Diagnosis and Management of Malignant Salivary Gland Tumors of the Parotid Gland

Nomograms predicting cancer-specific survival and overall survival of advanced salivary gland malignancy patients: a study based on the SEER database

OBJECTIVE

To establish a clinical prediction model for specific and overall survival in advanced salivary gland malignant tumors, providing a potential reference tool for personalized clinical care and adjunct treatment decision-making.

METHODS

Retrospective data from the Surveillance, Epidemiology, and End Results (SEER) 8.4.3 version were utilized. Clinical variables collected included patient age, gender, race, diagnosis year, SERR historic stage A, histological types(The histological classification of advanced salivary gland malignant tumors in this study mainly include acinic cell carcinoma, adenoid cystic, mucoepidermoid carcinoma, salivary duct carcinoma, carcinoma ex pleomorphic adenoma, squamous cell carcinoma NOS, salivary gland carcinoma NOS and other histological types), T stage, N stage, M stage, treatment modalities (including surgery, radiotherapy, and chemotherapy), marital status, cancer-specific survival (CSS), overall survival (OS), and survival status. Patients diagnosed with TNM III/TNM IV stage salivary gland malignant tumors between 2010 and 2015 were allocated to the training set, while those diagnosed between 2004 and 2009 served as the test set. Chi-square test compared clinical variables between the training and test sets. Univariate and multivariate COX regression models identified prognostic factors, Kaplan-Meier analysis depicted survival curves, and predictive models for patient OS and CSS were constructed using R-studio environment, with calibration curves and C-index calculated. All statistical analyses were conducted using SPSS 25.0 and R-studio, with P < 0.05 considered significant.

RESULTS

A total of 1477 late-stage salivary gland malignant tumor patients were included. Independent prognostic factors for OS included age, tumor histology, histologic types, T stage, M stage, surgery, and radiotherapy. CSS shared similar prognostic factors with OS. Predictive nomograms based on clinical variables showed high accuracy for 1, 2, 3, 5, and 10-year OS and CSS, with C-indexes of 0.748 and 0.783, respectively. External validation confirmed the models' accuracy, with well-fitted calibration curves between predicted and observed survival rates.

CONCLUSION

Nomograms constructed from clinical data can effectively predict OS and CSS for advanced salivary gland malignant tumor patients, providing a potential reference tool for personalized clinical care and adjunct treatment strategies.

Clinical Outcomes of Intensity Modulated Proton Therapy for Salivary Gland Carcinoma: High Local Control and Quality of Life Preservation

BACKGROUND

In recent years, particle therapy has shown promise as a local treatment for salivary gland carcinoma (SGC); however, its efficacy and safety remain unclear. This study aimed to evaluate the clinical outcomes of intensity-modulated proton therapy (IMPT) for SGC.

METHODS

We performed a single-institution retrospective analysis of patients with SGC who underwent IMPT.

RESULTS

IMPT was performed on 28 SGC patients, of which 18 were for definitive treatment and 10 were for postoperative treatment. The 2-year overall survival (OS), progression-free survival (PFS), and local control (LC) rates for definitive treatment cases were 70.1%, 25.0%, and 82.5%, respectively. The 2-year OS, PFS, and LC rates for postoperative treatment cases were 100%, 80.0%, and 90.0%, respectively. Quality of life scores in the EORTC QLQ-C30 and QLQ-HN35 were preserved for 1 year after treatment.

CONCLUSIONS

Our study suggests the efficacy and safety of IMPT in SGC patients.

Patterns of lymph node metastasis and treatment outcomes of parotid gland malignancies

BACKGROUND

This study aimed to characterize the pattern of cervical lymph node spread and evaluate prognostic factors and outcomes of surgery and postoperative adjuvant therapy in primary parotid carcinoma (PPC).

METHODS

We retrospectively enrolled 136 patients with PPC. The primary outcomes were disease-free survival (DFS) and overall survival (OS). We used Cox hazards models to assess variables influencing survival, and chi-square tests and logistic regression models to evaluate correlations between pN + and clinicopathological factors.

RESULTS

Pathology-confirmed lymph node metastasis was detected in 60.0% and 84.1% of the patients with cT1-2 and cT3-4 tumors, respectively. The occult metastasis rate in cN0 was 55.2%. Level II metastasis was most common (93.2%), followed by level I (49.3%). Histological type, histologic grade, pT stage, and AJCC stage were significant risk factors for lymph node metastasis. One- and five-year OS were 86.0% and 49.3%, respectively (median, 60 months) and 71.6% and 34.8%, respectively, for DFS (median, 24 months). Surgery with 125I seed implant brachytherapy conferred survival benefits to patients. Predictive factors for DFS were pT stage, pN stage, histological type, histological grade, and management strategy, and for OS, pT stage, pN stage, histological type, and histological grade.

CONCLUSION

Histological high grade and advanced T classification were associated with occult lymph node metastasis. Postoperative radiotherapy (RT)/radiochemotherapy (RCT), conferred significant survival benefits in PPC. Neck dissection in patients with cN0 cancer significantly improved DFS and should be performed on those with high-grade and/or advanced T-stage tumors.

Machine learning-assisted diagnosis of parotid tumor by using contrast-enhanced CT imaging features

PURPOSE

This study aims to develop a machine learning diagnostic model for parotid gland tumors based on preoperative contrast-enhanced CT imaging features to assist in clinical decision-making.

MATERIALS AND METHODS

Clinical data and contrast-enhanced CT images of 144 patients with parotid gland tumors from the Peking University School of Stomatology Hospital, collected from January 2019 to December 2022, were gathered. The 3D slicer software was utilized to accurately annotate the tumor regions, followed by exploring the correlation between multiple preoperative contrast-enhanced CT imaging features and the benign or malignant nature of the tumor, as well as the type of benign tumor. A prediction model was constructed using the k-nearest neighbors (KNN) algorithm.

RESULTS

Through feature selection, four key features-morphology, adjacent structure invasion, boundary, and suspicious cervical lymph node metastasis-were identified as crucial in preoperative discrimination between benign and malignant tumors. The KNN prediction model achieved an accuracy rate of 94.44 %. Additionally, six features including arterial phase CT value, age, delayed phase CT value, pre-contrast CT value, venous phase CT value, and gender, were also significant in the classification of benign tumors, with a KNN prediction model accuracy of 95.24 %.

CONCLUSION

The machine learning model based on preoperative contrast-enhanced CT imaging features can effectively discriminate between benign and malignant parotid gland tumors and classify benign tumors, providing valuable reference information for clinicians.

Establishment of prognostic nomogram for high-grade parotid gland mucoepidermoid carcinoma based on the SEER database

Purpose: We aim to investigate the clinical factors that affect the prognosis of overall survival (OS) for patients with high-grade parotid gland mucoepidermoid carcinoma (high-grade pMEC) and construct a nomogram for prognosis prediction. Subjects and method: Totally, 519 patients diagnosed as high-grade pMEC from the surveillance, epidemiology, and end results (SEER) database between 2004 and 2015 were reviewed. Independent prognostic factors for OS were identified by univariate and multivariate Cox regression analyses. Nomogram was generated to predict the individual's 3- and 5- year OS rates by using R software. Prediction ability was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) and model calibration was evaluated through calibration plots. Decision curve analysis (DCA) was used to assess the clinical usefulness and net benefit. Results: The results of univariate analysis demonstrated that age, AJCC stage, T stage, N stage, M stage, extraparenchymal lesions, regional lymph nodes status, lymph node dissection status, radiotherapy, chemotherapy, and surgery were significantly correlated with the OS (P < 0.05). Multivariate Cox regression analyses showed that older age at diagnosis, advanced AJCC stage, and positive regional lymph nodes were independent risk factors for OS. In addition, the present study revealed that radiotherapy and surgery were independent protective factors for OS (P < 0.05). The nomograms showed accurate prognostic ability that individually predict 3-years and 5-years overall survival (OS) rates based on age, AJCC stage, regional lymph nodes status, radiotherapy, and surgery. The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram used to predict the 3-year and 5-year overall survival rate were 0.779 and 0.793, indicating that the model had a good predictive power for the overall survival in high-grade pMEC patient. Conclusions: Using the SEER database, we performed univariate and multivariate analyses to determine independent prognostic factors in high-grade pMEC patients. Subsequently, we constructed and validated a prognostic nomogram to predict 3-and 5-year OS rates based on the SEER database and can assist clinicians to intuitively evaluate prognosis of high-grade pMEC patients.

