An algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion-weighted magnetic resonance images: a retrospective analysis of 158 cases
Abstract
Background: To verify the usefulness of a new algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion- -weighted magnetic resonance imaging (MRI).
Materials and methods: The retrospective analysis included 158 consecutive surgical patients with parotid tumours. Aside from ultrasound-guided fine needle biopsy, the protocol of preoperative evaluation included dynamic and diffusion-weighted MRI. According to the new diagnostic algorithm, the result of fine needle biopsy was considered only in the case of lesions with time to peak enhancement (Tpeak) > 60 s and washout rate (WR) ≤ 30% on dynamic MRI and apparent diffusion coefficient (ADC) ≤ 1.7 × 103 mm/s2 on diffusion-weighted MRI, or those presenting with concomitant lymphadenopathy. The accuracy of this algorithm was verified against final histopathological diagnoses.
Results: The new algorithm gave 10 true positive and 2 false positive results, as well as 132 and 14 true and false negative results, respectively. Its sensitivity and specificity (41.7% and 98.5%, respectively) were the same as in the case of fine needle biopsy alone. None of the 59 tumours that were qualified as benign solely on the basis of preoperative MRI turned out to be malignant on postoperative histopathological examination.
Conclusions: Interpreted together, dynamic and diffusion-weighted MRIs provide the same accuracy in preoperative differential diagnostics of parotid tumours as fine needle biopsy. This substantiates the use of diagnostic algorithms in which biopsy would serve mostly as a secondary test to verify selected ambiguous radiological diagnoses. (Folia Morphol 2018; 77, 1: 29–35)
Keywords: pleomorphic adenomaWarthin tumoursurgeryfine needle biopsy
References
- Asaumi JI, Shigehara H, Konouchi H, et al. Assessment of carcinoma in the sublingual region based on magnetic resonance imaging. Oncol Rep. 2002; 9(6): 1283–1287.
- Batsakis JG, el-Naggar AK. Warthin's tumor. Ann Otol Rhinol Laryngol. 1990; 99(7 Pt 1): 588–591.
- Donovan DT, Conley JJ. Capsular significance in parotid tumor surgery: reality and myths of lateral lobectomy. Laryngoscope. 1984; 94(3): 324–329.
- Dykun RJ, Deitel M, Borowy ZJ, et al. Treatment of parotid neoplasms. Can J Surg. 1980; 23(1): 14–19.
- Eida S, Sumi M, Sakihama N, et al. Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy. AJNR Am J Neuroradiol. 2007; 28(1): 116–121.
- Flezar M, Pogacnik A. Warthin's tumour: unusual vs. common morphological findings in fine needle aspiration biopsies. Cytopathology. 2002; 13(4): 232–241.
- Hisatomi M, Asaumi Ji, Konouchi H, et al. Assessment of dynamic MRI of Warthin's tumors arising as multiple lesions in the parotid glands. Oral Oncol. 2002; 38(4): 369–372.
- Hisatomi M, Asaumi Ji, Yanagi Y, et al. Assessment of pleomorphic adenomas using MRI and dynamic contrast enhanced MRI. Oral Oncol. 2003; 39(6): 574–579.
- Matsuzaki H, Yanagi Y, Hara M, et al. Diagnostic value of dynamic contrast-enhanced MRI in the salivary gland tumors. Oral Oncol. 2007; 43(9): 940–947.
- Ikarashi F, Nakano Y, Nonomura N, et al. Radiological findings of adenolymphoma (Warthin's tumor). Auris Nasus Larynx. 1997; 24(4): 405–409.
- Ikeda M, Motoori K, Hanazawa T, et al. Warthin tumor of the parotid gland: diagnostic value of MR imaging with histopathologic correlation. AJNR Am J Neuroradiol. 2004; 25(7): 1256–1262.
- Joe VQ, Westesson PL. Tumors of the parotid gland: MR imaging characteristics of various histologic types. AJR Am J Roentgenol. 1994; 163(2): 433–438.
- Park J, Inoue S, Ishizuka Y, et al. [Salivary gland masses: dynamic MR imaging and pathologic correlation]. Nihon Igaku Hoshasen Gakkai Zasshi. 1997; 57(9): 581–585.
- Parwani AV, Ali SZ. Diagnostic accuracy and pitfalls in fine-needle aspiration interpretation of Warthin tumor. Cancer. 2003; 99(3): 166–171.
- Przewoźny T, Stankiewicz C. Neoplasms of the parotid gland in northern Poland, 1991-2000: an epidemiologic study. Eur Arch Otorhinolaryngol. 2004; 261(7): 369–375.
- Que Hee CG, Perry CF. Fine-needle aspiration cytology of parotid tumours: is it useful? ANZ J Surg. 2001; 71(6): 345–348.
- Stewart CJ, MacKenzie K, McGarry GW, et al. Fine-needle aspiration cytology of salivary gland: a review of 341 cases. Diagn Cytopathol. 2000; 22(3): 139–146.
- Takashima S, Noguchi Y, Okumura T, et al. Dynamic MR imaging in the head and neck. Radiology. 1993; 189(3): 813–821.
- Traxler M, Hajek P, Solar P, et al. Magnetic resonance in lesions of the parotid gland. Int J Oral Maxillofac Surg. 1991; 20(3): 170–174.
- Tsushima Y, Matsumoto M, Endo K, et al. Characteristic bright signal of parotid pleomorphic adenomas on T2-weighted MR images with pathological correlation. Clin Radiol. 1994; 49(7): 485–489.
- Yabuuchi H, Fukuya T, Tajima T, et al. Salivary gland tumors: diagnostic value of gadolinium-enhanced dynamic MR imaging with histopathologic correlation. Radiology. 2003; 226(2): 345–354.
- Yabuuchi H, Matsuo Y, Kamitani T, et al. Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization? Radiology. 2008; 249(3): 909–916.
- Zbären P, Schär C, Hotz MA, et al. Value of fine-needle aspiration cytology of parotid gland masses. Laryngoscope. 2001; 111(11 Pt 1): 1989–1992.
