Combined role of spectral Doppler and diffusion-weighted MRI in the differentiation between benign and malignant masses of major salivary glands: a prospective cross-sectional study

The aim of this study was to evaluate the role of three diagnostic sonographic methods, greyscale sonography (GSS), colour Doppler sonography (CDS) and spectral Doppler (SPD), in differentiating between benign and malignant salivary gland (SG) tumours. 44 patients with SG masses were examined using GSS, CDS and SPD. The morphological features of each tumour were evaluated using GSS, the distribution and number of detected blood vessels were assessed using CDS, and peak systolic velocity (PSV), resistive index (RI) and pulsatility index (PI) were measured on SPD. All cases underwent excisional biopsy and a definite tissue diagnosis was obtained. Histopathological examination revealed that 28 of the 44 tumours were benign and 16 were malignant. GSS showed that malignant SG tumours had a significantly higher incidence of ill-defined borders and lymph node involvement than benign tumours, but there was no significant difference between benign and malignant SG tumours regarding echogenicity, homogeneity or sonographic shape. CDS demonstrated malignant tumours with significantly higher vascularity and a scattered distribution. Using SPD, malignant tumours had significantly higher PSV, RI and PI compared with benign tumours. RI values above 0.7, PI values above 1.2, PSV values above 44.3 cm s(-1), ill-defined borders, lymph node involvement, Grade 2 or 3 vascularity and hilar distribution of blood vessels should alert the clinician to suspect a malignant SG tumour. After consensus on the threshold values of PSV, RI and PI in differentiating benign from malignant SG tumours, these numbers should be incorporated into the software of ultrasound machines to guide the sonographer in his or her analysis.

Objectives: To explore the polarizing color profile in connective tissue stroma of Picro-Sirius Red (PSR) stained sections of benign and malignant salivary gland tumors (SGT) and to assess the possible utility of this method as a diagnostic tool. Materials and Methods: A total number of 60 Paraffin blocks of benign (30 cases) and malignant (30 cases) salivary gland tumors were selected from the archives of our institute and regional cancer hospital. 30 cases of Mucous Extravasation Phenomenon (MEP) were selected as control. Salivary gland tumors and control were stained with PSR stain and examined under polarizing microscope. We counted 50 thin and 50 thick collagen fibers in each section of benign and malignant SGT and were categorized as Greenish Yellow (GY) or Yellowish Orange (YO). Statistical analysis was performed by using oneway ANOVA and Paired t-test. Results: We found similar presentation of polarizing color arrangement for thin collagen fibers (80-85% GY and 15-20% YO) in both benign and malignant SGT and MEP. In malignant SGT, thick collagen fibers exhibited different polarizing color (80% GY) than benign SGT and MEP (12-14% GY). Polarizing color profile of collagen in malignant SGT displayed a different presentation as compared to benign SGT and control (MEP) and differences were statistically significant(p<0.05). Conclusion: This study concluded about the difference of stromal collagen fibers in benign and malignant SGT. Malignant SGT suggesting loosely arranged collagen fibers could be involved in further growth and invasion of disease along with other cellular and molecular events. Keywords: Collagen, Mucous Extravasation Phenomenon, Picro-Sirius Red (PSR) Stain, Polarized Microscopy, Salivary Gland Tumor