Treatment outcomes of primary salivary gland squamous cell carcinoma: A multi-institutional retrospective study in Japan

OBJECTIVE

Primary salivary gland squamous cell carcinoma (SCC) is extremely rare, accounting for 0.3-10.4 % of all salivary gland malignancies. Due to this rarity, the clinical characteristics of primary salivary gland SCC remain unelucidated. In the present study, we conducted a multi-institutional retrospective analysis-including a large number of cases compared with that of previous studies-to reveal the prognosis, treatment outcomes, and prognostic factors of primary salivary gland SCC.

METHODS

The clinical course of patients with primary salivary gland SCC between January 2012 and December 2022 was retrospectively investigated. Thirteen university hospitals and cancer centers in Japan participated in this study. The diagnosis of primary salivary gland SCC was based on the following criteria: 1) pathological diagnosis of SCC and exclusion of other histological types and 2) exclusion of metastatic SCCs from other organs. Progression-free and overall survival rates were compared using Kaplan-Meier curves and log-rank tests. Treatment outcomes were assessed using univariate and multivariate analyses with Cox proportional hazards models.

RESULTS

In total, 723 patients with salivary gland cancer were admitted to the participating institutions. Among them, 63 patients (8.7 %) were diagnosed with primary salivary gland SCC. The clinical courses of the 58 patients that received definitive treatment and had complete data were analyzed. Primary treatments included surgery in 35 patients (60.3 %), chemoradiotherapy in 16 (27.6 %), radiotherapy in 5 (8.6 %), and chemotherapy in 2 (3.4 %). Complete response and objective response rates to chemoradiotherapy were 62.5 % and 93.8 %, respectively. Five-year progression-free and overall survival rates were 30.1 % and 60.1 %, respectively. Five-year progression-free survival rates for each treatment were 37.7 % (surgery), 33.0 % (chemoradiotherapy), 0 % (radiotherapy), and 0 % (chemotherapy). Overall survival rates were 71.5 % (surgery), 39.5 % (chemoradiotherapy), 53.3 % (radiotherapy), and 0 % (chemotherapy). Multivariate analysis revealed that age ≥70 years, N classification ≥1, and surgery were independent predictors of progression-free (hazard ratios: 3.75, 2.46, and 0.33, respectively) and overall survival (hazard ratios: 3.11, 6.24, and 0.32, respectively). Adjuvant radiotherapy significantly improved progression-free and overall survival in patients with stage Ⅳ cancer or positive surgical margins. Log-rank tests revealed no significant difference between patients with or without elective neck dissection in progression-free and overall survival; however, a relatively high percentage of occult lymph node metastasis (50.0 %) was observed.

CONCLUSION

Surgical resection is a favorable first-line treatment option in salivary gland SCC, and definitive chemoradiotherapy would show acceptable complete and objective response rates.

Clinical and patient-reported outcomes between full-endoscopic and conventional parotidectomy: a prospective cohort study

OBJECTIVES

This study investigates the clinical and patient-reported outcomes of full-endoscopic parotidectomy compared to the conventional approach.

METHODS

Between July 2021 and December 2023, patients who underwent parotidectomy were prospectively enrolled and assigned to either the full-endoscopic parotidectomy group (Group I) or the conventional surgery group (Group II). Clinical outcomes were evaluated, and patient-reported outcomes were assessed using a Visual Analogue Scale and five FACE-Q scales.

RESULTS

A total of 293 patients were prospectively included, with 146 in the full-endoscopic group and 147 in the conventional group. Blood loss was significantly lower in the full-endoscopic group (regression coefficient, 0.61; 95% CI, 0.15 to 1.07), as was the rate of immediate facial paralysis (0.76; 95% CI, 0.25 to 1.27). The full-endoscopic group also showed superior outcomes on the Visual Analogue Scale (- 0.14; 95% CI, - 0.23 to - 0.05) and FACE-Q scales for Appearance-Related Psychosocial Distress (1.15; 95% CI, 0.59 to 1.71), Social Function (- 0.37; 95% CI, - 0.59 to - 0.15), Satisfaction with Facial Appearance (- 0.44; 95% CI, - 0.64 to - 0.23), Psychological Function (- 0.39; 95% CI, - 0.58 to - 0.20), and Satisfaction With Outcome (- 0.42; 95% CI, - 0.66 to - 0.19).

CONCLUSIONS

Full-endoscopic parotidectomy yields less blood loss and a reduced incidence of immediate facial paralysis compared to conventional surgery. Patients undergoing full-endoscopic parotidectomy reported better aesthetic and psychological outcomes.

CLINICAL RELEVANCE

The combined analysis of clinical and patient-reported outcomes is valuable in guiding surgical planning. These findings provide valuable insights for patients considering full-endoscopic parotidectomy and underscore the importance of addressing functional, aesthetic, and psychological aspects for both patients and healthcare providers.

Effect of Epidermos Barrier Cream on Postoperative Parotidectomy Incision Scar

Introduction: The modified Blair incision is commonly used for superficial and deep lobe lesions of the parotid gland. The most common complication of the parotidectomy procedure is the postoperative surgical scar. Epidermos barrier cream is a type of cream that helps in wound healing by covering the wound. Objective: The purpose of this study was to evaluate the effect of epidermos barrier cream on postoperative incision scars. Methods: Forty-six patients scheduled for surgery due to benign parotid masses were included in the study. Patients were called for a follow-up appointment to remove sutures 1 week after standard surgical intervention. In the study group, epidermos cream was used on the wound site until complete healing was achieved after suture removal, while wound healing in the control group was monitored without any medication. The patients were evaluated in the first, second, and fourth postoperative weeks using a wound site assessment questionnaire and surgical wound assessment for wound healing evaluation. Results: There were no statistically-significant differences between the groups in the evaluation results in the first week. On examination of the data in the second week, a difference was only observed in terms of the presence of hyperemia at the edges of the wound between the groups (P = .005), with no statistically-significant differences found in any other assessment tools. In the 4-week wound healing evaluation, a statistically-significant difference was observed in favor of the study group both in the patient's evaluation of the wound site (P < .001) and in the surgeon's evaluation of the wound site (P = .029). Conclusion: Epidermos cream was found to significantly improve postoperative scar healing in parotidectomy incisions considered challenging in terms of healing. Epidermos barrier cream was found to be beneficial for wound healing in wound sites.

Refining parotid acinic cell carcinoma treatment: Balancing risk factors and extent of resection

OBJECTIVES

Acinic cell carcinoma (ACC) most frequently arises in the parotid gland. Treatment consists of surgical resection and sometimes adjuvant therapy. ACC is most often a low-grade malignancy with good prognosis. Higher-grade tumors are often treated aggressively with total parotidectomy, neck dissection, and adjuvant therapy; however, the effect of parotid gland resection extent on oncologic outcomes has not been studied. Herein, we examine predictors of oncologic outcomes, including the effect of extent of resection.

METHODS

Patients with diagnosis of parotid ACC treated at our institution were included in this retrospective study. Patient factors were examined, and patients were grouped by extent of resection and tumor grade.

RESULTS

58 patients, including 32 low-grade, 7 intermediate-grade, and 14 high-grade were included. Patients with low-grade tumors were more likely to undergo lesser extent of parotidectomy and less likely to undergo neck dissection. Two patients with low grade tumors developed recurrence, one local and one regional. Recurrence rate did not differ with resection extent in low-grade tumors. High tumor grade was found to be associated with disease progression. There was no association with adjuvant treatment and outcomes. Across all tumor grades advanced AJCC stage was found to be associated with disease progression.

CONCLUSIONS

In ACC patients with low-grade tumors and lower disease stage who undergo lesser extent of surgical resection oncologic outcomes were favorable. Patients with high-grade tumors carry a high risk of recurrence, despite aggressive treatment. AJCC stage and histopathologic grade may predict outcomes and guide treatment.

Quality of Life Outcomes for Parotid Malignancies

BACKGROUND

This study describes patient-reported outcome measures (PROMs) and associated factors in patients who underwent surgery for malignant parotid tumors (MPT).

METHODS

This is a retrospective study of all surgically treated MPT patients in a multidisciplinary head and neck cancer (HNC) survivorship clinic (2017-2023). PROMs included University of Washington Quality of Life Questionnaire (UW-QOL), Eating Assessment Tool (EAT-10), Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Neck Disability Index (NDI), and Insomnia Severity Index. Multivariable regression analysis was used to investigate clinical predictors associated with PROMs.

