Preoperative Diagnosis Of Parotid Tumors Research Articles

The Usefulness of Ultrasound-Guided Core Needle Biopsy Compared to Fine Needle Aspiration in Pre-Operative Diagnosis of Cystic-Predominant Parotid Tumors

Background and Objectives Accurate preoperative prediction of final histopathologic diagnosis is essential in parotid tumor management, which also includes surgical planning. As a preoperative diagnostic examination for parotid tumors, the accuracy of ultrasound-guided fine needle aspiration (US-FNA) and ultrasound-guided core needle biopsy (US-CNB) was compared, and factors affecting the accuracy of diagnosis and adequacy of the specimen were analyzed.Subjects and Method This study was conducted as a retrospective analysis of 90 patients with parotid tumor who had undergone parotidectomy after pre-operative ultrasound-guided biopsy. We divided the study subjects into US-FNA and US-CNB groups and evaluated the diagnostic accuracy by comparing the pre-operative results with the final histopathologic diagnosis after surgery. In addition, accuracy and specimen adequacy were analyzed according to tumor components.Results The US-FNA group showed significantly higher rates of non-diagnostic results than the US-CNB group (44.0% vs. 13.8%, <i>p</i>=0.002) did. Diagnostic accuracy was also significantly higher in US-CNB than in US-FNA (95.4% vs. 64.0%, <i>p</i><0.001), and the non-diagnostic result of US-FNA was the main factor in reducing accuracy. Meanwhile, in both cysticpredominant tumors and solid-predominant tumors (94.8% vs. 75%, <i>p</i>=0.023), US-CNB showed significantly better accuracy than US-FNA (100.0% vs. 20.0%, <i>p</i>=0.010) did.Conclusion US-CNB has superiority in both sample adequacy and diagnostic accuracy compared to US-FNA in preoperative diagnosis of parotid tumors, and it seems necessary to consider its use more actively in the diagnosis of cystic-predominant tumors.

Ultrasonography techniques in the preoperative diagnosis of parotid gland tumors - an updated review of the literature.

Preoperative diagnosis of parotid tumors plays a crucial role in selecting and planning the surgical treatment. Ultrasound (US) with its modern techniques can contribute to the differential diagnosis of parotid tumors. This paper aims to achieve a comprehensive review of the ultrasound techniques used in the differential diagnosis of parotid tumors, based on the latest literature data. Considering that most parotid gland tumors are located in the superficial lobe, US is frequently the first imaging technique used for the diagnosis of parotid tumors. Sonoelastography can provide additional data on the elasticity of parotid tumors, but there is an overlap between malignant and benign parotid tumors parameters. Contrast-enhanced ultrasound adds value to conventional ultrasound and allows a more complete characterization of parotid tumors. Many authors have reported promising results using contrast-enhanced ultrasound in the differential diagnosis of parotid tumors. Multiparametric ultrasound with a careful and systematic approach usually allows an accurate differential diagnosis of parotid tumors.

Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review.

An accurate preoperative diagnosis of parotid tumors is essential for the selection and planning of surgical treatment. Various modern cross-sectional imaging and cytologic investigations can support the differential diagnosis of parotid tumors. The aim of this study was to achieve a comprehensive and updated review of modern imaging and cytologic investigations used in parotid tumor diagnosis, based on the latest literature data. This literature review could serve as a guide for clinicians in selecting different types of investigations for the preoperative differential diagnosis of parotid tumors. Magnetic resonance imaging (MRI) with its dynamic and advanced sequences is the first-line imaging investigation used in differentiating parotid tumors. Computed tomography (CT) and positron emission tomography (PET)-CT provide limited indications in differentiating parotid tumors. Fine needle aspiration biopsy and core needle biopsy can contribute with satisfactory results to the cytological diagnosis of parotid tumors. Dynamic MRI with its dynamic contrast-enhanced and diffusion-weighted sequences provides the best accuracy for the preoperative differential diagnosis of parotid tumors. CT allows the best evaluation of bone invasion, being useful when MRI cannot be performed, and PET-CT has value in the follow-up of cancer patients. The dual cytological and imaging approach is the safest method for an accurate differential diagnosis of parotid tumors.