Objective To evaluate the application of high b-value diffusion weighted imaging (DWI) and ADC values for malignant and benign breast lesions.Methods There were 165 patients with 171 suspicious malignant breast lesions received low and high b-value ( 500 and 1500 s/mm2 ) DWI scan before dynamic contrast-enhanced MRI (DEC-MRI).Using normal breast as the reference base,the signal intensity and ADC values of the 171 lesions on high-b-value ( b = 1500 s/mm2 ) DWI were retrospectively analyzed If a lesion showed abnormal enhancement on DCE-MRI and high signal intensity on high-b-value (b = 1500 s/mm2 ) DWI,that lesion was defined as positive result on behalf of malignant lesion; the otherwise was defined as negative result on behalf of benign lesion.ADC values were calculated for the 111 lesions with positive results on DWI.And all lesions received a biopsy after MR scan.References to the histopatholngical results,the amounts of positive and negative results on high-b value DWI were recorded.Using 1.13 × 10 -3mm2/s as the cutoff value,the sensitivity and specificity of ADC value for the diagnosis of malignant breast lesion were calculated.Fisher exact tests and Wilcoxon rank sum tests were used for statistical analyses.Results There are 91 malignant and 80 benign lesions the 171 lesions confirmed by histopathology.On high-b value DWI,139 lesions were visually positive results,including 83 malignant and 56 benign lesions.Other 32 lesions were visually negative results,including 24 benign lesions and 8 malignant lesions (non-mass ductal carcinoma in situ).There are statistically significant difference between malignant and benign lesions ( P ＜ 0.01 ).All invasive carcinoma and mass-forming DCIS were visually positive results,whereas eight non-mass DCIs lesions were visually negative results,the overall sensitivity and specificity were 91.2％ (83/91)and 30.0％ (24/80),respectively.In the 111 lesions with DWI positive result ( 110 mass lesions and one focal lesion),the mean ADC value of the 63 malignant lesions was (0.73 ±0.24) × 10-3 mm2/s,whereas the mean ADC value of the 48 benign lesions was( 1.19 ±0.42) ×10-3 mm2/s.There was statistically significant difference between benign and malignant lesions (Z =5.818,P ＜0.01 ).When ADC value of 1.13 × 10-3 mm2/s was chosen as the cutoff value,61 malignant lesions were true positive results,2 mucinous carcinoma were false-negative results,27 benign lesions were true negative results,21 benign lesions were false-positive results,the sensitivity and specificity was 96.8％(61/63) and 56.2％ (27/48),respectively.Conclusions High b-value DWI and ADC values were useful for distinguishing of malignant and benign breast lesions,but it should be cautious when it was used for the diagnosis of non-mass breast lesions. Key words: Breast neoplasms; Magnetic resonance imaging; Comparative study

Objectives: The aim of the study is to analyze the usefulness of resistive index in differentiating benign lesions from malignant breast lesions among suspected breast cancer patients using color Doppler ultrasound.Method: The study was conducted in the Department of Diagnostic Radiology in Lahore General Hospital, from March 2022 to May 2022. Prospective cross-sectional study and convenient sampling technique was used. Total 200 patients suspected of Breast cancer after clinical examination were included in the study. Color Doppler ultrasound was performed. Systolic peak and resistive index were evaluated for each patient and results were compared with biopsy and cytology reports.Results: From the results of color Doppler ultrasound, 86 lesions were found malignant and 114 breast lesions were found benign. From findings mean value of RI in malignant lesions was 0.76 ± 0.092 and in benign lesions was 0.64 ± 0.064. Statistical significance was found 0.05. It was also observed that benign breast lesions showed less vascularity in comparison to high vascularity in malignant breast lesions. Increased vascularity in benign lesions was 37.7% and in malignant lesions was 96.5%. Systolic velocity and systolic peak were low in benign lesions and in malignant lesions high systolic velocity and sharp systolic peak was observed. Conclusion: In developing countries where public health screening programs are not sufficiently available, color and spectral Doppler ultrasound has an important role in early detection of breast cancer. It is a noninvasive imaging technique. Resistive index, systolic peak and hyper vascularity are useful indicators for differentiating benign lesions from malignant breast lesions.

Aim: Breast cancer is the second leading cause of death in women. This study sought to evaluate the role of ultrasonography in identifying benign from malignant breast tumors using the Resistive Index and Pulsatility Index values. Materials and Methods: The data were collected from 60 patients having breast cancer between the ages of 20-60 who visited the Allied Hospital for breast imaging by close-ended questionnaire. The data were analyzed by correlation with the help of SPSS V22. Results: Patients were divided into two groups; benign (35 cases) and malignant (25 cases). Fibroadenoma was the most common benign tumor while invasive ductal carcinoma was the most common malignant tumor. There was no obvious difference in the location of benign and malignant breast lesions, but the majority of lesions (40%) were located in the upper outer quadrant. After combining all benign and malignant lesions, the correlation coefficient, or r value, was 0.399 (P=0.066). The resistive index revealed 25 malignant cases (41%) and 35 benign cases (58%) which were not statistically significant (P=0.16). However, Pulsatility Index revealed 34 benign cases (57%) and 26 cancer cases (43%) which were statistically insignificant (P=0.13). However, ultrasound’s sensitivity, specificity, and positive and negative predictive values were 93.8%, 86.5%, 86.9%, and 93.8% respectively. Conclusion: This study showed that malignant lesions had higher values for the Doppler parameters (RI, PI), while benign lesions had lower values while benign lesions are more common than malignant ones. RI helps radiologists when to perform a biopsy.