RESULTS

In 62 MPT patients, the prevalence of clinically relevant dysphagia symptoms (EAT-10), elevated symptoms of depression (PHQ-8), moderate/severe symptoms of anxiety (GAD-7), moderate/severe neck pain with activities of daily living (NDI), and moderate/severe symptoms of insomnia at last follow-up was 32.3%, 15.5%, 7.1%, 17.7%, and 7.2%, respectively. Nonparametric one-sided test revealed that patients treated with adjuvant CRT had significantly worse physical QOL, social-emotional QOL, and swallowing scores than patients treated with surgery alone (p = 0.01, p = 0.02, p = 0.03, respectively); that patients treated with surgery and adjuvant RT had significantly worse physical QOL and social-emotional QOL than patients treated with surgery alone (p < 0.01, p = 0.01, respectively) and that patients treated with surgery and adjuvant CRT had significantly worse swallowing and neck pain than patients treated with surgery and adjuvant RT (p = 0.03, p = 0.05, respectively).

CONCLUSIONS

In patients with surgically treated MPT, adjuvant CRT and RT were associated with worse PROMs.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:4549-4556, 2024.

Salivary glands - a new site of Helicobacter pylori occurrence

OBJECTIVE

The role of Helicobacter pylori (Hp) in the pathological processes of the gastric mucosa is well understood. Decreasing trend in successful eradication of HP from the stomach was observed in last years. This lack of succes is mainly caused by increasing ATB resistance. Nevertheless other possible causes of this phenomenon are being explored. Thus, many studies have focused on the search for extragastric reservoirs as potential sources of persistence or reinfection after successful Hp eradication. The pathological potential of Hp at these localities has also been studied.

METHODS

Our study aimed to determine the presence of Hp inside the salivary glands ductal system through its detection from sialolites. Subsequently, we tried to prove the possible ability of Hp to penetrate the salivary gland parenchyma by detecting Hp from the tissue of salivary tumors. Concrements and salivary tumor tissue samples were collected using sialendoscopy or standard surgery, and Hp detection and genotyping were performed through PCR.

RESULTS

Hp was detected in 68.3% of the sialopathy samples. VacA S1AM1 was the most common genotype. CagA-positive genotype represented only 34% of the total number of positive samples.

CONCLUSION

Our findings of Hp positivity in concrements provide compelling evidence of Hp presence in the ductal system of salivary glands. Confirmation of Hp presence in tumor tissue suggests its potential ability to infiltrate the gland's parenchyma. Further research is needed to confirm Hp's ability to cause local infection, as well as the possible causal association between Hp presence in the studied region, sialolithiasis, and salivary gland tumors.

Salivary Gland Fine-Needle Aspiration: The Current and Future Landscape

Fine-needle aspiration represents a valid tool for the diagnosis/management of salivary gland lesions. The past years assessed the lack of uniform diagnostic reports for salivary cytopathology leading to interpretative issues. In 2015, an international group of cytopathologists developed an evidence-based tiered classification system for reporting salivary gland fine-needle aspiration (FNA) specimens, the "Milan System for Reporting Salivary Gland Cytopathology" (MSRSGC). The present landscape of salivary cytology is represented by the growing adoption of the MSRSGC and the assessment of its diagnostic role. The future landscape is characterized by the increasing role of ancillary techniques for diagnostic and prognostic purposes.

Epidemiology, prognostic factors, and treatment of head and neck mucoepidermoid carcinoma: Analysis of the surveillance, epidemiology, and end results database

OBJECTIVES

To investigate prognostic factors in patients with head and neck Mucoepidermoid Carcinoma (MEC), especially the impact of treatment modalities on survival.

METHODS

Patients with primary head and neck MEC between 2000 and 2015 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors related to Overall Survival (OS) and Cancer-Specific Survival (CSS), as well as the impact of treatments, were evaluated by multivariable Cox regression analysis.

RESULTS

We identified 2692 patients diagnosed with head and neck MEC, of whom 1397 (51.89%) had a parotid gland primary, 569 (22.14%) died, and 341 (12.67%) died of MEC. Older age (≥53 years), males, unmarried, lower income, tumor site in other head and neck areas, higher tumor grade, larger tumor size, and higher stage were related to poorer OS and CSS. Patients who did not undergo surgery (HR=3.20, 95% CI 2.45‒4.18) had worse OS, while no significant difference was detected between partial and total organ excision on patients' OS (p=0.729). For combination therapy, patients who received radiotherapy only (HR=3.21, 95% CI 2.27-4.53) or no surgery and no radiotherapy (HR=2.59, 95% CI 1.83-3.67) were correlated with worse OS (vs. surgery only), but no significant difference was detected between surgery only and surgery combined with radiotherapy on patients' OS (p=0.218). For CSS, the corresponding results were consistent with OS.

CONCLUSION

Surgical resection only may be a better survival option for head and neck MEC.

Deep learning-assisted diagnosis of benign and malignant parotid gland tumors based on automatic segmentation of ultrasound images: a multicenter retrospective study

Objectives

To construct deep learning-assisted diagnosis models based on automatic segmentation of ultrasound images to facilitate radiologists in differentiating benign and malignant parotid tumors.

Methods

A total of 582 patients histopathologically diagnosed with PGTs were retrospectively recruited from 4 centers, and their data were collected for analysis. The radiomics features of six deep learning models (ResNet18, Inception_v3 etc) were analyzed based on the ultrasound images that were obtained under the best automatic segmentation model (Deeplabv3, UNet++, and UNet). The performance of three physicians was compared when the optimal model was used and not. The Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) were utilized to evaluate the clinical benefit of the optimal model.

Results

The Deeplabv3 model performed optimally in terms of automatic segmentation. The ResNet18 deep learning model had the best prediction performance, with an area under the receiver-operating characteristic curve of 0.808 (0.694-0.923), 0.809 (0.712-0.906), and 0.812 (0.680-0.944) in the internal test set and external test sets 1 and 2, respectively. Meanwhile, the optimal model-assisted clinical and overall benefits were markedly enhanced for two out of three radiologists (in internal validation set, NRI: 0.259 and 0.213 [p = 0.002 and 0.017], IDI: 0.284 and 0.201 [p = 0.005 and 0.043], respectively; in external test set 1, NRI: 0.183 and 0.161 [p = 0.019 and 0.008], IDI: 0.205 and 0.184 [p = 0.031 and 0.045], respectively; in external test set 2, NRI: 0.297 and 0.297 [p = 0.038 and 0.047], IDI: 0.332 and 0.294 [p = 0.031 and 0.041], respectively).

Conclusions

The deep learning model constructed for automatic segmentation of ultrasound images can improve the diagnostic performance of radiologists for PGTs.

Advances in H2O2-supplying materials for tumor therapy: synthesis, classification, mechanisms, and applications

Hydrogen peroxide (H2O2) as a reactive oxygen species produced by cellular metabolism can be used in antitumor therapy. However, the concentration of intracellular H2O2 limits its application. Some materials could enhance the concentration of intracellular H2O2 to strengthen antitumor therapy. In this review, the recent advances in H2O2-supplying materials in terms of promoting intracellular H2O2 production and exogenous H2O2 supply are summarized. Then the mechanism of H2O2-supplying materials for tumor therapy is discussed from three aspects: reconstruction of the tumor hypoxia microenvironment, enhancement of oxidative stress, and the intrinsic anti-tumor ability of H2O2-supplying materials. In addition, the application of H2O2-supplying materials for tumor therapy is discussed. Finally, the future of H2O2-supplying materials is presented. This review aims to provide a novel idea for the application of H2O2-supplying materials in tumor therapy.

Differential expression of epidermal growth factor receptor in various pathological types of salivary gland cancers

OBJECTIVE

While several studies reported epidermal growth factor receptor (EGFR) expression in salivary gland cancer (SGC), results varied due to a lack of unified definition of EGFR positivity. In this study, we assessed the EGFR expression level using both EGFR positive score and cumulative EGFR score in the patients with SGC.

METHODS

Between January 2010 and April 2021, 102 patients with SGC who underwent surgical resection were reviewed retrospectively by immunohistochemistry. The membrane staining intensity was scored as follows: no staining (0), weak staining (1+), intermediate staining (2+), and strong staining (3+). The cumulative EGFR score was determined on a continuous scale of 0-300 using the formula:1 × (1+: percentage of weakly stained cells) + 2 × (2+: percentage of moderately stained cells) + 3 × (3+: percentage of strongly stained cells).

RESULTS

EGFR expression in SGC varied widely even among the same as well as different histopathological types. The average EGFR positive scores were 46.0 %, 55.7 %, 51.6 %, 1.0 %, 26.8 %, 50 %, and 76.8 % for mucoepidermoid carcinoma (MEC), salivary duct carcinoma (SDC), adenoid cystic carcinoma (AdCC), acinic cell carcinoma (AcCC), adenocarcinoma NOS (ACNOS), carcinoma ex pleomorphic adenoma (CAexPA), and squamous cell carcinoma (SqCC), respectively. The average cumulative EGFR scores were 82, 91, 80, 1, 52, 93, and 185 for MEC, SDC, AdCC, AcCC, ACNOS, CAexPA, and SqCC, respectively.

