Diagnosis Of Parotid Gland Lesions Research Articles

Diagnostic Accuracy of Ultrasonography in Diagnosis of Parotid Gland Lesions Using Fine-Needle Aspiration Cytology as The Gold Standard

Objective: To determine the diagnostic accuracy of ultrasound by using ultrasound-guided FNAC as the gold standard for diagnosing parotid salivary gland conditions. Methods: A prospective observational study was conducted at the Radiology department of Islamabad Diagnostic Centre from January 2022 to December 2022. Patients of all ages and genders with suspected major salivary gland conditions were included. All patients underwent ultrasonography and FNAC after providing informed consent and receiving an explanation of the procedure. Following local anesthesia, a needle was inserted under ultrasound guidance to aspirate tissue samples. The aspirated material was labeled, handled, and transported for laboratory analysis. Data were collected using a self-designed form, and data analysis was carried out using SPSS version 20. Results: A total of 47 cases were evaluated, with a mean participant age of 47.31 years. Of all participants, 57.4% were males, and 42.6% were females. Among the cases with benign FNAC results, 19 were correctly identified as benign in histopathology (True Positives, TP), while 2 were incorrectly classified as malignant (False Positives, FP). Conversely, for the cases with malignant FNAC results, 6 were falsely identified as benign (False Negatives, FN), and 20 were correctly classified as malignant (True Negatives, TN). Sensitivity was found to be 76%, and specificity was 95%. The positive predictive value (PPV) was 90%, and the negative predictive value (NPV) was 76%. The overall accuracy of ultrasound-guided FNAC was calculated to be 82%. Conclusion: Ultrasonography has proven to be an effective, non-invasive, and reliable diagnostic tool for assessing parotid gland pathology. It demonstrated a strong capability in accurately distinguishing between benign and malignant cases, with high sensitivity and specificity.

Value of magnetic resonance imaging and sialography of the parotid gland for diagnosis of primary Sjögren syndrome

To evaluate the utility of magnetic resonance imaging (MRI) and magnetic resonance sialography (MRS) for diagnosis of primary Sjögren syndrome (pSS) singly or integrated with 2016 American College of Rheumatology (ACR)/European League Against Rheumatic Diseases (EULAR) classification criteria. The diagnostic efficiencies of MRI, MRS, and labial salivary gland biopsy (LSGB) were evaluated. The prediction model was established by multivariate analysis. Finally, performance of the ACR/EULAR criteria was evaluated after addition of MRI + MRS or replacement of original items by MRI + MRS. The combined use of LSGB + MRI + MRS provided the greatest diagnostic value. MRI and MRS grade had positive correlations with disease duration and pathological grade of the labial gland (both P < 0.001). MRI and MRS grade had positive correlations with xerostomia severity and negative correlations with unstimulated salivary flow rate (both P < 0.001). The consistency of MRI grade and MRS grade in the diagnosis of parotid gland lesions was poor (κ=0.253, P < 0.001). The diagnostic efficiency of our prediction model (AUC 0.906) was similar to that of criteria from the ACR/EULAR (AUC 0.930). Adding MRI + MRS to the ACR/EULAR criteria improved the sensitivity (92.3% vs 90.8%), whereas the specificity remained the same (88.9% vs 89.1%). Replacing LSGB by MRI + MRS in the ACR/EULAR criteria decreased both sensitivity and specificity (88.1% vs 90.8% and 86.4% vs 89.1%, respectively). The combined application of MRI and MRS has ideal clinical application value in the diagnosis of early-stage pSS. Validity of the ACR/EULAR criteria remains high after incorporation of MRI + MRS.

Diagnostic discrepancies in fine needle aspiration diagnosis of parotid gland lesions in a resource limited hilly region

The characteristic cytological features of parotid gland lesions have been well described in literatures, but there also exist cytological diagnostic pitfalls that make it difficult to form an accurate diagnosis in some cases. Aim: To evaluate the sensitivity, specificity, along with positive predictive value, negative predictive value by Cyto- histological correlation in various lesions with an emphasis on discordant cases. Materials and Methods: A retro-prospective study of 250 non- guided/palpable FNAC of suspected parotid gland enlargements were performed from 2006 to 2018 at tertiary care hospital. The cytological smears were stained with May grunwald giemsa, papanicolaou, hematoxylin eosin stains. Surgically resected specimens were received for histopathology in 103 relevant cases only. The cytologic and Histologic slides were studied, compared and correlated where ever possible and statistical analysis done. Result: Out of 250 patients male to female ratio was 1.4: 1. The different categories of salivary gland lesions included: non neoplastic, benign and malignant constituted 109,108 and 33 cases respectively. Pleomorphic adenoma and mucoepidermoid carcinoma was the commonest benign and malignant neoplasm reported in this study respectively. False negative and false positive results were mainly due to cystic and papillary lesions. The sensitivity, specificity, along with positive predictive value, negative predictive value and diagnostic accuracy of present study was 68.42%, 98.80%, 92.85%, 93.25% and93.20% respectively. Conclusion: Though palpable FNAC of the parotid gland tumors is simple, rapid and cost-effective in a developing country but rate of characterization of specific type of parotid gland tumor is lower due to overlapping cytomorphology. Keywords: Parotid swelling, Histopathology, Cytology, Morphological discordance.

