific brain surgery, patients are often affected by face palsy, and rehabilitation to renew mimetic muscle innervation takes several months. It is important to be able to observe the rehabilitation process in an objective way. The most commonly used House–Brackmann (HB) scale is based on the clinician’s subjective opinion. This paper compares different methods of supervised learning classification that should be independent of the clinician’s opinion. We compare a parametric model (based on logistic regression), non-parametric model (based on random forests), and neural networks. The classification problem that we have studied combines a limited dataset (it contains only 122 measurements of 93 patients) of complex observations (each measurement consists of a collection of time curves) with an ordinal response variable. To balance the frequencies of the considered classes in our data set, we reclassified the samples from HB4 to HB3 and HB5 to HB6—it means that only four HB grades are used for classification algorithm. The parametric statistical model was found to be the most suitable thanks to its stability, tractability, and reasonable performance in terms of both accuracy and precision.
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Ning Y, Wang W, Cai Y, Zhou Y, Jiang J, Zeng D, Sun R, Wang X, Zheng W, He T, Shui C, Liu W, Zhang Y, Chen X, Li C. The application of venous nerve conduit trap in the immediate repair and reconstruction of facial nerve in parotid gland tumor: an attempt of a new technique. Eur Arch Otorhinolaryngol 2021; 278:4967-4976. [PMID: 33948682 DOI: 10.1007/s00405-021-06732-6] [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: 12/18/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To introduce the application of venous nerve conduit in the immediate repair and reconstruction of facial nerve in parotid gland tumor. METHODS Three patients with parotid gland tumor in Sichuan Provincial Cancer Hospital were reviewed. All patients were found that the tumor encased and invaded the facial nerve which was difficult to be separated during the operation when all patients were treated with facial nerve repair and reconstruction with the venous nerve conduit trapping technique. RESULTS After 1-year follow-up, all patients recovered well in facial nerve function. CONCLUSION The venous nerve conduit trapping technique is an effective attempt in the immediate repair and reconstruction of facial nerve in parotid gland tumor, but it needs to be further confirmed by multiple studies.
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Affiliation(s)
- Yudong Ning
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Wei Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Jian Jiang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Xu Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Wanghu Zheng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Tianqi He
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Chunyan Shui
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Wei Liu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Yuyao Zhang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Xiaolei Chen
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China. .,Department of Head and Neck Surgery, Sichuan Cancer Hospital, No.55, 4th Section of Southern Renmin Road, Chengdu, 610041, Sichuan, China.
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Masmoudi M, Hasnaoui M, Guizani R, Lahmar R, Jerbi S, Mighri K. [Performance of the magnetic resonance imaging in parotid gland tumor histopathology]. Pan Afr Med J 2021; 39:10. [PMID: 34178238 PMCID: PMC8197060 DOI: 10.11604/pamj.2021.39.10.27813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/20/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction salivary gland tumors mainly occur in the parotid gland. These tumors are rare but are characterized by histological heterogeneity, thus posing diagnostic challenges. Magnetic resonance imaging (MRI) is currently the most reliable imaging test for the evaluation of these tumors. The purpose of this study was to highlight the diagnostic value of MRI and its role in parotid gland tumor histopathology. Methods we conducted a retrospective descriptive and analytical study of 50 patients with parotid gland tumor, operated and treated in the ear, nose and throat (ENT) Department and in the Department of cervicofacial surgery at the Tahar Sfar University Hospital of Mahdia between 2001 and 2019. All patients underwent preoperative MRI of the parotid gland. Results out of 50 patients included in the study, 36 (72%) had benign tumor and 14 (28%) malignant tumor. The sensitivity of MRI for the diagnosis of malignant tumor was 92.8% with a specificity of 97.2%, a negative predictive value of 93% and a positive predictive value of 97%. With respect to benign tumor characterization, MRI suggested the diagnosis of Warthin tumor in all cases (13 cases) and of pleomorphic adenoma in 22 out of 23 cases. There were two diagnostic errors: MRI suggested the diagnosis of pleomorphic adenoma instead of adenoid cystic carcinoma in one case and of malignant tumor instead of pleomorphic adenoma due to diffusion restriction. Conclusion MRI is highly efficient in the assessment of parotid tumor histology and, especially, after the advent of new functional sequences. However, only histological examination allows to confirm with certainty the diagnosis.