CONCLUSIONS

EGFR positive scores and cumulative EGFR scores in SGCs varied among the various histological types, and even in the same histological type. These scores may predict the clinical outcome of SGC treated with EGFR-targeting therapies, such as head and neck photoimmunotherapy, and need to be evaluated in future studies.

Clinical Behavior of the Mucoepidermoid Carcinoma of the Larynx-A Scoping Review

OBJECTIVE

Mucoepidermoid carcinomas (MEC) of the larynx account for less than 1% of all laryngeal tumors. The unique features and clinical behavior of these rare entities remain unknown. To fill this knowledge gap, we performed a scoping review of every reported case of laryngeal MEC to study the clinical behavior and the treatment modalities in this rare entity.

REVIEW METHODS

We followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) statement.

DATA SOURCES

MedLine, Google Scholar, and Science Direct databases were searched to identify eligible studies.

RESULTS

We concluded with 25 studies and overall 66 cases. Our study revealed that the average age of cases was 55.7 years, and the range was from 12 to 81 years, with younger onset in females. Supraglottic (60%) is the most common subsite of laryngeal MEC s followed by glottis (27.3%). Supraglottic carcinomas frequently present with metastatic neck disease at the time of the initial diagnosis and require more extensive surgical approaches. Surgery with negative surgical margins seems to be the cornerstone in the treatment of MEC. Radiation therapy has not been tested widely as monotherapy but is considered a useful adjuvant modality.

CONCLUSION

This study suggests that negative surgical margins seem to be associated to higher disease control rate and that high-grade supraglottic cases likely benefit from addressing neck disease simultaneously.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:2578-2584, 2024.

Discriminating atypical parotid carcinoma and pleomorphic adenoma utilizing extracellular volume fraction and arterial enhancement fraction derived from contrast-enhanced CT imaging: A multicenter study

OBJECTIVES

To investigate the added value of extracellular volume fraction (ECV) and arterial enhancement fraction (AEF) derived from enhanced CT to conventional image and clinical features for differentiating between pleomorphic adenoma (PA) and atypical parotid adenocarcinoma (PCA) pre-operation.

METHODS

From January 2010 to October 2023, a total of 187 cases of parotid tumors were recruited, and divided into training cohort (102 PAs and 51 PCAs) and testing cohort (24 PAs and 10 atypical PCAs). Clinical and CT image features of tumor were assessed. Both enhanced CT-derived ECV and AEF were calculated. Univariate analysis identified variables with statistically significant differences between the two subgroups in the training cohort. Multivariate logistic regression analysis with the forward variable selection method was used to build four models (clinical model, clinical model+ECV, clinical model+AEF, and combined model). Diagnostic performances were evaluated using receiver operating characteristic (ROC) curve analyses. Delong's test compared model differences, and calibration curve and decision curve analysis (DCA) assessed calibration and clinical application.

RESULTS

Age and boundary were chosen to build clinical model, and to construct its ROC curve. Amalgamating the clinical model, ECV, and AEF to establish a combined model demonstrated superior diagnostic effectiveness compared to the clinical model in both the training and test cohorts (AUC = 0.888, 0.867). There was a significant statistical difference between the combined model and the clinical model in the training cohort (p = 0.0145).

CONCLUSIONS

ECV and AEF are helpful in differentiating PA and atypical PCA, and integrating clinical and CT image features can further improve the diagnostic performance.

Evaluation of Quantitative Dual-Energy Computed Tomography Parameters for Differentiation of Parotid Gland Tumors

RATIONALE AND OBJECTIVES

To assess the diagnostic performance of quantitative parameters from dual-energy CT (DECT) in differentiating parotid gland tumors (PGTs).

MATERIALS AND METHODS

101 patients with 108 pathologically proved PGTs were enrolled and classified into four groups: pleomorphic adenomas (PAs), warthin tumors (WTs), other benign tumors (OBTs), and malignant tumors (MTs). Conventional CT attenuation and DECT quantitative parameters, including iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number (Zeff), electron density (Rho), double energy index (DEI), and the slope of the spectral Hounsfield unit curve (λHU), were obtained and compared between benign tumors (BTs) and MTs, and further compared among the four subgroups. Logistic regression analysis was used to assess the independent parameters and the receiver operating characteristic (ROC) curves were used to analyze the diagnostic performance.

RESULTS

Attenuation, Zeff, DEI, IC, NIC, and λHU in the arterial phase (AP) and venous phase (VP) were higher in MTs than in BTs (p < 0.001-0.047). λHU in VP and Zeff in AP were independent predictors with an area under the curve (AUC) of 0.84 after the combination. Furthermore, attenuation, Zeff, DEI, IC, NIC, and λHU in the AP and VP of MTs were higher than those of PAs (p < 0.001-0.047). Zeff and NIC in AP and λHU in VP were independent predictors with an AUC of 0.93 after the combination. Attenuation and Rho in the precontrast phase; attenuation, Rho, Zeff, DEI, IC, NIC, and λHU in AP; and the Rho in the VP of PAs were lower than those of WTs (p < 0.001-0.03). Rho in the precontrast phase and attenuation in AP were independent predictors with an AUC of 0.89 after the combination. MTs demonstrated higher Zeff, DEI, IC, NIC, and λHU in VP and lower Rho in the precontrast phase compared with WTs (p < 0.001-0.04); but no independent predictors were found.

CONCLUSION

DECT quantitative parameters can help to differentiate PGTs.

The extracapsular dissection technique in the management of benign tumours of the parotid gland: our experience in 194 patients

OBJECTIVE

The indications for and approaches to extracapsular dissection for parotid gland benign tumours are debated in the literature. This study retrospectively evaluates a single site's short- and long-term results with a standardised extracapsular dissection approach to benign parotid tumours.

METHODS

A retrospective review of a single institution's records identified cases with extracapsular dissection as the primary surgery for non-recurrent benign parotid tumours. A total of 194 eligible patients were identified (124 women and 70 men, age 47.75 ± 15.62 years). Pre-, intra- and post-surgical data were reviewed for complications and recurrences.

RESULTS

Histology reported pleomorphic adenoma in 165 patients, Warthin's tumour in 28 patients and both in one patient. Mean follow up was 36 ± 16 months (range, 12-84 months). The incidences of complications following extracapsular dissection were temporary (n = 13) and permanent (n = 0) facial nerve dysfunction, Frey's syndrome (n = 1)) and recurrences (n = 5). These rates align with prior literature.

CONCLUSION

This case series shows how a standardised approach to extracapsular dissection for benign parotid tumours yields favourable results, supporting a progressive change of strategy towards reduced invasiveness.

Evaluation of the efficacy of adjuvant radiotherapy versus chemoradiotherapy in patients with salivary gland tumors

AIMS

The aim of this study was to compare the efficacy of adjuvant radiotherapy (RT) versus adjuvant chemoradiotherapy (CRT) in patients with salivary gland tumors (SGTs).

MATERIALS AND METHODS

Data from patients who underwent adjuvant RT for a diagnosis of SG cancer at Ankara Atatürk Education and Research Hospital, Ankara Numune Education and Research Hospital and Ankara Bilkent City Hospital between September 01, 2009 and September 01, 2022 were analysed retrospectively. We evaluated the efficacy of RT alone versus CRT in these patients in terms of acute response, treatment tolerance, overall survival (OS), and disease-free survival (DFS).

RESULTS

Fifty-five patients who underwent RT between September 14, 2009 and August 04, 2022 at Ankara Atatürk Education and Research Hospital, Ankara Numune Education and Research Hospital and Ankara Bilkent City Hospital were included in this study. Eight patients who did not meet the study criteria were excluded; thus, the analysis was performed for 47 patients. The median follow-up period was 60 months (range: 6-160 months). The median patient age was 53 years (range: 18-86 years). Thirty-nine patients (83%) had parotid tumors and eight patients (17%) had submandibular cancer. The time from surgery to RT was 48 days (range: 20-126 days). Intensity-modulated radiotherapy was administered to all patients and the median RT dose was 66 Gy (range: 52-70 Gy). Concomitant chemotherapy (CCT) (40 mg/m 2 of cisplatin weekly) was administered to 13 patients (27.7%). Acute adverse events were observed in 17 patients (36.2%). Interruption of RT was noted for only six patients (12.8%), and this proportion did not differ significantly between the CRT and RT-only arms ( P = 0.538). Acute side effects were observed in 17 patients (36.2%), and there were no significant relationships between acute side effects and the administration of CCT ( P = 0.112). Recurrence was observed in 10 patients (21.3%). All recurrences were locoregional and no distant metastases were observed during the follow-up period. The median DFS of the patients was 48 months (range: 4-160 months), 1-year DFS was 86%, 2-year DFS was 83.5%, and 5-year DFS was 77.9%. There was no statistically significant difference in DFS between the adjuvant CRT and RT-alone arms ( P = 0.114). At the date of last follow-up, 14 patients (29.8%) had died. The median OS of the patients was 58.5 months (range: 6-160 months), 1-year OS was 91.4%, 2-year OS was 86.8%, and 5-year OS was 78%. There was no statistically significant difference in OS between the adjuvant CRT and RT-only arms ( P = 0.453).