F.N.A.C. AS DIAGNOSTIC TOOL OF PAROTID TUMORS AND ASSOCIATED PITFALLS IN CORRELATION WITH HISTOPATHOLOGY

F.NA.C has been used for ages as a safe and economical tool for fast preoperative diagnosis of parotid tumors. It has certain pitfall which sometimes leads to misdiagnosis and consequently it may have affect on treatment of the tumors. Keeping in view of the diverse classification of parotid tumors’ information from cytology should be combined with radiology as well as clinical diagnosis.
 Aim: To discuss some cases where there was discrepancy between cytological diagnosis and histopathological result and also suggest measures to improve the efficacy of F.N.A.C.
 Material and methods: The study includes 50 cases of parotid tumours who presented to the department of ENT at Government medical college Haldwani which is a tertiary referral centre during 2009 to 2016. Only adult patients were included and inflammatory swelling were excluded from the study. All patients evaluated Contrast enhanced computerized tomography(CECT) and Magnetic resonance imaging (MRI) followed by Fine needle aspiration cytology .Preoperative diagnosis was made upon the findings of the above investigations and different types of parotid surgeries were done. . Final diagnosis was made on histopathological examination.
 Result :The most common tumour came out to be pleomorphic adenoma (23 cases-46%) followed by mucoepidermoid carcinoma(12cases-24%). In ten cases there was no clear cut association between cytological diagnosis and final histopathological diagnosis.
 Conclusion: FNAC is highly sensitive and specific technique for diagnosis of many salivary gland swellings. FNAC can be used preoperatively to avoid unnecessary surgery and biopsy. Details of clinical information and radiologic features may help the pathologist to arrive at the appropriate diagnosis and reduce false interpretation. Pitfalls may also occur with improper technique of FNAC which can be overcome by proper caution.

Diagnostic accuracy of magnetic resonance imaging techniques for parotid tumors, a systematic review and meta-analysis

ObjectiveTo assess the added benefit of combining different MRI techniques for preoperative diagnosis of parotid tumors when compared to conventional MRI and advanced MRI techniques alone with meta-analysis. MethodsA comprehensive PubMed electronic database search was performed for original diagnostic studies up to July 2017. The methodologic quality of each study was evaluated by two independent reviewers who used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Statistical analysis included pooling of sensitivity and specificity with 95% confidence intervals (CI). All analyses were conducted using STATA (version 12.0), RevMan (version 5.2), and Meta-Disc 1.4 software programs. ResultsPooled sensitivity and specificity of conventional MRI, diffusion weighted imaging (DWI), dynamic contrast enhanced (DCE) and the above combination were 76% (95%CI)/91% (95%CI)/80% (95%CI)/86% (95%CI) and 83% (95%CI)/56% (95%CI)/90% (95%CI)/90% (95%CI). ConclusionConventional MRI combined with DWI and DCE showed higher diagnostic accuracy than conventional or advanced MRI alone, supporting their use in parotid tumors diagnosis.

Does Virtual Touch IQ elastography help to improve the preoperative diagnosis of parotid tumors: A prospective trial.

It is difficult to assess tumors of the parotid gland preoperatively. However, it is essential for the surgeon to know which kind of tumor is present. Ultrasound is the method of choice, but there is still no reliable differential diagnostic tool for determining whether a tumor is malignant or benign. The aim of our study was to examine the value of Virtual Touch imaging quantification (VTIQ) elastograpy in distinguishing between malignant and benign tumors as well as in identifying the most common benign tumor types. The parenchyma of 100 parotid glands and 12 lymph nodes of healthy volunteers and 50 tumors of the parotid gland were analyzed via ultrasound, color Doppler ultrasound, and VTIQ, and the results were then compared with histopathology. In comparison with benign tumors, in malignant tumors the tumor border was diffuse, the perfusion higher, and the VTIQ quality much lower. Share wave velocity of the user-defined region of interest was more frequently higher than 6.8 m/s in malignant tumors in comparison to benign tumors. VTIQ in combination with ultrasound examination provides additional information for distinguishing between benign and malignant tumors and shows promise for integration into preexisting ultrasound protocols.

Diffusion-weighted MRI in the differential diagnosis of parotid malignancies and pleomorphic adenomas: can the accuracy of dynamic MRI be enhanced?

(1) To verify whether appropriate selection of cutoff values for dynamic and diffusion-weighted magnetic resonance imaging (MRI) parameters optimizes the accuracy of preoperative differential diagnosis of parotid malignancies and pleomorphic adenomas. (2) To define the role of preoperative MRI in the differential diagnosis of parotid tumors. The retrospective analysis included 221 surgical patients with parotid tumors. Aside from ultrasonography-guided fine-needle biopsy, the preoperative protocol included dynamic and diffusion-weighted MRI. Final diagnoses were based on histopathologic examination of surgical specimens. Receiver operating characteristic analysis was conducted to determine the sensitivity and specificity of preoperative MRI with various combinations of cutoff values. Twenty-four patients with parotid malignancies (10.8%) and 57 with pleomorphic adenomas (25.8%) were identified. Parotid malignancies had significantly lower values of apparent diffusion coefficient and Tpeak, as well as significantly higher values of Tmax and washout rate. An apparent diffusion coefficient ≤1.267×103mm/s2 yielded optimum accuracy in identification of parotid malignancies (95.8% sensitivity and 93% specificity). Diffusion-weighted MRI is effective in differential diagnosis of parotid malignancies. Optimization of preoperative diagnosis of parotid tumors should include preselection identification of Warthin tumors on the basis of dynamic MRI, followed by identification of pleomorphic adenomas based on diffusion-weighted MRI and cytologic examination of the remaining lesions.