BackgroundWhereas the antimicrobial peptides hBD-2 and -3 are related to inflammation, the constitutively expressed hBD-1 might function as 8p tumour suppressor gene and thus play a key role in control of transcription and induction of apoptosis in malignant epithelial tumours. Therefore this study was conducted to characterise proteins involved in cell cycle control and host defence in different benign and malignant salivary gland tumours in comparison with healthy salivary gland tissue.Methods21 paraffin-embedded tissue samples of benign (n = 7), and malignant (n = 7) salivary gland tumours as well as healthy (n = 7) salivary glands were examined immunohistochemically for the expression of p53, bcl-2, and hBD-1, -2, -3.ResultsHBD-1 was distributed in the cytoplasm of healthy salivary glands and benign salivary gland tumours but seems to migrate into the nucleus of malignant salivary gland tumours. Pleomorphic adenomas showed cytoplasmic as well as weak nuclear hBD-1 staining.ConclusionHBD-1, 2 and 3 are traceable in healthy salivary gland tissue as well as in benign and malignant salivary gland tumours. As hBD-1 is shifted from the cytoplasm to the nucleus in malignant salivary gland tumours, we hypothesize that it might play a role in the oncogenesis of these tumours. In pleomorphic adenomas hBD-1 might be connected to their biologic behaviour of recurrence and malignant transformation.

Salivary gland tumours: an epidemiological review of non-neoplastic and neoplastic pathology

Prostate-specific membrane antigen (PSMA) is a key diagnostic/prognostic, therapeutic target in prostate cancer. While PSMA expression is well established in prostate cancer, its expression is also observed in non-prostatic tissues and other tumors. PSMA expression is observed in salivary gland tumors (SGTs); however, its expression pattern is not well established. This study assessed the distribution of PSMA expression in SGT specimens. This study retrospectively analyzed archived SGT specimens. Patient records were reviewed and their formalin-embedded tumor blocks were retrieved from the pathology department files.Immunohistochemical staining and examination was performed using an antibody directed againstPSMA to assess expression levels in 243 salivary gland specimens containing 126 specimens of malignant and 117 specimens of benign SGTs. PSMA staining was quantified using a modified immunohistochemical scoring method (H score; range 0-300). PSMA expression was observed in both benign SGTs and malignant SGTs; however, PSMA expression in malignant SGTs was higher than in benign SGTs.PSMA was expressed in 94% (118/126) of malignant SGTs (represented as average histochemical [Havg] score, [Havg = 95.2]), and 61% (71/117) of benign SGTs (Havg = 37.3). Amongst malignant SGT specimens, the highest Havg scores were observed for adenoid cystic carcinoma (Havg = 133.7) and acinic cell carcinoma (Havg = 133.6). Based on the modal staining intensity scoring, strong PSMA staining (staining intensity score = 3) was observed at higher rates in malignant (38%, 48/126) versus benign (18%, 21/117) SGTs. This study demonstrated that PSMA is commonly expressed in malignant SGTs, suggesting that PSMA could be effective for targeted imaging and therapeutics in these tumor types.

Background: The diffusion weighted imaging and ADC value give appreciable information about tumor cellularity with tissue contrast between the active and necrotic areas within the tumor. This would be valuable and could direct the beneficial site for interventional procedure and biopsy to be taken from the viable tumoral tissue especially in case with non-enhanced studies due to renal impairment. Objective: The aim of this study was to investigate the capacity of Diffusion MRI to predict the benign and malignant Salivary gland tumors, using ADC value and DWI. Patients and Methods: This study included 40 patients (24 male and 16 female). Sixteen patients had malignant lesions and twenty-four had benign ones. The DWI was obtained with b values including 0 and 800mm2/second. The Apparent Diffusion Coefficient (ADC) generated by measuring identical images at different b-values and represented as ADC map, from which the ADC value was calculated. Results: The absolute ADC value of lesions was significantly different between benign and malignant salivary gland tumors (p<0.001). The sensitivity of ADC in differentiating benign from malignant lesions in our study was 93.7% indicating a high true positive rate. Hence, if the average ADC is below 0.85 x 10 -3 mm2/sec, there is high probability that the mass will be malignant with high specificity of 95.8 %. Results revealed that the mean ADC value of benign and malignant salivary gland tumors were 1.33±0.46x 10-3 mm2/s and 0.65±0.21 x 10-3 mm2/s, respectively. The mean ADC value of benign was significantly higher than that of malignant lesions. Conclusion:Theuse of DWI and ADC values can provide better assessment of salivary gland tumors and predict the benign and malignant lesions.