CONCLUSION

Stage was identified as the most important prognostic factor for DFS and OS. No significant differences in OS, DFS, or acute side effects were observed between the CRT and RT-only arms. Additional studies are needed to identify the subgroup of SGT patients for which CRT is most warranted.

Exploring Immunological Effects and Novel Immune Adjuvants in Immunotherapy for Salivary Gland Cancers

Salivary gland cancer (SGC) is rare and comprises over 20 histological subtypes. Recently, clinical experience regarding immunotherapies for SGCs has been accumulating, yet their efficacy remains controversial. Understanding the tumor microenvironment (TME), including the expression of immune checkpoint molecules in SGC, is crucial to optimizing immunotherapy. In this review, we demonstrate that high-grade mucoepidermoid carcinoma and salivary duct carcinoma generally exhibit immune-hot TME with high immune cell infiltration, frequent genetic mutations, and robust immune checkpoint molecule expression. In contrast, adenoid cystic carcinomas exhibit an immune-cold TME. While the reported efficacy of immune checkpoint inhibitors (ICIs) for SGCs is generally poor, several studies showed promising clinical efficacy of ICIs, with an objective response rate ranging from 20.0-33.3%, indicating that ICIs might be beneficial for a specific population of SGC. Molecule-targeted therapies including anti-human epidermal growth factor receptor 2 and anti-androgen receptor therapies have shown promising clinical efficacy against SGC. Recent evidence indicates that these molecules could be targets for antigen-specific immunotherapies including chimeric antigen receptor-T therapy and cancer vaccines. This review discusses the current understanding and future directions of immunotherapies for SGCs, including ongoing clinical trials.

Persistent bleeding following biopsy of an epidermoid cyst within the parotid gland

Epidermoid cysts are benign lesions most commonly found in the skin but which can arise in many other locations including, very rarely the salivary glands. This rarity often leaves them off standard differential lists and can create a diagnostic dilemma. A patient with an incidentally detected parotid mass on MRI underwent core biopsy, which was unfortunately complicated by formation of a pseudoaneurysm and persistent arterial bleeding requiring coil embolisation. The histology showed only keratinous material and, in retrospect, the signal characteristics of the mass were entirely typical of an epidermoid cyst. Recognition of this common, benign entity in a very rare location can obviate the need for invasive tests and potential complications and direct management to more appropriate imaging follow-up.

Brain metastases in patients with salivary duct carcinoma: A retrospective study

BACKGROUND

Salivary duct carcinoma (SDC) is a high-grade adenocarcinoma with a 5-year survival rate of 40%. Although drug therapy has improved patients' prognosis, the impact of brain metastasis (BM) remains poorly understood. We aimed to retrospectively examine the incidence of BM in patients with SDC (n = 464) and develop a tool to estimate their prognoses.

METHODS

We retrospectively examined 464 patients with SDC enrolled in a multicenter study. We investigated the incidence of BM, overall survival (OS) rates, and factors affecting prognosis in patients with BM. We also developed an SDC-graded prognostic assessment (GPA) score for disease prognostication.

RESULTS

Sixty-five (14%) patients had BM. The median OS (mOS) was 13.1 months. On univariate and multivariate analyses, factors such as Eastern Cooperative Oncology Group Performance Status >1, human epidermal growth factor receptor 2-negative status, and locoregional uncontrolled disease were associated with poor OS. SDC-GPA scores according to the prognostic factors were 0, 1, 2, and 3 points, and mOS estimates were 50.5, 16.1, 3.9, and 1.2 months, respectively (p < 0.001).

CONCLUSION

The SDC-GPA score emerged as a useful prognostication tool for patients with BM.

Prognostic effects of previous cancer history on patients with major salivary gland cancer

OBJECTIVES

To explore the prognostic effects of previous cancer history on patients with major salivary gland cancer (SGC).

SUBJECTS AND METHODS

SGC patients with (sec-SGC) and without (one-SGC) a previous cancer from the SEER database were identified. Cox proportional hazards regression (CoxPH) models were used to compare the prognosis between sec-SGC and one-SGC patients. Subgroup analyses for sec-SGC patients by gender, previous cancer types, previous cancer histology, and cancer diagnosis interval (CDI) were performed. Two CoxPH models were constructed to distinguish sec-SGC patients with different prognostic risks.

RESULTS

9098 SGC patients were enrolled. Overall, sec-SGC patients (adjusted HR [aHR] = 1.26, p < 0.001), especially those with a CDI ≤ 5 years (aHR = 1.47, p < 0.001), had worse overall survival (OS) than one-SGC patients. In subgroup analysis, only sec-SGC patients with a previous head and neck cancer who were female (aHR = 2.38, p = 0.005), with a CDI ≤ 5 years (aHR = 1.65, p = 0.007) or with a previous squamous cell carcinoma (aHR = 6.52, p < 0.001) had worse OS. Our models successfully differentiated all sec-SGC patients into high-, intermediate- and low-risk groups with different prognosis.

CONCLUSIONS

Sec-SGC patients with different previous cancer types, gender, CDI and previous cancer histology had varied prognosis. The models we constructed could help differentiate the prognosis of sec-SGC patients with different risks.

A Radiomics-Based Machine Learning Perspective on the Parotid Gland as a Potential Surrogate Marker for HPV in Oropharyngeal Cancer

BACKGROUND

In treatment of oropharyngeal squamous cell carcinoma (OPSCC), human papillomavirus status (HPV) plays a crucial role. The HPV-positive subtype tends to affect younger patients and is associated with a more favorable prognosis. HPV-associated lesions have been described in the parotid gland, which is included in routine imaging for OPSCC. This work aims to explore the ability of an ML system to classify HPV status based on imaging of the parotid gland, which is routinely depicted on staging imaging.

METHODS

Using a radiomics approach, we investigate the ability of five contemporary machine learning (ML) models to distinguish between HPV-positive and HPV-negative OPSCC based on non-contrast computed tomography (CT) data of tumor volume (TM), locoregional lymph node metastasis (LNM), and the parotid gland (Parotid). After exclusion of cases affected by streak artefacts, 53 patients (training set: 39; evaluation set: 14) were retrospectively evaluated. Classification performances were tested for significance against random optimistic results.

RESULTS

The best results are AUC 0.71 by XGBoost (XGB) for TM, AUC 0.82 by multi-layer perceptron (MLP) for LNM, AUC 0.76 by random forest (RF) for Parotid, and AUC 0.86 by XGB for a combination of all three regions of interest (ROIs).

CONCLUSIONS

The results suggest involvement of the parotid gland in HPV infections of the oropharyngeal region. While the role of HPV in parotid lesions is under active discussion, the migration of the virus from the oral cavity to the parotid gland seems plausible. The imaging of the parotid gland offers the benefit of fewer streak artifacts due to teeth and dental implants and the potential to screen for HPV in cases of an absent or unlocatable tumor. Future investigation can be directed to validation of the results in independent datasets and to the potential of improvement of current classification models by addition of information based on the parotid gland.

Prognostic factors for sublingual gland carcinoma: a population-based Surveillance, Epidemiology and End Results database study

OBJECTIVE

To identify the clinical features and prognostic factors for sublingual gland carcinoma.

METHODS

This was a case-control study. Patients with surgically treated sublingual gland carcinoma were retrospectively included in the Surveillance, Epidemiology and End Results database and divided into adenoid cystic carcinoma (ACC) and non-ACC groups. Primary outcome variables were disease-specific survival (DSS) and overall survival (OS). Prognostic factors for each group were analyzed using Cox models.

RESULTS

We included 251 patients (115 men and 136 women). Compared with the non-ACC group, the ACC group had a larger average tumor size and received more adjuvant radiotherapy. In patients with ACC, the pathologic grade had an independent impact on DSS and OS, and patients who were undergoing adjuvant chemotherapy had worse DSS than those who were not receiving chemotherapy. In the non-ACC group, pathologic grade IV, lymph node metastasis, and adjuvant chemotherapy were associated with poor DSS and OS, and tumor extension predicted worsening DSS.

