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Holgado A, León X, Llansana A, Valero C, Casasayas M, Fernandez-León A, Quer M. Warthin's Tumour as a Parotid Gland Incidentaloma Identified by PET-CT Scan in a Large Series of Cases. Indian J Otolaryngol Head Neck Surg 2024; 76:3046-3050. [PMID: 39130264 PMCID: PMC11306454 DOI: 10.1007/s12070-024-04592-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/29/2024] [Indexed: 08/13/2024] Open
Abstract
Occasionally in imaging scans there are findings unrelated to the pathology for which the scan was indicated, findings that are called incidentalomas. Warthin tumors have a high glucose avidity, being one of the common incidentalomas in PET-CT scans. The aim of the present study is to analyze the frequency of occurrence of Warthin's tumor as an incidental finding in a large series of patients undergoing 18F-FDG PET-CT. Retrospective analysis of 18F-FDG PET-CT scans performed in our center during the period 2010-2021. Parotid hypermetabolic lesions were identified, as well as their SUVmax, size, smoking habit, BMI (body mass index), and otorhinolaryngology follow-up. 31,423 PET-CT-18FDG studies corresponding to 12,806 patients were analyzed. The frequency of incidentalomas at the parotid level with a diagnosis compatible with Warthin's tumor was 0.87% (n = 111). Eighty percent of the patients with incidentalomas accordant to Warthin's tumor had a history of tobacco use. The highest percentage of incidentalomas compatible with a Warthin tumor was found in patients in whom the indication for PET-CT was the study of a lung carcinoma (1.44%). Only 37% of patients with a PET-CT lesion compatible with a Warthin's tumor were referred for evaluation by the Otorhinolaryngology service. The incidence of Warthin's tumor in 18-FDG PET-CT scans in our center was 0.87%.
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Affiliation(s)
- Anna Holgado
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Mas Casanovas, 90, 08041 Barcelona, Spain
| | - Xavier León
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Mas Casanovas, 90, 08041 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- UVIC, Universitat Central de Catalunya, Vic, Spain
| | - Albert Llansana
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Mas Casanovas, 90, 08041 Barcelona, Spain
| | - Cristina Valero
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Mas Casanovas, 90, 08041 Barcelona, Spain
| | - Maria Casasayas
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Mas Casanovas, 90, 08041 Barcelona, Spain
| | - Alejandro Fernandez-León
- Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Mas Casanovas, 90, 08041 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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Jung JH, Lee YS, Jung YH, Choi SH, Nam SY, Cho HJ, Kwon M. Incidentally found parotid gland lesion in 18F-FDG PET/CT for staging evaluation of patients with hepatocellular carcinoma: remote possibility of metastatic tumor or second primary salivary gland malignancy. BMC Surg 2024; 24:124. [PMID: 38658868 PMCID: PMC11040990 DOI: 10.1186/s12893-024-02422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES We primarily aimed to evaluate whether parotid incidental lesion (PIL) in 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging evaluation of patients with hepatocellular carcinoma (HCC) would represent a possibility of extrahepatic metastasis or second primary malignancy (SPM). Additionally, we explored the incidence of PIL in HCC patients and examined any associated risk factors. METHODS We retrospectively analyzed patients with HCC who underwent 18F-FDG PET/CT at our institution from 2010 to 2022. The pathological findings of PILs in HCC patients were investigated for confirmatory identification of the risk of HCC metastasis or SPM in parotid gland. Healthy controls received 18F-FDG PET/CT for health screening were also enrolled to compare the incidence of PILs with HCC patients. Various parameters associated with patient demographics and characteristics of HCC were analyzed to find the related factors of PILs. RESULTS A total of 17,674 patients with HCC and 2,090 healthy individuals who had undergone 18F-FDG PET/CT scans were enrolled in the analyses. Among the 54 HCC patients who underwent pathological confirmation for PILs, benign primary parotid tumor was most commonly observed (n = 43 [79.6%]); however, no malignant lesions were detected, including HCC metastasis. The incidence of PILs was higher in patients diagnosed with HCC compared with the control group (485 [2.7%] vs. 23 [1.1%], p = 0.002). Analysis for the risk factors for PILs revealed that patient age, sex, and positive viral markers were significantly associated with the incidence of PILs in patients with HCC (all p < 0.001). CONCLUSIONS Our study demonstrates that PILs are more frequently identified in patients with HCC on 18F-FDG PET/CT. However, no malignant PIL, including extrahepatic metastasis of HCC, was identified. Therefore, the presence of PIL should not impede or delay the treatment process for patients with HCC. Additionally, we suggested that for future swift and straightforward differential diagnoses of PIL, the development of additional protocols within the PET/CT imaging could be beneficial.
