Assessment of parotid gland masses with B-mode ultrasonography and strain elastography findings

Year 2019, , 800 - 804, 01.11.2019

Umut Öğüşlü , Sibel Aydın Aksu Sadık Ahmet Uyanık Burçak Gümüş

https://doi.org/10.28982/josam.642092

Abstract

Aim: Ultrasound elastography (USE) has been found useful in differentiation between malignant and benign lesions of various tissues, such as the thyroid, breast, lymph node and prostate, however, there is limited data on the parotid gland. The aim of this study is to assess the diagnostic performance of B-mode ultrasonography (US) and USE findings in differentiating between benign and malignant parotid gland masses. A secondary goal is to evaluate results for the most frequent benign lesions. 

Methods: In this cross-sectional study, 57 masses in 48 patients were evaluated. 2 radiologists examined each patient. B-mode US (size, contour, skin depth, internal structures, calcification, cystic component) and USE (a semiquantitative value strain index (SI)) findings were noted. We considered each feature individually. All patients underwent fine needle aspiration cytology (FNAC) and surgical resection.

Results: 50 masses were benign and 7 were malignant. Among B-mode US results, contour irregularity was found to have the highest accuracy (85.7%) in differentiating malignant lesions. When USE findings were considered, intra-observer agreement was moderate to fair and interobserver agreement was moderate. Malignant masses had mildly high SI scores. There was a wide range overlap between malignant and benign lesions. There was no statistically significant difference (P=0.422) and we could not attain a reliable SI cut-off value.

Conclusion: Despite the promising results of USE in breast and thyroid lesions, conventional US findings and FNAC are still the primary diagnostic tool to evaluate parotid lesions.

Keywords

Ultrasound elastography, Strain elastography, Strain index, Parotid gland

Parotis bezi kitlelerinin B-mod ultrasonografi ve strain elastografi bulguları ile değerlendirilmesi

Abstract

Amaç: Ultrason elastografi (USE) tiroid, meme lenf nodu ve prostat dokularının benign ve malign lezyonlarının ayrımında kullanışlı bulunmuştur. Bununla birlikte parotis bezindeki kullanımında sınırlı data mevcuttur. Biz bu çalışmada parotis bezi lezyonlarında benign malign ayrımında B-mod ultrasonografi (US) ve USE bulgularının tanısal performansını değerlendirmeyi amaçladık. İkincil hedef olarak da en sık rastlanan benign parotis bezi lezyonlarını kendi içerisinde değerlendirmeyi hedefledik.

Yöntemler: Bu kesitsel çalışmada 48 hastada 57 lezyon değerlendirilmeye alındı. Her hasta iki radyolog tarafından muayene edildi. B-mod US (boyut, kontur, ciltten derinlik, içyapı, kalsifikasyon, kistik komponent) ve USE (gerinim oranı olarak belirtilen yarı nicel değer) bulguları not edildi. Her bulgu ayrı ayrı değerlendirildi. Her hastaya ince iğne aspirasyon biyopsisi ve sonrasında cerrahi rezeksiyon uygulandı.

Bulgular: Lezyonların 50’si benign, 7’si malign olarak patolojik tanı aldı. B-mod ultrason bulguları dikkate alındığında düzensiz kontur özelliğinin malign lezyonların ayrımında en yüksek doğruluk oranına (%85,7) sahip olduğu görüldü. USE bulguları değerlendirildiğinde gözlemciler içi uyum orta-ortanın altında; gözlemciler arası uyum ise orta olarak saptandı. Malign kitleler benign olanlar ile kıyaslandığında hafif daha yüksek gerinim oranı değerlerine sahip olmakla birlikte istatistiksel olarak anlamlı fark tespit edilmedi (P=0,422) ve güvenilir bir eşik değer saptanamadı.

Sonuç: USE ile meme ve tiroid lezyonlarındaki umut verici sonuçlar elde edilmesine rağmen parotis kitlelerinin değerlendirilmesinde konvansiyonel US bulguları ve ince iğne aspirasyon biyopsisi hala temel tanı aracı olarak geçerliliğini sürdürmektedir.