Preoperative imaging of salivary gland tumors is important for predicting and differentiating benign from malignant tumors, and for aiding management planning. We aimed to investigate the accuracy of combined quantitative diffusion-weighted magnetic resonance imaging (MRI) and routine contrast-enhanced MRI in the evaluation of salivary gland tumors and the differentiation of benign from malignant tumors. This study included 51 patients with a total of 16 benign and 35 malignant lesions that were detected by histopathological analysis. There was a statistically significant difference between the apparent diffusion coefficient values (ADC) of malignant and benign lesions (0.69 ± 0.22 × 10-3 mm2/s and 1.39 ± 0.52 × 10-3 mm2/s respectively). The optimal cut-off ADC value was 1.08 with 75% specificity and 97% sensitivity. The routine contrast-enhanced MRI had predicted benign and malignant tumors with 65% sensitivity and 44% specificity. The sensitivity and specificity were greatly increased when quantitative diffusion-weighted MRI was combined with routine contrast-enhanced MRI: 100%, and 88% respectively. A receiver operating curve was generated. The area under curve was 0.88 (p < 0.001, 95% CI: 0.76-0.99). Combined quantitative diffusion-weighted MRI with ADC measurements and routine contrast-enhanced magnetic resonance imaging are helpful tools for the evaluation of salivary gland tumors and help differentiate benign from malignant lesions.

Objective To evaluate the value of quantitative 3T dynamic contrast enhanced MRI in the diagnosis of breast lesions. Methods One-hundred and eighteen patients suspected of breast lesions underwent MRI examination. A 3.0 T MR scanner was used to obtain the quantitative MR pharmacokinetic parameters: Ktrans( volume transfer constant), Kep (exchange rate constant) and Ve (extravascular extracellular volume fraction). The mean Ktrans, Kep and Ve of malignant, benign and normal glandular tissues were calculated and compared each other using LSD method. Independent sample t test was used between invasive ductal carcinoma and ductal carcinoma in situ (microinvasion included). Finally, the areas under the ROC curve (AUC) of Ktrans, Kep and Ve between malignant and benign lesions were compared. Results The mean Ktrans, Kep and Ve of malignant lesions (n=87) were (1.010±0.580) min-1, (1.634 ± 1.481) min-1 and (0.735 ±0.273); the mean Ktrans, Kep and Ve of benign lesions (n=23) were (0.331±0.192) min - 1, (0.417±0.324) min - 1 and (0.847±0.291); and the mean Ktrans, Kep and Ve of normal glandular tissues (n =83) were (0.051 ±0.028) min-1, (0.133±0.125) min-1 and (0.597±0.354), respectively. There were significant differences between normal glandular tissues and benign lesions, normal glandular tissues and malignant lesions, benign and malignant lesions in Ktrans (t=9.681, 11.189, 5. 590, respectively, P ＜ 0. 01 ), normal glandular tissues and malignant lesions, benign and malignant lesions in Kep(t =5. 287, 3. 874, P＜0. 05). There were a statistic differences between normal glandular tissues and benign lesions, normal glandular tissues and malignant lesions in Ve(t =2. 932, 2. 562 ,P ＜0. 05). There were no significant differences between normal glandular tissues and benign lesions in Kep, benign and malignant lesions in Ve ( t = 0. 760, 0. 832, P ＞ 0.05 ),invasive ductal carcinoma and ductal carcinoma in situ (microinvasion included) in Ktrans, Kep and Ve(t =0.834,0.075,0.454,P＞0.05). The areas under the ROC curve (AUC) of Ktrans, Kep and Ve between malignant and benign lesions were 0. 934, 0. 941 and 0. 659. The sensitivity of Ktrans, Kep and Ve were 77.01% ,91.95% ,56. 32% and the specificity of Ktrans, Kep and Ve were 95. 65%, 86. 96%, 78.26% for the differential diagnosis of breast lesions if taken the maximum Youden's index as cut-off. Conclusion The differential diagnosis of benign and malignant breast lesions by Ktrans, Kep is applicable. Key words: Breast neoplasms; Magnetic resonance imaging; Diagnosis,differential

To explore the molecular mechanisms involved in pathophysiology of malignant and benign salivary gland tumors (SGTs), we investigated main tumor-inducing chemokines and chemokine receptors, CXCL12/CXCR4/ACKR3 (CXCR7), CXCR3/CXCL10, CCR5/CCL5, CCL21/CCR7, CCL2, CCR4, CXCR5, CCR6, and CXCL8 in tumor tissues. Parotid tissues were obtained from 30 patients with malignant and benign SGTs. Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to determine the mRNA expression pattern of the mentioned chemokines/chemokine receptors and immunohistochemistry (IHC) was performed to verify the expression of CCR7. Expression levels of CCR7 and CCR4 transcripts were higher in the tumor tissues of malignant cases in comparison to benign ones (p=0.03 and 0.02). Immunohistochemistry analysis confirmed that the protein level of CCR7 concurred with the mRNA expression. CCL2 gene transcripts were observed with a higher expression in patients with tumor-free lymph nodes (LN-) and early stages, whereas CCR7 transcript was higher in LN+ and late stages of the disease. A significant inverse correlation was found between CXCL10 transcript and tumor size in benign cases. The mRNA expression of CCR7, CCR4, CXCR3, CCL21, CCL5, and CXCL12 was significantly higher in mucoepidermoid carcinoma in comparison to pleomorphic adenoma subtypes (p<0.05). On the basis of the present study, it was determined that malignant and benign SGTs exhibit a distinct pattern of chemokines and chemokine receptors, which are probably associated with known biological and clinical behaviors of these tumors. Significant increased CCR4 and CCR7 expression in malignant SGTs might play a central role in malignant transformation that introduces them as new targets for cancer immunotherapy.

