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Sonoelastography: a) Pleomorphic adenoma: mixed aspect, with predominant stiffness; b) Warthin tumor: stiff solid areas, large fluid areas with color stratification artefact; c) Malignant tumor (adenocarcinoma): the same case as in fig. 3d-on elastography the mass appears predominantly stiff; d) Malignant tumor (basal cell carcinoma)-deceiving ultrasound and elastographic aspect, with well-defined borders and predominant elasticity.
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The typical ultrasound features of pleomorphic adenomas are considered to be the well-defined contour, the regular, sometimes lobulated shape, homogeneous structure and poor vascularization. The goal of our study was to verify the validity of these features and to identify a typical sonoelastographic pattern for pleomorphic adenomas.
Between April...
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Objective: High resolution ultrasonography (US) has played a significant role in the study of salivary gland (SG) pathology and has surpassed sialography in the study of SG tumours. This report discusses the sonographic features of SG tumours examined during the last 5 years. The value of these features as diagnostic indicators of the nature (benig...
Warthin's tumor is the second most common type of salivary gland tumor. Microscopically, Warthin's tumor displays a proliferative epithelial component and lymphoid stroma. Carcinomas arising from the epithelial component are well known, but malignant transformations of the lymphoid stroma are rare. When they do occur, they are most commonly B-cell...
Citations
... On SGUS, the typical appearance of a pleomorphic adenoma is a hypoechoic, often inhomogeneous, lobulated lesion, well defined and with posterior acoustic enhancement, without evidence of internal vascularization on color Doppler imaging ( Figure 5A and B). 72 Calcifications may be present. 73 Warthin tumors are less frequent, accounting for 5−10% of all benign SG lesions. ...
Salivary gland ultrasound (SGUS) is the imaging modality of choice for the assessment of parotid and submandibular gland parenchyma. Being highly effective, non-invasive and easy to perform, SGUS has become increasingly popular among specialists in assessing salivary gland (SG) abnormalities, including those commonly found in primary Sjögren’s syndrome (pSS). SGUS may be useful in the assessment of pSS and its complications, the most serious being the development of non-Hodgkin’s lymphoma (NHL). SGUS may also be useful in the characterization and differential diagnosis of diffuse and focal abnormalities commonly associated with pSS, and may act as a guide for core-needle biopsy (CNB), an established, safe, and feasible technique, which provides enough viable tissue for the diagnosis and assessment of lymphoproliferative diseases of the SG. The combination of SGUS with other tools, such as sonoelastography and artificial intelligence (AI), could further improve the usefulness of SGUS in the management of pSS. In this perspective, we summarize current and future applications of SGUS in pSS.
... [4] The presence of lobulations is the most common feature of pleomorphic adenoma. [5,6] The absence of regional cervical lymphadenopathy is necessary to rule out malignant change in pleomorphic adenoma. On color Doppler the lesion typically takes up peripheral flow around the nodule termed as "basket like flow pattern" due to subtle vascular pattern around the mass. ...
Submandibular gland tumors are uncommon. Elastography is a recent addition in ultrasound diagnosis particularly in cases of soft-tissue tumor imaging. In this case report, we are describing ultrasonographic and elastographic imaging findings of submandibular pleomorphic adenoma.
... The following patterns were considered at the evaluation with baseline ultrasound: 1) suspected malignant lesions: nodular appearance, irregular or frankly infiltrating margins, heterogeneous hypoechoic structure, calcifications and hypo-anechoic necrotic-hemorrhagic internal areas, associated regional lymphadenopathy [1,15]; 2) pleomorphic adenoma: homogeneous, lobulated, hypoechoic structure with posterior wall enhancement, with or without calcifications, poor vascularization [1,16]; 3) Warthin's tumor: oval, hypoechoic mass, capsulated with anechoic and hypervascularized areas [1,17,18]. ...
... Bathia et al [33] have reported that USE does not allow to differentiate the tumors, since areas that show the same stiffness can be found in lesions that present a different histology. Dumitriu et al [16] reported the absence of any elastographic pattern that could define the malignant or benign nature of a lesion, observing little benefits in differentiating parotid tumors, particularly regarding the quantitative values of the pleomorphic adenoma which presented similar results to malignant tumors. In particular, the authors observed an intra-lesional variability of rigidity, which may be high in the pleomorphic adenoma due to the heterogeneity of the tissue, concluding that USE in the parotid gland is not a valid tool to exclude malignancy. ...