Keywords

Ultrason elastografi, Strain elastografi, Gerinim oranı, Parotis bezi

References

• 1. O'Brien CJ. Current management of benign parotid tumors--the role of limited superficial parotidectomy. Head Neck. 2003;25(11):946-52.
• 2. Khandekar MM, Kavatkar AN, Patankar SA, Bagwan IB, Puranik SC, Deshmukh SD. FNAC of salivary gland lesions with histopathological correlation. Indian journal of otolaryngology and head and neck surgery: official publication of the Association of Otolaryngologists of India. 2006;58(3):246-8.
• 3. Das DK, Petkar MA, Al-Mane NM, Sheikh ZA, Mallik MK, Anim JT. Role of fine needle aspiration cytology in the diagnosis of swellings in the salivary gland regions: a study of 712 cases. Med Princ Pract. 2004;13(2):95-106.
• 4. Okahara M, Kiyosue H, Hori Y, Matsumoto A, Mori H, Yokoyama S. Parotid tumors: MR imaging with pathological correlation. Eur Radiol. 2003;13 Suppl 4:L25-33.
• 5. Joe VQ, Westesson PL. Tumors of the parotid gland: MR imaging characteristics of various histologic types. AJR Am J Roentgenol. 1994;163(2):433-8.
• 6. Bhatia KS, Lee YY, Yuen EH, Ahuja AT. Ultrasound elastography in the head and neck. Part I. Basic principles and practical aspects. Cancer Imaging. 2013;13(2):253-9.
• 7. Yılmaz B, Şener ÖK, Çevik H. Shear Wave Velocity results of non-alcoholic fatty liver disease in diabetic patients. J Surg Med. 2019;3(1):27-30.
• 8. Bhatia KS, Rasalkar DD, Lee YP, Wong KT, King AD, Yuen HY, et al. Evaluation of real-time qualitative sonoelastography of focal lesions in the parotid and submandibular glands: applications and limitations. Eur Radiol. 2010;20(8):1958-64.
• 9. Alam F, Naito K, Horiguchi J, Fukuda H, Tachikake T, Ito K. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. AJR Am J Roentgenol. 2008;191(2):604-10.
• 10. Nazarian LN. Science to practice: can sonoelastography enable reliable differentiation between benign and metastatic cervical lymph nodes? Radiology. 2007;243(1):1-2.
• 11. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Hiraoka M, et al. Cervical lymph node metastases: diagnosis at sonoelastography--initial experience. Radiology. 2007;243(1):258-67.
• 12. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237(1):202-11.
• 13. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.
• 14. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L. Major and minor salivary gland tumors. Crit Rev Oncol Hematol. 2010;74(2):134-48.
• 15. Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. Eur J Radiol. 2008;66(3):419-36.
• 16. Gritzmann N, Rettenbacher T, Hollerweger A, Macheiner P, Hubner E. Sonography of the salivary glands. Eur Radiol. 2003;13(5):964-75.
• 17. Kim SJ, Ko KH, Jung HK, Kim H. Shear Wave Elastography: Is It a Valuable Additive Method to Conventional Ultrasound for the Diagnosis of Small (≤2 cm) Breast Cancer? Medicine (Baltimore). 2015;94(42).
• 18. Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z. Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med. 2009;28(7):861-7.
• 19. Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F, et al. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008;18(5):523-31.
• 20. Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239(2):341-50.
• 21. Kilic A, Colakoglu Er H. Virtual touch tissue imaging quantification shear wave elastography for determining benign versus malignant cervical lymph nodes: a comparison with conventional ultrasound. Diagn Interv Radiol. 2019;25(2):114-21.
• 22. Cantisani V, David E, De Virgilio A, Sidhu PS, Grazhdani H, Greco A, et al. Prospective evaluation of Quasistatic Ultrasound Elastography (USE) compared with Baseline US for parotid gland lesions: preliminary results of elasticity contrast index (ECI) evaluation. Med Ultrason. 2017;19(1):32-8.
• 23. Wierzbicka M, Kaluzny J, Ruchala M, Stajgis M, Kopec T, Szyfter W. Sonoelastography--a useful adjunct for parotid gland ultrasound assessment in patients suffering from chronic inflammation. Med Sci Monit. 2014;20:2311-7.
• 24. Bhatia KS, Cho CC, Tong CS, Lee YY, Yuen EH, Ahuja AT. Shear wave elastography of focal salivary gland lesions: preliminary experience in a routine head and neck US clinic. Eur Radiol. 2012;22(5):957-65.
• 25. Karaman CZ, Basak S, Polat YD. The Role of Real-Time Elastography in the Differential Diagnosis of Salivary Gland Tumors. 2018.
• 26. Yerli H, Eski E, Korucuk E, Kaskati T, Agildere AM. Sonoelastographic qualitative analysis for management of salivary gland masses. J Ultrasound Med. 2012;31(7):1083-9.
• 27. Celebi I, Mahmutoglu AS. Early results of real-time qualitative sonoelastography in the evaluation of parotid gland masses: a study with histopathological correlation. Acta Radiol. 2013;54(1):35-41.
• 28. Zhang YF, Li H, Wang XM, Cai YF. Sonoelastography for differential diagnosis between malignant and benign parotid lesions: a meta-analysis. Eur Radiol. 2019 Feb;29(2):725-35.
• 29. Jones AV, Craig GT, Speight PM, Franklin CD. The range and demographics of salivary gland tumours diagnosed in a UK population. Oral Oncol. 2008;44(4):407-17.
• 30. Liyanage SH, Spencer SP, Hogarth KM, Makdissi J. Imaging of salivary glands. Imaging. 2007;19(1):14-27.
• 31. Luukkaa H, Klemi P, Leivo I, Koivunen P, Laranne J, Mäkitie A, et al. Salivary gland cancer in Finland 1991–96: an evaluation of 237 cases. Acta Oto-Laryngologica. 2005;125(2):207-14.
• 32. Dumitriu D, Dudea S, Botar-Jid C, Baciut M, Baciut G. Real-time sonoelastography of major salivary gland tumors. AJR Am J Roentgenol. 2011;197(5):W924-30.