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Ultraschall Med 2017; 38(02): 166-173
DOI: 10.1055/s-0035-1553267
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Multimodal Ultrasonographic Pathway of Parotid Gland Lesions

Multimodaler sonografischer Diagnosepfad für Parotisläsionen
Naglaa Mansour
1   Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany
,
Murat Bas
1   Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany
,
Konrad Friedrich Stock
2   Department of Nephrology, Klinikum rechts der Isar der Technischen Universität München, Germany
,
Ulrich Strassen
1   Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany
,
Benedikt Hofauer
1   Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany
,
Andreas Knopf
1   Department of Otorhinolaryngology, Klinikum rechts der Isar der Technischen Universität München, Germany
› Author Affiliations
Further Information

Publication History

17 June 2014

08 May 2015

Publication Date:
14 August 2015 (online)

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Abstract

Purpose To evaluate a multimodal pathway in solitary circumscribed parotid gland lesions (PL) to predict tumor dignity and to avoid repeat surgery.

Materials and Methods 202 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.

Results Histology 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.

Conclusion The multimodal pathway is a useful method to predict dignity in PLs and reduces the number of repeat surgeries.

Zusammenfassung

Ziel Präoperative Bestimmung der Dignität umschriebener Parotisläsionen (PL) mittels eines multimodalen Diagnosepfads zur Vermeidung von Re-Operationen.

Material und Methoden Bei 202 Patienten mit PL wurde durchgeführt: eine Anamnese, eine klinische Untersuchung, eine Sonografie der Kopf-Halsregion (US), eine farbkodierte Duplexsonografie (FKDS), ein kontrastverstärktes Ultraschall (CEUS), eine Elastografie (RTE). Die PL war anhand des multimodalen Diagnosepfads malignomsuspekt bei: 1. positiver Vorgeschichte für maligne Hauttumore, 2. suspekten Hauttumoren und/oder einer Fazialisparese, 3. unscharfen Tumorgrenzen und/oder pathologischen Halslymphkoten im US, 4. moderater/starker Vaskularisation in der FKDS und verzögerter Perfusion in der CEUS, und/oder 5. schwacher Vaskularisation und rascher Perfusion der PL. Alle Patienten wurden operiert. Bei den präoperativ malignomsuspekten PL wurde intraoperativ ein Schnellschnitt durchgeführt. Bestätigte sich der Verdacht, wurde die OP erweitert. Für alle Entitäten wurden die Sensitivität, Spezifität, positiver und negativer Vorhersagewert (PPV/NPV) bestimmt.

Ergebnisse Histologisch ergaben sich 170 benigne und 32 maligne PL. Durch Anamnese, klinische Untersuchung und US ergab sich für Malignome eine Sensitivität/Spezifität von 77 %/98 %. Durch zusätzlichen Einsatz von FKDS und CEUS konnte für Malignome die Sensitivität auf 91 % gesteigert werden. Die reduzierte Spezifität (81 %) wurde durch den Schnellschnitt egalisiert (PPV/NPV 48 %/98 %). Durch den multimodalen Diagnosepfads musste nur 1 Patient nachoperiert werden.

Schlussfolgerung Der multimodale Diagnosepfad ist hilfreich, um präoperativ die Dignität von PL zu bestimmen und die Rate an Re-Operationen zu senken.

Key words

salivary glands - ultrasound - elastography - color-coded duplex sonography - contrast-enhanced ultrasound
 

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