Multimodal Ultrasonographic Pathway of Parotid Gland Lesions.
PurposeTo evaluate a multimodal pathway in solitary circumscribed parotid gland lesions (PL) to predict tumor dignity and to avoid repeat surgery.Materials and Methods202 patients with PL underwent medical history, clinical examination, high-resolution B-mode ultrasound (US), real-time sonoelastography (RTE), color-coded duplex sonography (CDS), and contrast-enhanced ultrasound (CEUS). Malignancy was suspected when: 1. patients reported on previous cutaneous head and neck (H&N) malignancy; 2. patients presented synchronous cutaneous H&N malignancy and/or facial palsy; 3. US visualized poorly defined tumor borders and/or pathological cervical lymph nodes; 4. PL showed poor vascularization in CDS with enhanced perfusion kinetics in CEUS; 5. PL showed moderate/strong vascularization with delayed perfusion kinetics. Intraoperative frozen section was performed in PLs suspicious for malignancy, and surgery was extended when malignancy was confirmed. The sensitivity, specificity, negative, and positive predictive values (NPV/PPV) were calculated.ResultsHistology revealed 170 benign and 32 malignant PLs. Medical history, clinical examination, and B-mode US identified malignancy with a sensitivity/specificity of 77 %/98 %. After application of CDS and CEUS in the multimodal pathway, the sensitivity of malignant tumors increased to 91 %. The decreased specificity (81 %) was equalized by intraoperative frozen section (PPV 48 %, NPV 98 %). After application of the multimodal pathway, only 1 patient underwent repeat surgery.ConclusionThe multimodal pathway is a useful method to predict dignity in PLs and reduces the number of repeat surgeries.
Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany.
Naglaa
N
Mansour
Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany.
Murat
M
Bas
Department of Nephrology, Klinikum rechts der Isar der Technischen Universität München, Germany.
Konrad Friedrich
KF
Stock
Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany.
Ulrich
U
Strassen
Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany.
Benedikt
B
Hofauer
Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany.
Andreas
A
Knopf
D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008949:Adenoma, Pleomorphic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010306:Parotid Gland / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010307:Parotid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D011237:Predictive Value of Tests; D012086:Reoperation; D018615:Ultrasonography, Doppler, Color