Significance of resistive index in color doppler ultrasonogram: Differentiation between benign and malignant breast masses

Differentiation of breast cancer has been receiving increasing attention in attempts to minimize the numbers of excisional biopsies for benign tumors. Doppler spectral parameters, such as peak systolic velocity (PSV) and pulsatility index (PI), have been used but these are unable to differentiate breast cancers and benign tumors with adequate levels of specificity and sensitivity. The aim of this study was to determine whether the acceleration time index (ATI) could reliably differentiate breast tumors. In 102 breast masses, Doppler ultrasonography (US) was performed with a LOGIQ700MR. PSV, PI and ATI were calculated from intratumoral flow. Forty-eight malignant tumors were identified by histologic evaluation, 13 benign tumors were diagnosed by fine needle aspiration biopsy (FNAB) and 41 benign masses were diagnosed by characteristic gray-scale findings and long-term (>18 months) follow-up examinations. Doppler signals were detected in 35 of 54 (64.8%) benign lesions and in 46 of 48 (95.8%) breast cancers. PSV and PI value showed no statistical significance between malignant and benign lesions (PSV; p=0.1147, PI; 0.1506). ATI values were lower in benign lesions (p<0.0001). An ATI value of 0.14 seems to be the optimum threshold for the differentiation of benign and malignant lesions (79.4% sensitivity, 87.2% specificity). No malignant lesions were seen when the ATI value was <0.14 and the PI value was <1.1. ATI was found to be the most useful parameter for differentiating benign breast tumors from malignant ones.

Objective To discuss the value of conventional ultrasound combined with virtual touch tissue imaging (VTI) in differentiating benign and malignant breast lesions by breast imaging reporting and data system (BI-RADS) diagnostic criteria. Methods From January 2013 to October 2014, 395 breast lesions from 389 patients from the Tenth People's Hospital, Tongji University were included in present study. All the lesions were confirmed by surgery pathology. Conventional ultrasound and VTI examinations were done before surgery. Both benign and malignant lesions were classified into varied categories based on the boundary of lesions under VTI mode. Benign and malignant breast lesions were classified into BI-RADS categories by conventional ultrasound or conventional ultrasound combined with VTI. The χ2 test was used to compare the differences of lesions′ boundaries between VTI categories and VTI mode. The pathology findings were used as golden criteria, to calculate the sensitivity, specificity and accuracy of conventional ultrasound as well as conventional ultrasound combined with VTI. And their diagnostic performances were compared by McNemar′s test. Results Of 395 breast lesions, 282 (71.4%) were benign, 113 (28.6%) were malignant. 75.5% (213/282) benign lesions were classified as Ⅱ-Ⅲ under VTI mode, while 83.2% (94/113) malignant lesions were classified as Ⅳ-Ⅴ under VTI mode. The differences in classification between them was statistically significant (χ2=114.759, P<0.01). 77.7% (219/282) benign lesions had unclear boundaries under VTI mode, while 78.8% (89/113) malignant lesions had clear boundaries under VTI mode. The differences in boundaries between them was statistically significant (χ2=108.480, P<0.01). The sensitivity, specificity and accuracy of conventional ultrasound in differentiating benign and malignant breast lesions were 97.3%, 54.2% and 66.6% respectively; while the sensitivity, specificity and accuracy of conventional ultrasound combined with virtual touch tissue imaging in differentiating benign and malignant breast lesions were 98.2%, 84.4% and 88.4% respectively. The specificity and accuracy were higher when only using conventional ultrasound with statistical significance (χ2=79.425, 67.549, both P<0.01); however the sensitivity had no significantly different (χ2=11.974, P<0.01). Conclusion Conventional ultrasound combined with virtual touch tissue imaging can improve the specificity and the accuracy in differentiating benign and malignant breast lesions. Key words: Elasticity imaging techniques; Ultrasonography; Breast diseases; Diagnosis, differential