Primary extraosseous plasmacytoma of the parotid gland: A case report and literature review.

Extraosseous plasmacytoma (EOP) is an uncommon malignant tumour that is characterised by the monoclonal proliferation of abnormal plasma cells in soft tissue; however, EOP lacks the defining features of multiple myeloma or medullary plasmacytoma. Although the majority of EOP lesions occur in the head and neck, EOP of the parotid gland is extremely uncommon. The present study aimed to explore the clinical features of parotid plasmacytoma, in addition to the diagnostic and therapeutic options for its management. Using the Medline database, a search was conducted for articles published on the topic of ‘parotid plasmacytoma’ up until the year 2016. A total of 20 cases were evaluated, including 19 clinical cases from the literature and 1 new clinical case from our hospital. Among the 19 previously published cases, the mean age at the time of diagnosis of EOP was 65.1±10.9 years (range, 38–78 years). Plasmacytomas were located unilaterally in all cases: On the right side in 9 patients (47.4%), on the left side in 10 patients (52.6%). Treatment included chemotherapy in 3 cases, radiotherapy in 11 cases and surgical removal in 15 cases. The diagnosis of EOP is based on the presence of a localised tumour comprising monoclonal plasma cells, and EOP is identical to multiple myeloma in this regard; however, EOP, in contrast to multiple myeloma, does not exhibit the signs that are indicative of disseminated disease, such as additional lesions on skeletal radiological examination, plasmacytosis in the bone marrow, and hypercalcaemia, anaemia, or renal failure. Thus, EOP must be considered in the differential diagnosis of parotid gland lesions in order to avoid confusion with other tumoural diseases.

Fine-needle aspiration cytology (FNAC): is it useful in preoperative diagnosis of parotid gland lesions?

Background: Salivary gland tumors are an uncommon entity and its histopathology is highly varied due to heterogeneous cellular composition. The role of the preoperative fine-needle aspiration cytology (FNAC) remains controversial. The purpose of this study is to compare the cytologic findings of salivary gland lesions with the histologic diagnoses, in order to assess the usefulness and accuracy of fine-needle aspiration cytology in the diagnosis of parotid gland tumors.Methods: A retrospective study was performed, regarding patients (n = 65) submitted to surgery for the treatment of parotid gland disease, who had performed preoperative FNAC, in our department between 2002 and 2012.A histologic diagnosis was considered as the gold standard for the assessment of sensitivity and specificity of FNAC. A cytohistologic correlation was done and appropriate statistical tests were applied.Results: Concordance between FNAC and histological specimen analysis was 78%. FNAC specificity was 82% and sensitivity was 71%. Positive and negative predictive values were 65% and 86% and positive likelihood ratio and negative likelihood ratio were 3.92 and 0.35, respectively. The diagnostic accuracy for this test was 78%.Conclusion: Preoperative FNAC of parotid lesions is reasonably accurate and useful in diagnosing benign from malignant lesions and in planning appropriate approach for treatment.

A Systematic Review and Meta-Analysis of the Diagnostic Accuracy of Fine-Needle Aspiration Cytology for Parotid Gland Lesions

The clinical usefulness of fine-needle aspiration cytology (FNAC) for the diagnosis of parotid gland lesions is controversial. Many accuracy studies have been published, but the literature has not been adequately summarized. We identified 64 studies on the diagnosis of malignancy (6,169 cases) and 7 studies on the diagnosis of neoplasia (795 cases). The diagnosis of neoplasia (area under the summary receiver operating characteristic [AUSROC] curve, 0.99; 95% confidence interval [CI], 0.97-1.00) had higher accuracy than the diagnosis of malignancy (AUSROC, 0.96; 95% CI, 0.94-0.97). Several sources of bias were identified that could affect study estimates. Studies on the diagnosis of malignancy showed significant heterogeneity (P < .001). The subgroups of American, French, and Turkish studies showed greater homogeneity, but the accuracy of these subgroups was not significantly different from that of the remaining subgroup. It is not possible to provide a general guideline on the clinical usefulness of FNAC for parotid gland lesions owing to the variability in study results. There is a need to improve the quality of reporting and to improve study designs to remove or assess the impact of bias.

