The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice

Anna Rzepakowska, Ewa Osuch-Wójcikiewicz, Maria Sobol, Raul Cruz, Ewelina Sielska-Badurek, Kazimierz Niemczyk, Anna Rzepakowska, Ewa Osuch-Wójcikiewicz, Maria Sobol, Raul Cruz, Ewelina Sielska-Badurek, Kazimierz Niemczyk

Abstract

The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). Seventy-two consecutive parotid gland tumors were analysed with high-resolution ultrasonography (12 MHz) with color Doppler imagining. The histopathological diagnosis was confirmed after parotidectomy for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for the US were established. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. Area under the curve (AUC) was calculated for each parameter considered. The analysed material included 27 MA, 26 PA, 1 basal cell adenoma, 8 inflammatory conditions, and 10 malignant neoplasms. The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The predictive values were: PPV 66.8% and NPV 93.6%. Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. The predictive values were: PPV 50% and NPV 68.8%, respectively. For distinguishing malignant from benign tumors, the highest AUC values noted were for heterogeneity and vascularization (0.8 and 0.743, respectively). The AUC values were the highest for hypoechogenicity and vascularization in separating PA from MA (0.718 and 0.685, respectively).

Keywords: Malignant parotid gland neoplasms; Monomorphic adenoma; Parotid gland tumor; Pleomorphic adenoma; Ultrasound.

Conflict of interest statement

Conflict of interest

None declared.

Animal and human rights

This article does not contain any studies with animals performed by any of the authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Examples of criteria for the description of the echogenicity (slightly hypoechoic, highly hypoechoic) and the homogeneity (slightly heterogenous, highly heterogenous) of the parotid gland tumors: a highly hypoechogenic, slightly heterogenic, b slightly hypoechogenic, slightly heterogenic, c highly hypoechogenic, highly heterogenic, and d slightly hypoechogenic, highly heterogenic
Fig. 2
Fig. 2
US of malignant parotid glands tumors: SCC—poor defined margins, highly hypoechogenic, slightly heterogenic, and poor vascularity pattern (a1, a2); MALT lymphoma—with regular, round shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and high vascularization (b1, b2); acinic cell carcinoma with regular, oval shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and no vascularization (c1, c2); follicular lymphoma with irregular, well-defined margins, highly hypoechogenic, slightly heterogenic, and high vascularization (d1, d2); mucoepidermoid carcinoma with regular, oval shape, well-defined margins, highly hypoechogenic, highly heterogenic, and high vascularization (e1, e2); adenoid cystic carcinoma with irregular shape, well-defined margins, highly hypoechogenic, highly heterogenic, and poor vascularization (f1, f2)
Fig. 3
Fig. 3
US of: PA with irregular shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and no vascularity (a); MA with regular, oval shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and high vascularization (b1, b2); adenocarcinoma with irregular shape, poor-defined margins, highly hypoechogenic, slightly heterogenic, and poor vascularity pattern (c1, c2); Sarcoidosis with regular, poor-defined margins, highly hypoechogenic, slightly heterogenic, and high vascularization (d1, d2)
Fig. 4
Fig. 4
US of different pleomorphic adenomas: a1, a2 polycyclic shape, highly hypoechogenic, highly heterogenic, and no vascularization; b1, b2 polycyclic shape, slightly hypoechogenic, slightly heterogenic, no vascularization, and adenolymphomas; c1, c2 polycyclic shape, slightly hypoechogenic, slightly heterogenic, and high vascularization; and d1, d2 oval shape, highly hypoechogenic, highly heterogenic, and no vascularization
Fig. 5
Fig. 5
Receiver operating characteristic curves for malignant and benign parotid tumors
Fig. 6
Fig. 6
Receiver operating characteristic curves for pleomorphic adenomas/adenolymphomas of parotid gland

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