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Affiliation(s)
- Jin Hyung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Seung-Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Hyo Jung Cho
- Department of Gastroenterology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
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Klug TE, Hillerup S, Dias AH, Gormsen LC, Kristensen PN. Incidental [18F]FDG-avid focuses in parotid glands on PET/CT. Acta Otolaryngol 2024; 144:147-152. [PMID: 38530196 DOI: 10.1080/00016489.2024.2328720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/04/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND The number of unexpected focal [18F]FDG-avid findings (incidentalomas) within the parotid gland (PGI) continues to increase with the expanding use of PET/CT scanning. The prevalence of malignancy in PGIs is uncertain and appropriate management is unsettled. AIMS We aimed to explore the underlying pathologies associated with PGI. MATERIALS AND METHODS A retrospective review of all patients with parotid gland incidentaloma(s) treated at the Ear-Nose-Throat Department, Aarhus University Hospital, Denmark in the period 2012-2021, was performed. RESULTS In total, 94 patients with one (n = 86) or two (n = 8) PGI(s) were included. In patients with one PGI, 72 (84%) focuses were benign, two (2%) focuses were malignant (both malignant melanoma metastases), and 12 (14%) focuses were undiagnosed. In patients with two PGIs, all 12 lesions with pathological examinations were benign (4 PGIs were undiagnosed). The median SUVmax found in benign lesions was higher (12.0) compared to malignant lesions (5.5) (p = .043). CONCLUSIONS AND SIGNIFICANCE The prevalence of malignancy was low (2/94, 2.4%) in PGIs. Based on our findings, PGI in patients without a history of parotid malignancy, who undergo PET/CT scanning for reasons other than head and neck cancer (including malignant melanoma), may be managed similarly to patients with asymptomatic parotid gland tumors.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- Aarhus University, Aarhus, Denmark
| | - Sara Hillerup
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- Aarhus University, Aarhus, Denmark
| | - André Henrique Dias
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Christian Gormsen
- Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Nørgaard Kristensen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Gür H, İsmi O, Vayısoğlu Y, Görür K, Ünal M, Güven O, Özcan C. Results of 301 Parotidectomies: A Twenty-Year Experience of One Single Institution. Indian J Otolaryngol Head Neck Surg 2023; 75:208-217. [PMID: 37007887 PMCID: PMC10050268 DOI: 10.1007/s12070-022-03157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/05/2022] [Indexed: 10/14/2022] Open
Abstract
To evaluate demographic, clinical, surgical and histopathological results and complications of 301 parotidectomies performed in southern part of Turkey. The results of 297 patients undergoing 301 parotidectomies between 2000 and 2019 were retrospectively reviewed. Four patients underwent bilateral parotidectomy. Age, gender, side and size of lesion, postoperative facial nerve function (FNF) for benign tumors and types of surgery were evaluated. There were 172 male and 125 female patients. The mean age was 52.53 ± 16.67 years (range 11-90 years). Patients with malignant tumor had higher mean age than the patients with benign diseases (p < 0.001) and the mean age of Warthin tumor (WT) patients was significantly higher than pleomorphic adenoma (PA) (p < 0.001). There was a significant male dominancy in WTs than the PAs (p < 0.001). The mean size of the malignant tumors was significantly higher than the benign tumors (p = 0.012). The mean of cigarette smoking value (pack/year) was higher in WTs than the PAs (p < 0.001). WT incidence was slightly higher than PA in between years 2010 and 2019 (p = 0.272) compared to between years 2000 and 2009. Fine needle aspiration biopsy had a sensitivity of 96% and specificity of 78% for the benign tumors. Tumor location (p < 0.001) and tumor size (p = 0.034) had negative effect on the postoperative FNF. The incidence of WT had a significant rise in the last decade. Deep lobe tumors and increased tumor size had effect postoperative FNF. Experience of surgeon is more important than nerve monitoring to prevent facial paralysis. Partial superficial parotidectomy was available methods for small benign tumors in tail of the parotid gland.