CONCLUSIONS

In sublingual gland carcinoma, the pathologic grade and adjuvant chemotherapy were the most important prognostic factors, whereas lymph node metastasis had a negative impact in non-ACC patients but not in ACC patients.

Deep learning-assisted diagnosis of parotid gland tumors by using contrast-enhanced CT imaging

OBJECTIVES

Imaging interpretation of the benignancy or malignancy of parotid gland tumors (PGTs) is a critical consideration prior to surgery in view of therapeutic and prognostic values of such discrimination. This study investigates the application of a deep learning-based method for preoperative stratification of PGTs.

MATERIALS AND METHODS

Using the 3D DenseNet-121 architecture and a dataset consisting of 117 volumetric arterial-phase contrast-enhanced CT scans, we developed a binary classifier for PGT distinction and tested it. We compared the discriminative performance of the model on the test set to that of 12 junior and 12 senior head and neck clinicians. Besides, potential clinical utility of the model was evaluated by measuring changes in unassisted and model-assisted performance of junior clinicians.

RESULTS

The model finally reached the sensitivity, specificity, PPV, NPV, F1-score of 0.955 (95% CI 0.751-0.998), 0.667 (95% CI 0.241-0.940), 0.913 (95% CI 0.705-0.985), 0.800 (95% CI 0.299-0.989) and 0.933, respectively, comparable to that of practicing clinicians. Furthermore, there were statistically significant increases in junior clinicians' specificity, PPV, NPV and F1-score in differentiating benign from malignant PGTs when unassisted and model-assisted performance of junior clinicians were compared.

CONCLUSION

Our results provide evidence that deep learning-based method may offer assistance for PGT's binary distinction.

Radiomics Analysis in Characterization of Salivary Gland Tumors on MRI: A Systematic Review

Radiomics analysis can potentially characterize salivary gland tumors (SGTs) on magnetic resonance imaging (MRI). The procedures for radiomics analysis were various, and no consistent performances were reported. This review evaluated the methodologies and performances of studies using radiomics analysis to characterize SGTs on MRI. We systematically reviewed studies published until July 2023, which employed radiomics analysis to characterize SGTs on MRI. In total, 14 of 98 studies were eligible. Each study examined 23-334 benign and 8-56 malignant SGTs. Least absolute shrinkage and selection operator (LASSO) was the most common feature selection method (in eight studies). Eleven studies confirmed the stability of selected features using cross-validation or bootstrap. Nine classifiers were used to build models that achieved area under the curves (AUCs) of 0.74 to 1.00 for characterizing benign and malignant SGTs and 0.80 to 0.96 for characterizing pleomorphic adenomas and Warthin's tumors. Performances were validated using cross-validation, internal, and external datasets in four, six, and two studies, respectively. No single feature consistently appeared in the final models across the studies. No standardized procedure was used for radiomics analysis in characterizing SGTs on MRIs, and various models were proposed. The need for a standard procedure for radiomics analysis is emphasized.

Diagnosis and Management of Parotid Gland Cancer with Focus on the Role of Preoperative Fine-Needle Aspiration Cytology: A 10-Year-Long Retrospective Study with 5-Year Follow-Up

Introduction

Salivary gland cancers represent a rare heterogeneous group of neoplasms with complex clinicopathological characteristics and distinct biological behaviour. The appropriate diagnosis and management of parotid gland cancer are challenging and should be based on the clinical, imaging, cytological, and histological features. The present study analysed the use of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen section (FS) to guide the appropriate surgical and postoperative treatment of parotid gland cancers.

Materials and Methods

We selected 48 patients with primary malignancy of the parotid gland surgically treated between 1 January 2008 and 30 June 2017 at the Maxillo-Facial Surgery Division, University Hospital of Parma, Italy. The patients had postoperative histological diagnosis of malignant parotid cancer and were followed up for longer than 5 years.

Results

The 48 patients included in this study had a mean age of 56.7 years. The most frequent type of parotid gland cancer was carcinoma ex pleomorphic adenoma (22.9%), followed by mucoepidermoid carcinoma (16.7%) and acinic cell carcinoma (14.6%). All 48 patients underwent preoperative FNAC: 29 (60.4%) and 19 (39.6%) were suggestive of malignant and benign lesions, respectively. In 31 patients, intraoperative FS was performed.

Discussion

Compared to previous studies, the present study showed significantly lower diagnostic sensitivity of FNAC for parotid gland cancers. The preoperative diagnostic accuracy for suspected malignant cases may be improved by repeat analysis of the cytological specimen by experts, preoperative core needle biopsy, and/or intraoperative FS analysis of the suspected mass.

Extracapsular Dissection of Deep Lobe Parotid Mass Aided by Retromandibular Vein on Imaging: A Case Report

This report investigates the use of the retromandibular vein on imaging as a diagnostic tool for planning deep lobe parotid tumors. A unique aspect of this case is the performance of extracapsular dissection on a deep lobe parotid lesion, which is rare. Preoperative imaging showed a superficially displaced retromandibular vein, indicating a deeply seated tumor, which aided surgical planning. Under general anesthesia, extracapsular dissection was performed while protecting the facial nerve branches. The patient's postoperative course was uneventful, and the facial nerve was intact with no weakness.

Current trends in the treatment of recurrent adenocystic cancer of the salivary glands: case report

Salivary gland carcinomas is a rare family of neoplasms with different histological characteristics and biological behavior. Treatment regimens have remained virtually unchanged for decades, leaving the leading role for surgical treatment and radiation therapy. However, a special place in the salivary gland carcinomas group is occupied by adenoid cystic carcinoma, which is quite often characterized by a recurrent and / or metastatic course with the use of chemotherapy as the main option in treatment. It is worth noting the fact that the results of standard chemotherapy regimens show unsatisfactory results, respectively, with recurrent or metastatic adenoid cystic carcinoma, treatment options are minimal. Accordingly, there is a need to study new therapeutic methods for the treatment of this disease. In this situation, high hopes were placed on targeted therapy, in particular, the family of epidermal growth factor receptors, c-Kit are the most frequently studied molecular targets. Due to the rare occurrence of adenoid cystic carcinoma, the number of cases of using targeted therapy for analysis is relatively small, so each clinical observation is of particular value. The following is a clinical case of treatment of recurrent adenoid cystic carcinoma using a personalized treatment approach.

Aim. To describe the clinical observation of the use of targeted drugs in recurrent or metastatic adenocystic cancer of the salivary glands.

Molecular Targets in Salivary Gland Cancers: A Comprehensive Genomic Analysis of 118 Mucoepidermoid Carcinoma Tumors

INTRODUCTION

Salivary gland carcinomas (SGC) are histologically diverse cancers and next-generation sequencing (NGS) to identify key molecular targets is an important aspect in the management of advanced cases.

METHODS

DNA was extracted from paraffin embedded tissues of advanced SGC and comprehensive genomic profiling (CGP) was carried out to evaluate for base substitutions, short insertions, deletions, copy number changes, gene fusions and rearrangements. Tumor mutation burden (TMB) was calculated on approximately 1.25 Mb. Some 324 genes in the FoundationOne CDX panel were analyzed.

RESULTS

Mucoepidermoid carcinoma (MECa) mutations were assessed. CDKN2A and CDKN2B GA were common in mucoepidermoid carcinoma (MECa) (52.5 and 30.5%). PIK3CA was also common in MECa (16.9%). ERBB2 amplification/short variants (amp/SV) were found in MECa (5.9/0%). HRAS GA was common in MECa (14.4%) as well. Other targets, including BAP1, PTEN, and KRAS, were noted but had a low incidence. In terms of immunotherapy (IO)-predictive markers, TMB > 10 was more common in MECa (16.9%). PDL1 high was also seen in MECa (4.20%).

CONCLUSION

SGC are rare tumors with no FDA-approved treatment options. This large dataset reveals many opportunities for IO and targeted therapy contributing to the continuously increased precision in the selection of treatment for these patients.

Deep-Learning-Based Automatic Segmentation of Parotid Gland on Computed Tomography Images

This study aims to develop an algorithm for the automatic segmentation of the parotid gland on CT images of the head and neck using U-Net architecture and to evaluate the model's performance. In this retrospective study, a total of 30 anonymized CT volumes of the head and neck were sliced into 931 axial images of the parotid glands. Ground truth labeling was performed with the CranioCatch Annotation Tool (CranioCatch, Eskisehir, Turkey) by two oral and maxillofacial radiologists. The images were resized to 512 × 512 and split into training (80%), validation (10%), and testing (10%) subgroups. A deep convolutional neural network model was developed using U-net architecture. The automatic segmentation performance was evaluated in terms of the F1-score, precision, sensitivity, and the Area Under Curve (AUC) statistics. The threshold for a successful segmentation was determined by the intersection of over 50% of the pixels with the ground truth. The F1-score, precision, and sensitivity of the AI model in segmenting the parotid glands in the axial CT slices were found to be 1. The AUC value was 0.96. This study has shown that it is possible to use AI models based on deep learning to automatically segment the parotid gland on axial CT images.

