Management of high grade parotid carcinomas

Triple Assessment of a Palpable Parotid Lump in "One-Stop" Clinics

Introduction

The National Institute of Clinical Excellence in the UK (NICE) recommended the use of "one-stop" clinics for the assessment and management of head and neck lumps like those established for breast lumps. "One-stop" clinics should follow a triple assessment protocol involving physical examination, radiological imaging and fine-needle aspiration cytology (FNAC).

Methods

A retrospective analysis of 144 patients with suspected parotid tumours from 2005 to 2011 was done. Patients were assessed for individual modalities and compared against the final histological diagnosis. Statistical analysis was used for sensitivity and specificity, as well as positive and negative predictive values. All calculations were performed using SPSS version 16 (Statistical Packages for the Social Sciences, Chicago, IL). A p value of < 0.05 was considered to indicate statistical significance.

Results

A total of 105 patients underwent all the three modalities. Out of them, 93 had imaging that was considered radiologically benign and 12 were reported to have a malignant lesion. Cytologically, 75 were found to have a benign tumour, 13 were malignant, and 17 were considered to be indeterminate. The most common benign neoplasm was pleomorphic adenoma followed by Warthin's tumour. The sensitivity and specificity of triple assessment were 96% (p value 0.878-0.984) and 73% (p value 0.42-0.904), respectively. The positive predictive value was 96% (p value 0.878-0.984) and negative predictive value came out to be 93% (p value 0.42-0.904).

Conclusions

The overall accuracy of triple assessment was found to be 92%. This study concludes that triple assessment is a useful assessment tool to evaluate a patient with parotid lump.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-021-01590-5.

MR Imaging of 495 Consecutive Cases with Sensorineural Hearing Loss

Purpose:

To examine patients with sensorineural hearing loss (SNHL) with MR.

Material and Methods:

495 consecutive patients with SNHL and 120 age-matched healthy controls were examined. Spin-echo (SE) and fast spin-echo (FSE) images were used with 1.5 T equipment.

Results:

An intracranial abnormality was found in 211 (42.6%) of the patients with 95 (19.2%) along the acoustic pathway. Eleven of the 95 patients had sensory hearing loss while 84 had neural hearing loss with the retrocochlear auditory pathway affected by lesions. In 62 of the 84 patients, the internal acoustic canal and cerebellopontine angle were involved. Twenty-two patients had intra-axial lesions. The controls had no pathologic changes along the auditory pathway.

Conclusion:

MR imaging in a patient with SNHL must cover the entire acoustic pathway from the cochlea to the superior temporal gyrus, and all the components of the auditory pathway should be scrutinized. The FSE-technique can be used to detect the lesions causing SNHL. FSE-sequences can replace SE-sequences.