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Affiliation(s)
- Harun Gür
- Department of Otorhinolaryngology, University of Mersin School of Medicine, Çiftlikköy Kampüsü, Çiftlikköy/Yenişehir, Mersin, Turkey
| | - Onur İsmi
- Department of Otorhinolaryngology, University of Mersin School of Medicine, Çiftlikköy Kampüsü, Çiftlikköy/Yenişehir, Mersin, Turkey
| | - Yusuf Vayısoğlu
- Department of Otorhinolaryngology, University of Mersin School of Medicine, Çiftlikköy Kampüsü, Çiftlikköy/Yenişehir, Mersin, Turkey
| | - Kemal Görür
- Department of Otorhinolaryngology, University of Mersin School of Medicine, Çiftlikköy Kampüsü, Çiftlikköy/Yenişehir, Mersin, Turkey
| | - Murat Ünal
- Department of Otorhinolaryngology, University of Mersin School of Medicine, Çiftlikköy Kampüsü, Çiftlikköy/Yenişehir, Mersin, Turkey
| | - Onurhan Güven
- Department of Otorhinolaryngology, University of Mersin School of Medicine, Çiftlikköy Kampüsü, Çiftlikköy/Yenişehir, Mersin, Turkey
| | - Cengiz Özcan
- Department of Otorhinolaryngology, University of Mersin School of Medicine, Çiftlikköy Kampüsü, Çiftlikköy/Yenişehir, Mersin, Turkey
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McQueen A, Al-Zuhir N, Ali T. Incidentalomas in the head & neck. Br J Radiol 2023; 96:20220164. [PMID: 36317814 PMCID: PMC9975523 DOI: 10.1259/bjr.20220164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Incidental findings (IFs) in the head & neck are a frequent challenge to the reporting radiologist. A combination of complex anatomy, widely varied imaging techniques and the high prevalence of benign pathology, makes safe and appropriate management of head & neck IFs problematic. The non-head & neck radiologist is unlikely to have prior personal experience of the relevant specialties or current involvement with the pertinent multidisciplinary teams, creating unfamiliarity with both the clinical aspects of head & neck disease and the value of examination techniques. This triumvirate of complex anatomy, pathology and imaging creates the perfect environment for excessive investigation and overdiagnosis. In this article, the most frequently encountered and clinically relevant head & neck IFs are summarised. To reflect daily clinical practice, we will firstly consider anatomic abnormalities identified on cross-sectional imaging and ultrasound, followed by a review of PET-CT incidental findings.
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Affiliation(s)
- Andrew McQueen
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Naail Al-Zuhir
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Tamir Ali
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Abstract
OBJECTIVE Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management. METHODS A literature search was performed on 25 August 2020 using the keywords 'incidentaloma', 'incidental finding', 'parotid', 'parotid gland', 'salivary gland' and 'head and neck'. Articles were reviewed by two authors before their inclusion. RESULTS Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy. CONCLUSION If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.
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Alzimami K, Alanazi S, Gannam M, Alanazi A, Aljamaz I, Alyanbawi S, Alotaibi B, Almalki Y, Sulieman A, Sassi S. Evaluation of the Small-animal Nano Scan PET/CT System using 89Zr. Curr Med Imaging 2021; 17:296-305. [PMID: 33045969 DOI: 10.2174/1573405616666201012154548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/24/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The purpose of the present work was to evaluate the imaging characteristics of 89Zr-PET in comparison with those obtained using fluorine-18 Fluorodeoxyglucose (18FFDG) PET (a gold standard tracer in PET imaging) using a small-animal NanoScan PET/CT scanner. METHODS The system's spatial resolution, sensitivity, uniformity, and image quality were measured on a Nano Scan small-animal PET/CT scanner according to the NEMA NU4-2008 protocols. For reconstruction images, we used 2D and 3D reconstruction algorithms. The reconstruction methods included filter back projection (FBP), the ordered subsets expectation maximization (OSEM) algorithm, and the 3D Tera-Tomo algorithm, which are developed for the NanoScan small-animal PET/CT scanner. RESULTS The results obtained showed a significant difference in the spatial resolution for 89Zr as compared to 22Na and 18F when using a 2D reconstruction algorithm. The spatial resolution values were much enhanced by using the 3D Tera-Tomo reconstruction for each isotope, the Full width at half maximum (FWHM) values was less than 1 for all isotopes at the center of the field of view (FOV). This difference in spatial resolution is dependent on the positron range, energy, and the reconstruction method. CONCLUSION The long half-life of 89Zr makes it an ideal positron emitter for performing immuno- PET, which is matched with the biological half-life of intact mAbs.89Zr can also give several advantages over other long half-life positron emitters in relation to the overall imaging performance because of its relatively short positron range and simpler decay scheme. The values of 89Zr sensitivity that were obtained in the present study were less than those of previous studies.
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Affiliation(s)
- Khalid Alzimami
- Department of Radiological Sciences, College of Applied Sciences, King Saud University P. O.Box 10219, Riyadh 11433, Saudi Arabia
| | - Sitah Alanazi
- Department of Physics, College of Science, Imam Muhammad Ibn Saud Islamic University, Riyadh 11461, Saudi Arabia
| | - Magdi Gannam
- Department of Physics and Astronomy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alanazi
- Department of Radiological Sciences, College of Applied Sciences, King Saud University P. O.Box 10219, Riyadh 11433, Saudi Arabia
| | - Ibrahim Aljamaz
- Department of Cyclotron and Radiopharmaceuticals, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Suliman Alyanbawi
- Department of Cyclotron and Radiopharmaceuticals, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Basem Alotaibi
- Department of Cyclotron and Radiopharmaceuticals, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Yousif Almalki
- Department of Cyclotron and Radiopharmaceuticals, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Abdelmoneim Sulieman
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Salman bin Abdulaziz University. P.O.Box 422, Alkharj 11943, Saudi Arabia
| | - Salem Sassi
- Department of Medical Physics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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