Number of positive lymph nodes combined with the logarithmic ratio of positive lymph nodes predicts long-term survival for patients with node-positive parotid gland carcinoma after surgery: a SEER population-based study

PURPOSE

To evaluate the prognostic value of the number of positive lymph nodes (NPLN), the ratio of positive lymph nodes (pLNR), and the logarithmic ratio of positive lymph nodes (LODDS) in patients with parotid gland carcinoma. On this basis, establishing and validating an optimal nomogram.

METHODS

A total of 895 patients with T1-4N1-3M0 parotid gland carcinoma were included in our study from the Surveillance, Epidemiology, and End Results (SEER) database. Patients' data were randomly assigned to the training cohort and the validation cohort by a ratio of 7:3. Univariate and multivariate COX regression analysis were used to explore the relationship between the study factors and the prognosis of parotid gland carcinoma, including overall survival (OS) and cause-specific survival (CSS). The Akaike Information Criterion (AIC) was used to evaluate model fit. Harrell's concordance index (C-index), integrated discrimination improvement (IDI), and net reclassification index (NRI) were used to evaluate the predictive ability of these models. The decision curve analysis was used to evaluate the clinical benefit of the nomograms compared with the TNM stage.

RESULTS

NPLN, pLNR, and LODDS are independent risk factors for the prognostic of PGC. According to the AIC, C index, IDI, and NRI, the models combined with NPLN and LODDS were the best. The decision curves suggested that our nomograms had good predictive abilities for the prognosis of parotid gland carcinoma.

CONCLUSION

The two nomograms which contained NPLN and LODDS had the potential to predict OS and CSS in patients with parotid gland carcinoma.

Prognostic Factors of Pretreatment Magnetic Resonance Imaging for Predicting Clinical Outcome in Patients With Parotid Gland Cancer

PURPOSE

This study aimed to assess the utility of pretreatment magnetic resonance imaging (MRI) in predicting the clinical outcomes of patients with parotid gland cancer.

METHODS

A total of 43 patients with histopathologically confirmed primary parotid gland cancer, who underwent pretreatment MRI, were enrolled in this study. All images were retrospectively reviewed, and MRI features were evaluated as possible prognostic factors influencing the progression-free survival (PFS) using the Kaplan-Meier method and Cox proportional hazards regression model. Cox regression analysis was used to estimate the hazard ratios (HRs) with 95% confidence interval (95% CI) values.

RESULTS

Kaplan-Meier survival analysis showed that old age (>73 years, P < 0.01), large maximum tumor diameter (>33 mm, P < 0.01), low apparent diffusion coefficient value (≤1.29 ×10-3 mm2/s, P < 0.01), ill-defined margin (P < 0.01), skin invasion (P < 0.01), regional nodal metastasis (P < 0.01), heterogeneous enhancement (P < 0.05), and high signal intensity ratio on gadolinium-enhanced fat-suppressed T1-weighted images (>2.017, P < 0.05) were significant predictors of worse PFS. Cox proportional hazards regression analysis revealed that regional nodal metastasis (HR, 32.02; 95% CI, 6.42-159.84; P < 0.01) and maximum tumor diameter (HR, 1.04; 95% CI, 1.01-1.08; P < 0.05) were independent predictors of PFS.

CONCLUSION

Pretreatment MRI parameters could be prognostic factors of patients with parotid gland cancer. In particular, the maximum tumor diameter and regional nodal metastasis, which were closely associated with T and N classifications, were important prognostic factors in predicting the PFS.

Clinical value of adjuvant therapy on the prognosis of ductal carcinoma of the major salivary gland: a large-scale cohort study

PURPOSE

To explore the clinical characteristics, prognostic factors, and value of adjuvant therapy for major salivary duct carcinoma (SDC).

METHODS

Data of SDC patients who received surgery was obtained from Surveillance, Epidemiology, and End Results (SEER) database (2004-2016). Kaplan-Meier and Cox regression analyses were performed to assess prognostic factors. Propensity score matching (PSM) was done to evaluate the clinical value of adjuvant therapy.

RESULTS

A total of 287 patients were enrolled. The 5-year overall survival (OS) and disease-specific survival (DSS) rates were 53.8% and 70.8%, respectively. In the univariate analysis, tumor size, T, N, TNM staging, SEER combined staging, number of regional lymph nodes examined, and number of positive lymph nodes were associated with OS and DSS. Age and primary surgical methods were also related to OS. Among patients with negative lymph nodes, patients with tumor size > 4 cm had significantly worse prognosis (P = 0.009). Multivariate analysis showed that age > 75 years, T3-4, and positive lymph nodes were independent risk factors for SDC. After PSM, the prognostic factors were age, tumor site, and T and N stage. Postoperative radiotherapy could improve OS in patients with tumor size > 4 cm (P = 0.049).

CONCLUSIONS

Advanced age, submandibular gland lesions, T3-4 stage, and lymph node involvement were independent prognostic factors for SDC. In patients with tumors > 4 cm, adjuvant radiotherapy improved the OS of SDC patients.

High-grade mucoepidermoid carcinoma of the salivary gland in a bull

Salivary gland neoplasia is uncommon in veterinary species and has rarely been reported in cattle. Adenocarcinoma, squamous cell carcinoma, and pleomorphic carcinoma have been described in the parotid gland of dairy cows. Here we describe a case of high-grade mucoepidermoid carcinoma in a bull. The bull had a chronic history of caudal mandibular soft tissue swelling. Postmortem examination revealed a 30 × 30-cm mass with a caseonecrotic center, hemorrhage and necrosis of the ipsilateral cervical musculature, osteolysis of the right paracondylar process of the skull and right horn base, pulmonary nodules, and enlarged tracheobronchial lymph nodes. Histology of the mass, lungs, and lymph nodes revealed an invasive neoplasm composed of epithelial cells arranged in nests and ductular structures supported by a spindle cell stroma, with frequent central necrosis. Immunohistochemistry revealed that epithelial cells were diffusely positive for pancytokeratin and p63 with multifocal vimentin positivity; stromal cells were diffusely positive for vimentin and α-SMA. A salivary gland mucoepidermoid carcinoma was diagnosed based on these findings. Although rare, salivary gland neoplasia should be considered a differential diagnosis for mandibular masses in cattle.

Survival Outcome of Salivary Gland Carcinoma: A 50-Year Retrospective Study With Long-Term Follow-up

PURPOSE

Salivary gland carcinomas (SGCs) can be classified into more than 20 subtypes with various clinical behaviors. The present study aimed to analyze the clinical and pathological features of SGCs and evaluate their long-term prognosis.

METHODS

A retrospective cohort study was performed. This study investigated cases of histologically confirmed SGC at the authors' institution from January 1963 to December 2014. Data on sex, age, site, histopathological diagnosis, tumor-node-metastasis classification, postoperative radiotherapy and/or chemotherapy, local and regional recurrence, and distant metastasis (DM) were collected as covariates. The overall survival (OS) rate was analyzed as the outcome. Kaplan-Meier survival analysis and Cox multivariate analysis were used for survival analysis. The cohort was divided into 2 groups-before and after 1989. The clinicopathological characteristics of the 2 groups were compared using the χ² test.

RESULTS

The cohort included 1,637 patients who met the admission criteria and had a male-to-female ratio of 0.9:1. The median age was 47 years (range, 8 months to 86 years). The median follow-up time was 54 months (range, 1-432 months). The majority of the tumors occurred in the parotid gland (35.3%), followed by the palate gland (25.2%). Adenoid cystic carcinoma was the most common tumor type (34.3%), and mucoepidermoid carcinoma (29%) was the second most common type. In the 1,637 patients, the neck lymph node metastasis rate was 8.7% at the first surgery, and the overall DM rate was 14.1%. The 5-, 10-, and 15-year OS rates of the 1,637 cases were 93.1%, 87.2%, and 79.3%, respectively. Comparative analysis before and after 1989 showed statistically significant differences in sex, site, histologic subtype, T classification, local and regional recurrence rate, and radiotherapy (P < .05), while no significant differences were found in age, N classification, M staging, DM, or chemotherapy.

CONCLUSIONS

The OS rates of SGC have improved significantly over the past 30 years. This is attributable to an increase in the proportion of patients diagnosed at the early stage and receiving radiotherapy, as this has led to a reduction in the local and regional recurrence rate and, consequently, an improvement in the survival rates.