... Our results also confirmed that B-mode US is an important technique in the preoperative diagnosis, presenting high diagnostic accuracy (89%), in line with the literature [1,15,16,19,33,36,38]. However, being an operator-dependent examination, the results are linked to the execution by an experienced operator, especially in the study of the major salivary glands. ...
Aims:
To evaluate the pre-surgical diagnostic value of Multiparametric Ultrasound (MPUS) and Fine Needle Aspiration Cytology (FNAC) in differentiating parotid gland tumors, comparing the results with histology.
Materials and methods:
The study enrolled 84 patients with parotid gland lesions surgically treated in a single tertiary center and evaluated by MPUS. Each patient underwent FNAC. Histological examination was considered the gold standard.
Results:
Histology identified 62 benign tumors and 22 malignancies. In the differential diagnosis between malignant and benign lesions, B-mode Ultrasound (US), Color-Doppler US, Contrast-Enhanced US (CEUS), Elastography (USE) and FNAC showed the following values of sensitivity: 82%, 81%, 86%, 77%, 73% respectively; specificity: 97%, 61%, 95%, 71%, 97% respectively; PPV: 90%, 43%, 86%, 50%, 89% respectively; NPV: 93%, 90%, 95%, 88%, 91% respectively; and accuracy: 89%, 71%, 90%, 78%, 84% re-spectively.
Conclusions:
CEUS proved to be a valid and accurate method for identifying malignant tumors of parotid gland; the combination of B-mode US with CEUS showed similar diagnostic accuracy, but better sensitivity than CEUS taken alone. USE did not improve the diagnostic performance of the B-mode US, alone or in association with CEUS; however, it revealed the highest diagnostic accuracy in the differentiation between benign lesions. FNAC demonstrated lower values in comparison with CEUS and with USE. Therefore, according to our study, MPUS could be proposed as a valid alternative to FNAC.
... Many authors demonstrated differences in elastosonographic scores but they could not prove that they can discriminate between benign and malignant parotid lesions. (119,120). However, elastographic indices showed PA were stiffer than WT, in particular PAs than malignant parotid lesions (120). ...
Disorders affecting parotid gland represent a heterogeneous group comprising congenital, inflammatory and neoplastic diseases which show a focal or diffuse pattern of appearance. The differentiation of neoplastic from non-neoplastic conditions of parotid glands is pivotal for the diagnostic imaging. Frequently there is evidence of overlapping between the clinical and the imaging appearance of the various pathologies. The parotid gland is also often object of study with the combination of different techniques [ultrasound-computed tomography-magnetic resonance imaging (US-CT-MRI), ex.]. Compared to other dominant methods of medical imaging, US has several advantages providing images in real-time at lower cost, and without harmful use of ionizing radiation and of contrast enhancement. B-mode US, and the microvascular pattern color Doppler are usually used as first step evaluation of parotid lesions. Elastography and contrast-enhanced US (CEUS) has opened further possible perspectives to improve the differentiation between benign and malignant parotid lesions. The characterization of the parotid tumors plays a crucial role for their treatment planning and for the prediction of possible surgical complications. We present, here an updated review of the most recurrent pathologies of parotid gland focusing on the diagnostic power of multiparametric US including CEUS and ultrasound elastography (USE); limitations, advantages and the main key-points will be presented.
... Dumitriu et al (2010) could not identify in their study a sonoelastographic pattern characteristic for the PMA [37]. Although the same authors found a statistically significant difference between the elastography scores of malignant tumors compared to benign lesions, the detailed analysis was not possible to establish a cutoff point for this scores, more likely due to the high stiffness of PMAs (fig 4) [38]. ...
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.
... On the other hand, in their first study, Dimitriu et al 6 grouped the masses according to the stiff areas being less than or greater than 50%. 6 In our series, we used a 4-grade scoring system depending on the percent- age of the hard areas, which was in a way in concor- dance with the other grading systems in the relevant literature. 5,7-9 Regardless of the chosen method, the results were nearly identical in the above-mentioned studies. ...
Objectives
The aim of the study was to scrutinize the value of qualitative elastography in the diagnosis of salivary gland masses.
