Accuracy of Ultrasonography and Computed Tomography in the Evaluation of Patients Undergoing Sialendoscopy for Sialolithiasis

Abstract

Objective To determine the accuracy of the 2 most utilized imaging modalities in obstructive sialadenitis secondary to sialolithiasis-computed tomography (CT) and ultrasonography (US)-using sialendoscopic findings as a comparison standard. To review the impact of CT and US on the management of sialolithiasis managed with sialendoscopy alone and through combined approaches. Study Design Retrospective cohort study. Setting Quaternary academic referral center. Subjects and Methods All cases of patients undergoing sialendoscopy by a single surgeon for suspected parotid and submandibular gland pathology between the October 2013 and April 2016 were reviewed. Results Sixty-eight patients were in this cohort, of whom 44 underwent US, CT, and sialendoscopy; 20 underwent CT and sialendoscopy only; and 4 underwent US and sialendoscopy only. The sensitivity and specificity were 65% and 80% for US and 98% and 88% for CT, respectively. These 68 patients had 84 total stones addressed, with 79 being removed and 5 remaining in situ. The methods of stone removal were sialendoscopy alone (34 stones), open transoral approaches (36 stones), and an external approach: transcervical for submandibular and transfacial for parotid (11 stones). Conclusion US had a lower sensitivity (65%) than what has been reported in the literature (70%-94%), and the majority of missed stones were anterior Wharton's duct stones. These sialoliths were likely missed due to an incomplete examination. US and CT were complementary in this study, and the findings suggest that both modalities can be utilized to optimize the outcome of sialendoscopy and combined approaches.

Interrater Reliability of Ultrasound in the Diagnosis of Sialolithiasis

“…Overall, there were only a few false-negative findings (5.4-6.0 %), and as demonstrated in previous publications [10,11,15,17] most of these false-negative findings are located distally. The acoustic shadow of the mandible, combined with a large distance from the transducer to the ostium area in the floor of the mouth, as well as the mucosa-air interface, makes it difficult to assess hyperechoic reflexes in the distal area of Wharton's duct.…”

“…The lack of selection ▶ bias is also confirmed by the observation that the proportion of sialolithiasis in these consecutively sampled 100 cases did not show any differences in comparison with the epidemiological features of a much larger sample of nearly 3000 patients with sialolithiasis [19]. In a recent publication by Thomas et al, it was stated that ultrasound alone cannot be recommended due to the low sensi-tivity observed with the method (around 65 %) and its low interrater reliability in comparison with computed tomography (no data provided) [17]. The study's authors acknowledge that the volume of cases and experience in the use of ultrasound in their institution was relatively small.…”

Gland‐preserving surgery for salivary stones and the utility of sialendoscopes

“…Currently, thin‐cut (1.5 mm) CT scan without contrast is the favored imaging modality in North America for evaluation of salivary stones . CT scans have an estimated sensitivity of 98% and specificity of 88% for stone detection, which is higher than ultrasound (sensitivity 65%; specificity 80%) when compared to sialendoscopy as the gold standard . If a surgeon becomes familiar with the incisional approaches of gland‐preserving therapy and has a definable, fixed target, the majority of patients with sialolithiasis can be managed on site thereby reducing the need to refer to a center with salivary endoscopy.…”

Radyolojik bulgularla submandibular bezde dev siyalolit: Olgu sunumu

“…Submandibular tükürük bezindeki siyalolitlerin çoğu panoramik radyografilerde radyoopak oluşumlar olarak tespit edilir (6) Ultrasonografi, noninvaziv bir teknik olması, daha ucuz maliyet, kolay ulaşılabilirlik ve iyonize radyasyon kullanılmaması gibi avantajları nedeniyle tercih edilmektedir. Buna ek olarak çok küçük boyutlu siyalolitlerde, uygun olmayan prob ve cihaz kullanımında, uygulayıcının yeterli bilgi ve deneyime sahip olmadığı durumlarda ultrasonografi ile görüntüleme uygun olmayabilir (11). Manyetik rezonans görüntüleme ise pahalı ve kolay bulunmaması nedeniyle rutinde kullanılmamaktadır.…”