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Affiliation(s)
- Mohamed Masmoudi
- Département d´Oto-rhino-laryngologie, Hôpital Tahar Sfar Mahdia, Mahdia, Tunisia
| | - Mehdi Hasnaoui
- Département d´Oto-rhino-laryngologie, Hôpital Tahar Sfar Mahdia, Mahdia, Tunisia
| | - Rihab Guizani
- Département d´Oto-rhino-laryngologie, Hôpital Tahar Sfar Mahdia, Mahdia, Tunisia
| | - Rihab Lahmar
- Département d´Oto-rhino-laryngologie, Hôpital Tahar Sfar Mahdia, Mahdia, Tunisia
| | - Saida Jerbi
- Département d´Imagerie Médicale, Hôpital Tahar Sfar Mahdia, Mahdia, Tunisia
| | - Khalifa Mighri
- Département d´Oto-rhino-laryngologie, Hôpital Tahar Sfar Mahdia, Mahdia, Tunisia
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Sardar S, Dutta M, Dutta S, Das S, Sinha R. Do Benign Mass Lesions in the Superficial Lobe of Parotid Gland Influence Landmark-Based Search for Facial Nerve Trunk At Surgery? Medeni Med J 2021; 36:36-43. [PMID: 33828888 PMCID: PMC8020187 DOI: 10.5222/mmj.2021.43067] [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: 12/20/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the influence of benign mass lesions in the superficial lobe of parotid on the known anatomic landmarks for identifying the facial nerve trunk. Method Patients with unilateral biopsy-proven benign mass lesions in the superficial parotid were selected for this observational study. During superficial/partial superficial parotidectomy, distance of the facial nerve trunk from each landmark was assessed using spring calliper and correlated with the lesion’s volume (measured from the pre-operative imaging). At least two identifiers among tragal pointer (TP), posterior belly of digastric muscle (PBDM) and tympanomastoid suture (TMS) were considered. Results The study involved 32 patients. The lesions mostly involved the parotid tail (50%) and pretragal region (34.3%), and constituted of pleomorphic adenoma (~66%) and Warthin’s tumor (~9%), the rest being various cysts and hamartomas. TP was universally uncovered, while PBDM and TMS were exposed in 26 and 25 patients, respectively. Average distances between the facial nerve trunk and TP, PBDM and TMS were 12.79 mm (SD=2.33), 9.78 mm (SD=1.21) and 7.58 mm (SD=1.33), respectively. Correlation coefficients between the lesion’s volume and the distance of facial nerve from a given landmark were -0.11, 0.04 and -0.16 for TP, PBDM and TMS, respectively. Conclusion TP was the most easily available landmark on surgical dissection, while PBDM was the most consistent and the least variable when volumetric data of the benign mass lesions in the superficial lobe of parotid were considered as a factor influencing the distance from the facial nerve trunk.
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Affiliation(s)
- Subhadip Sardar
- R. G. Kar Medical College and Hospital, Department of Otorhinolaryngology and Head-Neck Surgery, West Bengal, India
| | - Mainak Dutta
- Kolkata Medical College and Hospital, Department of Otorhinolaryngology - Head and neck Surgery, West Bengal, India
| | - Sirshak Dutta
- Raigunj Government Medical College and Hospital, Department of Otorhinolaryngology- Head and neck Surgery, West Bengal, India
| | - Saumik Das
- North Bengal Medical College and Hospital, Department of Otorhinolaryngology- Head and Neck Surgery, West Bengal, India
| | - Ramanuj Sinha
- Kolkata Medical College and Hospital, Department of Otorhinolaryngology - Head and neck Surgery, West Bengal, India
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Saito ET, de Melo Costa LS, Trindade CP, Petrarolha SMP, Dedivitis RA. Evaluation of Outcome of Parotidectomy. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02177-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS Twenty-four sections on HNC-specific OD topics. CONCLUSION This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Vaz SC, Marques A, Lourenço J, Galzerano A. Warthin Tumor Incidentally Detected on PET/CT Showing Both 68Ga-DOTANOC and 18F-FDG Uptake. Clin Nucl Med 2021; 46:e118-e120. [PMID: 32956121 DOI: 10.1097/rlu.0000000000003291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A patient with moderately differentiated pancreatic neuroendocrine tumor with synchronous multifocal liver metastases was referred for further staging with PET/CT. The examinations were performed on 2 consecutive days and showed mild 68Ga-DOTANOC and intense 18F-FDG uptake in an incidental right parotid nodule. Differential diagnoses include primary or metastatic neuroendocrine tumor, malignant or benign primary parotid tumor, and intraparotid lymph node. Histology revealed characteristics of a Warthin tumor. While focal FDG uptake in Warthin tumor is frequently described, the somatostatin expression was rarely reported. This clinical case describes 68Ga-DOTANOC and 18F-FDG uptake in a parotid Warthin tumor histologically confirmed.
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Affiliation(s)
- Sofia C Vaz
- From the Champalimaud Centre for the Unknown, Champalimaud Foundation
| | | | - João Lourenço
- From the Champalimaud Centre for the Unknown, Champalimaud Foundation
| | - Antonio Galzerano
- From the Champalimaud Centre for the Unknown, Champalimaud Foundation
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