Methods
Sixty patients were enrolled in this prospective study. Patients aged between 1 and 91 years (mean age, 48.8 ± 20.48) with a salivary gland mass were studied with real‐time elastography. All patients were examined by 1 examiner, blinded to all relevant data. On elastography, masses were scored into 4 types according to their stiffness compared to normal tissue. Scores of 3 and 4 were accepted as signs of malignancy. Sensitivity, specificity, and positive and negative predictive value were calculated for elastography in verifying malignancy.
Results
Forty‐two percent of the masses were located in the parotid, and the rest in submandibular gland. The diameter of the lesions varied between 12 and 60 mm (mean, 24.36 ± 11.98 mm). Forty‐four masses were benign (73%), and among them the majority were inflammatory lesions (31 of 60; 51.7%). There were 16 malignant lesions (27%). On elastography, not only all malignant lesions but 15 benign lesions were scored as 3 to 4. All masses scored as 1 to 2 were benign. Sensitivity was 100%; specificity, 66%; positive predictive value, 52%; and negative predictive value, 100%. When only Score 4 lesions were accepted as malignant, these values became 75%, 77%, 55%, and 90%, respectively.
Conclusions
Elastography alone cannot be used to discriminate malignant from benign in the evaluation of salivary gland lesions. However, with its high negative predictive value, it may be used as an adjunct tool to increase the diagnostic value of ultrasonography.
... Therefore, the typical elastographic pattern for pleomor-phic adenomas could not be identified. The most specific finding they showed was lobulated contour which has not been seen in other benign tumors, but rarely seen in some malignant tumors (10). In another study conducted by Du- is not significant (P = 0.650 for score, P = 0.968 for ratio). ...
Objectives: To investigate the diagnostic efficiency of elastography in differentiation of malignant and benign tumors by evaluating salivary gland masses in means of their elastography scores and strain ratios. Patients and Methods: Twenty five patients with salivary gland mass lesions were detected through B- mode ultrasonography, Doppler ultrasonography, strain elastography and their strain ratios were calculated. The results were compared with histopathologic results. Results: Twenty five patients had 27 lesions consisting of seven malignant and 20 benign lesions. Mann Whitney U test, ROC analysis, Fisher test and Chi square tests were used statistically. Mean strain rates were calculated as 2.26 ± 0.29 in the benign group and 2.02 ± 0.59 in the malignant group. There was no statistically significant difference between the two groups (P = 0.698). Elastography score was calculated as mean 2.4 ± 0.94 in the benign group and mean 2.28 ± 0.38 in the malignant group. There was no statistically significant difference between the two groups (P = 0.708). Accepting the strain rate as 0.89; sensitivity of elastography in differentiating malignant from benign lesions is 71%, and the specificity is 50%. However, the area under the ROC curve is 0.55, which is not statistically significant (P = 0.699). Conclusion: In conclusion, elastography is a supporting method for B-mode ultrasonography in the differentiation of benign and malignant salivary gland masses. However, the overlap of elastographic findings is evident in benign and malignant masses. Care should be taken to have tissues with similar stiffness under the reference tissue and the lesions in elastographic evaluation of the superficial mass. We have not met a study that has pointed out the importance of stiffness of the tissue located beneath the lesion that may affect the elastography results in the literature. In this respect our study is unique.
... However, the results of elastography in salivary gland lesions have been rather poor so far. A huge overlap between benign and malignant lesions was found in the semiquantitative elastography scores [2][3][4][5][6][7][8]. ...
Aim
To create a predictive score for the discrimination between benign and malignant parotid tumors using elastographic parameters and to compare its sensitivity and specificity with standard ultrasound.
Methods
A total of 124 patients with parotid gland lesions for whom surgery was planned were examined using conventional ultrasound, Doppler examination, and shear wave elastography. Results of the examinations were compared with those ones of histology.
Results
There were 96 benign and 28 malignant lesions in our cohort. Blurred tumor margin alone proved to be an excellent predictor of malignancy with the sensitivity of 79% and specificity of 97%. Enlarged cervical lymph nodes, tumor vascularisation, microcalcifications presence, homogeneous echogenicity, and bilateral occurrence also discriminated between benign and malignant tumors. However, their inclusion in a predictive model did not improve its performance. Elastographic parameters (the stiffness maxima and minima ratio being the best) also exhibited significant differences between benign and malignant tumors, but again, their inclusion did not significantly improve the predictive power of the blurred margin classifier.