Kann die präoperative Feinnadelpunktion bei Parotistumoren die definitive histologische Diagnose erschweren?

Fine-needle aspiration cytology (FNAC) is a minimally invasive procedure that offers high specifity and acceptable sensitivity in the preoperative diagnosis of parotid tumors. FNAC provides information that can be particularly valuable in surgical planning and patient education. In some cases, it may even help prevent unnecessary surgery. After an FNA procedure, on rare occasions, morphological changes in the tumor may be observed and can make a definitive histological examination difficult or even impossible. Histopathological changes in parotid tumors after preoperative FNAC are described on the basis of a case report and a survey of the literature. In rare cases, puncture-induced histopathological changes, such as hyalinization of the subepithelial stroma, necrosis and squamous metaplasia, so extensive that a definitive histological diagnosis is difficult, are observed. In the present case report, fine-needle aspiration of a 3 x 2 cm tumor, which had been classified as malignant on the basis of cytological findings, resulted in complete necrosis and made a definitive histological diagnosis impossible. Similar cases have been described by other authors in recent years. In rare cases, histological changes in the tumor tissue can occur after an FNA procedure, making a definitive histological examination difficult or even impossible. When a preoperative FNAC is performed, the pathologist in charge should be advised accordingly. In addition, patients should be informed about this infrequent risk before undergoing the procedure.

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We compared the usefulness of magnetic resonance imaging(MRI), with that of X-ray computed tomography in the preoperative diagnosis of parotid tumors. We performed in 13 patients with parotid tumors and 10 of them were operated. The MRI equipment had a magnetic fild of 0.15 Tesla. We used the spine echo acquisition technique and a repetition time of 600, 1000 and 2000 milli-seconds, and echo time of 40 and 80 mi lli-seconds. We found that the T1, weighted image well visualized the duct of the parotid gland, the T2 weighted image provided fine pictures of the parotid tumor. The facial nerve of normal parotid glands could not be visualized by MRI.

Exfoliative cytology in the preoperative diagnosis of parotid tumors.

In the current literature most authors agree that no completely satisfactory method exists for the preoperative diagnosis of parotid tumor. Blady and Hocker state that on sialography most malignant tumors show infiltration of the ducts, which they feel is diagnostic. The present study was undertaken to see whether such infiltrating lesions shed malignant cells which might be collected in the saliva and studied in the same manner as are bronchial washings. I t was felt that if positive results could be obtained with Papanicolaou smears, surgeons might be encouraged to adopt more radical initial surgical measures in the hope of improving the present discouraging results in the treatment of malignant lesions of the parotid gland. We have found no such study recorded in the English literature. This investigation was made on 33 patients who underwent surgical treatment of parotid tumors at the Mayo Clinic from July 1 to December 5, 1953. A total of 45 patients underwent such treatment during this period, but because of the nature of the previous operations and other factors, the remaining 12 were not considered suitable for study. On the night before operation, a specimen was collected from each parotid gland, the normal side thus serving as a control. In the first patients studied, Stensen's duct was cannulated, but in the remaining patients the simple but efficient device of Curby was used. Salivary flow was stimulated by unsweetened lemon juice. From 2 to 5 ml. of secretion was obtained in all cases, which was stained by a method previously described for bronchial washings. Three slides were made from each specimen. After the tumor was removed, fresh imprints were made in most cases and these were fixed and stained in the same manner as the secretions; these slides showed the appearance of known tumor cells stained by the same technic and served as further controls. All frozen-section diagnoses were confirmed by paraffin sections. Table 1 lists the diagnoses made on the basis of the tumors removed. All the smears showed a few scattered normal-appearing squamous cells and occasional columnar cells. No cells characteristic of the various benign tumors, as seen on the fresh imprints, were found. In the 7 cases in which the tumor was malignant, the slides made from the secretion in 1 of the cases of muco-epidermoid tumor were suggestive of malignancy, while those made in 1 of the cases of adenocarcinoma and in the case of undifferentiated carcinoma showed a few