The Diagnostic Value of Fine Needle Aspiration Biopsy in Parotid Tumors

The aim of this study was to investigate the diagnostic accuracy rates of the patients who underwent an operation for parotid mass, by comparing their fine needle aspiration biopsy (FNAB) cytology results with the final pathology. A total of 136 patient files of those who applied to Otorhinolaryngology clinic due to parotid mass and underwent parotidectomy procedure between 2010 and 2020 at a tertiary center were scanned retrospectively. Database on patient age, gender, preoperative FNAB results, and final surgical histopathology results was created. The mean age of the patients was 48.26 ± 17.37 Superficial parotidectomy was performed to 108 (79.4%) and total parotidectomy to 28 (20.6%) of the patients. The sensitivity of FNAB was found as 85.2%, specificity as 96.2%, positive predictive value as 85.2%, negative predictive value as 96.2% and accuracy as 94.0%. It is found that FNAB has the high specificity and high negative predictive value with high diagnostic accuracy on detecting preoperative malignancy in parotid gland. We think that FNAB is a significant, necessary and safe method in the diagnosis of parotid lesions in preoperative sense.

The efficacy of PD-1 inhibitors in patients with salivary gland carcinoma: A retrospective observational study

Objective

Immune checkpoint inhibitors (ICIs) have been considered as novel therapeutic approaches for various cancers. ICIs were reportedly efficacious against rare cancers, including salivary gland carcinoma (SGC). We aimed to analyze the efficacy and safety of ICIs in patients with SGC.

Methods

We retrospectively analyzed the oncologic outcomes and immune-related adverse events (irAEs) in patients with SGC treated with at least one cycle of nivolumab or pembrolizumab.

Results

Among 12 patients, there were two with a complete response (CR), two with a partial response, five with stable diseases, and three with progressive diseases. The overall response rate was 33.3%. A CR was achieved in patients with poorly differentiated carcinoma (carcinoma ex pleomorphic adenoma) and salivary duct carcinoma. The progression-free survival ranged between 1 and 18 months (median, 4 months), while the overall survival ranged between 2 and 25 months (median, 13.5 months). An irAE was observed in only one patient who developed grade 3 erythema multiforme, and this patient's condition improved with withdrawal of pembrolizumab alone.

Conclusion

Programmed death-1 blockade was an effective therapy for patients with SGC, including aggressive histologic types.

Assessment of a limited-access parotidectomy technique's complications and scar characteristics - A cohort study

OBJECTIVE

Parotidectomy is the treatment of choice for benign tumors of the parotid gland, with the modified Blair incision most commonly utilized. This retrospective analysis aimed to determine the incidence of complications and assess the relationship between the mass and scar characteristics, in patients who had undergone parotidectomy.

MATERIALS AND METHODS

The scar characteristics of patients who had undergone parotidectomy for benign neoplasms at our medical center between 2013 and 2019 were evaluated.

RESULTS

Overall, 49 patients met the inclusion criteria, of whom 33 agreed to participate in the study. The mean patient age was 52.8 years; 57.5% were males. No correlation was identified between the parotid mass size or location and scar type or length. The most common complications in this study were similar to those reported in the literature.

CONCLUSION

The results of this study suggest that the smaller, tailored modified Blair incision for parotidectomy does not increase complication rates. Future studies with larger cohorts should be conducted to further assess the potential benefits of tailored incision size during modified Blair parotidectomies.

The Therapeutic Landscape of Salivary Gland Malignancies-Where Are We Now?

Salivary gland malignancies (SGMs) account for less than 5% of new diagnoses in head and neck tumors. If feasible, surgery is the preferred treatment modality. Nevertheless, some malignancies have a tendency of recurrence, with possible distant metastasis. Alternative treatment strategies, such as primary radiation or chemotherapeutics, often present low response rates. As a result, there is an unmet need for novel therapeutic approaches. Nowadays, target-based therapies (e.g., small inhibitors and immunotherapy) are used by the medical oncologist for possible treatment of advanced SGMs. Based on recent published trials, some novel treatments may provide additional disease control for some patients. However, sample sizes are small, the general findings are unsatisfactory, and a lot of uncertainties remain to be elucidated. Nevertheless, research shows that patients do not benefit from blind administration of systemic treatments and therefore a more personalized approach is highly needed. The aim of this review paper is to summarize the most recent advances in the biological understanding and molecular pathways of salivary gland cancers, the association of these pathways with the current treatments used and their implications for more personalized targeted-based therapies.

An attention base U-net for parotid tumor autosegmentation

A parotid neoplasm is an uncommon condition that only accounts for less than 3% of all head and neck cancers, and they make up less than 0.3% of all new cancers diagnosed annually. Due to their nonspecific imaging features and heterogeneous nature, accurate preoperative diagnosis remains a challenge. Automatic parotid tumor segmentation may help physicians evaluate these tumors. Two hundred eighty-five patients diagnosed with benign or malignant parotid tumors were enrolled in this study. Parotid and tumor tissues were segmented by 3 radiologists on T1-weighted (T1w), T2-weighted (T2w) and T1-weighted contrast-enhanced (T1wC) MR images. These images were randomly divided into two datasets, including a training dataset (90%) and an validation dataset (10%). A 10-fold cross-validation was performed to assess the performance. An attention base U-net for parotid tumor autosegmentation was created on the MRI T1w, T2 and T1wC images. The results were evaluated in a separate dataset, and the mean Dice similarity coefficient (DICE) for both parotids was 0.88. The mean DICE for left and right tumors was 0.85 and 0.86, respectively. These results indicate that the performance of this model corresponds with the radiologist's manual segmentation. In conclusion, an attention base U-net for parotid tumor autosegmentation may assist physicians to evaluate parotid gland tumors.

Parotid Gland Tumors: A Multicenter Analysis of 1020 Cases. Increasing Incidence of Warthin's Tumor

We assessed the frequency of the parotid gland tumor entities and correlated sex and age in different tumor types. Retrospective data were obtained from three major otorhinolaryngology clinics in Karlsruhe and Pforzheim, Germany within a 10-year period. In total, 1020 cases of parotidectomy for benign and malignant lesions were identified. We found 864 (84.7%) and 156 (15.3%) patients with benign and malignant tumors of the parotid gland, respectively. The most common benign parotid tumor was Warthin's tumor, followed by pleomorphic adenoma. The most common primary malignant tumor types were acinic cell carcinoma and mucoepidermoid carcinoma. Secondary malignant tumors of the parotid gland included lymphoma and metastatic, cutaneous squamous cell carcinoma. The frequency of Warthin's tumors was higher than that of pleomorphic adenomas. A large proportion of the malignant parotid tumors represent metastases from squamous cell carcinoma of the skin of the head and neck.

Diagnostic performance of elastosonography in the differential diagnosis of benign and malignant salivary gland tumors: A meta-analysis

Purpose

The clinical practice of elastosonography for the detection of salivary gland tumors is still a controversial issue. The objective of this meta-analysis was to evaluate the effect of elastosonography for the diagnosis of salivary gland tumors and to compare the diagnostic value of elastosonography and conventional ultrasound in the diagnosis of salivary gland tumors.

Methods

A comprehensive literature search through PubMed, EMBASE, and Cochrane Library was carried out from inception to November 2021. Two researchers independently extracted the data from the enrolled papers using a standard data extraction form. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to evaluate the diagnostic performance of elastosonography. The Quality Assessment of Diagnostic Accuracy Studies—2 (QUADAS-2) tool was utilized to evaluate the quality of each included study. Meta-DiSc version 1.4, Review Manager 5.3, and StataSE 15 were used.

Results

Sixteen studies with a total of 1105 patients with 1146 lesions were included in this meta-analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR of elastosonography for the differentiation between benign and malignant salivary gland tumors were 0.73 (95%CI, 0.66–0.78), 0.64 (95%CI, 0.61–0.67), 2.83 (95%CI, 1.97–4.07), 0.45 (95%CI, 0.32–0.62), and 9.86 (95%CI, 4.49–21.62), respectively, with an AUC of 0.82. Four studies provided data regarding the conventional ultrasound for the differentiation between benign and malignant salivary gland tumors. The pooled sensitivity, specificity, and DOR were 0.62 (95%CI, 0.50–0.73), 0.93 (95%CI, 0.90–0.96), and 25.07 (95%CI, 4.28–146.65), respectively. The meta-regression and subgroup analyses found that assessment methods were associated with significant heterogeneity, and quantitative or semiquantitative elastosonography performed better than the qualitative one.

Conclusions

Elastosonography showed a limited value for diagnosing malignant salivary gland tumors; it could be considered as a supplementary diagnostic technology to conventional ultrasound, and quantitative or semiquantitative elastosonography was superior to the qualitative one.