Conclusion
Even though elastography satisfactorily distinguishes benign from malignant lesions on its own, it hardly provides any additional value in evaluation of biological character of parotid gland tumors when used as an adjunct to regular ultrasound examination.
... Pleomorfik adenomun iyi sınırlı olması ve lobülasyon göstermesi gibi bilinen sonografik özellikleri SE'de yoktur. Bu nedenle klasik US'nin yetersiz olduğu durumlarda SE'nin ek katkı sağlamayacağı düşünülmektedir(17,18).Yerli ve Eşki(19) parotisin pleomorfik adenomları ve Whartin tümörlerini ultrasonografik yöntemlerle değerlendirdikleri çalışmalarında ES'nin tek başına değil, ancak B-mod ve renkli Doppler US ile birlikte kullanıldığında tanıda yardımcı olabileceğini bildirdiler. Wierzbicka ve ark.(20) parotis kitlelerini SE ile değerlendirdikleri çalışmada SE'nin maligniteyi dışlamakta tek başına yeterli olmadığını belirtmiştir. ...
Objective:
To evaluate the feasibility and value of sonoelastography in assessing non-thyroid neck masses.
Methods:
Non-thyroid neck masses requiring surgical interventions were evaluated using conventional B-mode ultrasonography (US) (size, short/long axis rate, shape, hilum, echogenity, calcification, necrosis, and peripheral edema) and sonoelastograpy (SE) with strain ratio (SR) and elasticity score (ES) before surgery. These parameters were compared with the histopathological examination.
Results:
In total, 116 non-thyroid neck masses (66 lymph node, 35 parotid gland, eight submandibular gland, and seven cervical mass) of 89 patients (51 men, 38 women) with a mean age of 50.3±15.1 (19-79) years were evaluated. Thirty-seven malignant lymph nodes (23 metastatic and 14 lymphoma), seven malignant parotid tumors, two malignant submandibular tumors, 29 benign lymph nodes, 28 benign parotid lesions, and six benign submandibular lesions were evaluated. Mean SR and ES values of malignant masses were 6.3/3.2 for lymph nodes, 5.5/3.3 for the parotid gland, and 4.2/3 for the submandibular gland. Mean SR and ES values of benign lesions were 2.0/2.1 for lymph nodes, 4.4/3.2 for the parotid gland, and 3.2/3 for the submandibular gland. SR and ES were significantly higher for malignant masses compared with those for benign ones. SR was more predictive than ES in evaluating malignant lymph nodes. The area under the curve was 0.917(0.827-1.00) (p<0.05) for SR in differentiating benign-malignant lymph nodes, and the upper cut-off value was two. SR and ES were higher in the malign parotid and submandibular gland lesions than the benign ones, but the difference was not statistically significant.
Conclusion:
Strain ratio value could be a useful parameter in differentiating benign-malignant lymph nodes. More studies are necessary for differentiating benign-malignant parotid and submandibular lesions using SE.
... In the present literature, the majority of data acquired by B-mode US are insufficient for serving as predictive markers for the assessment of focal parotid gland lesions. Only the detection of irregular lesion margins and pathological lymph node involvement are potent [41][42][43] . After promising results for tumorous lesions of the thyroid and breast, SE was introduced to assess major salivary gland tumours. ...
In Europe, ultrasound (US) is the diagnostic gold standard for the visualisation of parotid gland disorders. While high-resolution B-mode US reliably visualises focal lesions, its diagnostic capacity to distinguish tumour entities or to characterise diffuse lesions remains poor. Strain elastography (SE) and shear wave elastography (SWE) are novel imaging techniques that provide additional information about tissue elasticity. SE analyses the strain or displacement in response to force or compression and, therefore, shows the relative tissue elasticity within a selected region of interest (ROI). Recent studies suggest that SE might be able to predict parotid gland malignancy. In SWE, push pulses generate localised displacements within an ROI that describes mechanical tissue properties expressed in absolute values. Recent studies indicate that SWE can predict tissue fibrosis in different organs. This review article highlights the current role of SE and SWE modalities in diffuse and focal changes of the parotid gland.