Computer Aided Diagnosis of Parotid Gland Lesions Using Ultrasonic Multi-Feature Tissue Characterization

In this article, an ultrasound based system for computer aided characterization of biologic tissue and its application to differential diagnosis of parotid gland lesions is proposed. Aiming at an automated differentiation between malignant and benign cases, the system is based on a supervised classification using tissue-describing features derived from ultrasound radio-frequency (RF) echo signals and image data. Standard diagnostic ultrasound equipment was employed to acquire ultrasound RF echo data from parotid glands of 138 patients. Lesions were manually demarcated as regions-of-interest (ROIs) in the B-mode images. Spectral ultrasound backscatter and attenuation parameters are estimated from diffraction corrected RF data, yielding spatially resolved parameter images. Histogram based statistical measures derived from the parameters distributions inside the ROI are used as tissue describing features. In addition, texture features and shape descriptors are extracted from demodulated ultrasound image data. The features are processed by a maximum likelihood classifier. An optimal set of 10 features was chosen by a sequential forward selection algorithm. The classifier’s performance is evaluated using total cross validation and receiver operating characteristic (ROC) analysis. As a reference method, postoperative pathohistologic analysis was conducted and proved malignancy or prospective malignancy in 51 patients. The classification using the proposed system yielded an area under the ROC curve of 0.91, proving significant potential for differentiating between malignant and benign parotid gland lesions. (E-mail: stefan.siebers@rub.de)

Sonographic diagnosis of parotid gland lesions: Correlation with the results of sonographically guided fine‐needle aspiration biopsy

The aim was to assess the value of ultrasound (US) in differentiating benign from malignant parotid gland lesions. During a 3-year period, US-guided fine-needle aspiration biopsy was performed on 89 parotid lesions with a size > or = 5 mm in 68 patients. In 80 (90%) lesions, specimens were adequate for cytologic analysis. We recorded the seven following US parameters: size, number, echogenicity, echotexture, margins' clarity, distal acoustic enhancement, and regional lymph node enlargement. Fine-needle aspiration biopsy revealed 18 (22%) malignant tumors, 30 (38%) benign tumors, and 32 (40%) nonneoplastic lesions. The mean size of the malignant tumors was 25 +/- 17 mm versus 27 +/- 17 mm for benign tumors versus 21 +/- 12 mm for nonneoplastic lesions (p > 0.05). Among 33 solitary tumors, 9 were malignant tumors and 24 were benign tumors. The majority of the parotid lesions were hypoechoic. The US feature that was most often associated with a benign lesion was distal acoustic enhancement. The US features that suggested malignancy were a heterogeneous echotexture, indistinct margins, and regional lymph node enlargement. US can aid in the differentiation of parotid gland tumors, although benign and malignant parotid tumors often have a similar sonographic appearance.

Parotid gland involvement in sarcoidosis: Sonographic features

The purpose of this study was to describe the sonographic (US) features of parotid gland involvement in patients with sarcoidosis. The US findings of the parotid gland of 6 patients with histologically proven sarcoidosis of the parotid gland were reviewed. The sonographic features ranged from nodal enlargement to diffuse or partial involvement of the parotid gland with various degrees of echogenicity and vascularity. Because of the lack of specificity of US findings in sarcoidosis involvement of the parotid gland, sarcoidosis should be considered in the differential diagnosis of parotid gland lesions in the proper clinical setting.

New Strategy for the Diagnosis of Parotid Gland Lesions Utilizing Three-Dimensional Sialography

Three-dimensional (3D) imaging for parotid gland lesions was performed using 3D sialography. This method provided a detailed surface structure of the parotid gland, and made it possible to overcome the disadvantages of X-ray sialography, planar CT, and MRI. Immediately after the conventional sialography via an oral route, CT scanning was performed with a slice-thickness of 3 mm using a helical CT scanner. CT data were analyzed on a workstation to reconstruct 3D images. 3D sialography was found to have the following advantages: (1) The structure of the acinar surface is visualized in detail; (2) The 3D structure of the entire parotid system from Stensen's duct to the gland is shown in one image; (3) The parotid gland can be assessed in the context of the bony architecture of facial bones; (4) The surface structure of the parotid gland can be understood very easily, like a scanning electron micrograph. We conclude that 3D sialography is a useful imaging technique for parotid gland lesions.

Fine-needle aspiration biopsy in the diagnosis of parotid gland lesions: evaluation of 438 biopsies.

The usefulness of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of salivary gland lesions is still controversial. The 438 FNABs taken at the Turku University Central Hospital between 1984-1991 were reviewed. Of these FNABs, 218 had been confirmed histologically. Within this subset, 136 FNABs were taken from benign neoplasms, and of these, 103 were correct (sensitivity 76%, specificity 83%). Only 26 of the 47 FNABs from malignant lesions were cytologically considered to be malignant (sensitivity 55%) and 11 samples raised a false suspicion of malignancy (specificity 92%). Out of 35 FNABs from non-neoplastic lesions, 27 were correct (sensitivity 77%, specificity 80%). There were 175 patients (217 FNABs), who had not been operated on: the follow-up of these patients showed that false malignant and false benign findings were rare. FNAB was safe and no serious complications occurred. However, there was a delay in the treatment of six patients probably because of the physicians' limited understanding of the diagnostic role of FNAB. FNAB offers valuable information about the type of parotid lesion, but the clinician must know how to interpret the cytologic statement, and the decision to use operative and other treatment should not be based solely on the result of FNAB. Diagn Cytopathol 1996; 15:185-190.