Controversies in the Workup and Surgical Management of Parotid Neoplasms

Jung

et al. 2022

Preprint

OBJECTIVE: We analyzed and compared the clinical characteristics of benign and malignant parotid gland tumors.PATIENTS and METHODS: A total of 992 patients who underwent surgical treatment for parotid gland tumors from January 2010 to December 2020 were included in this study. This study population was subdivided into benign (n = 812, 81.9%) and malignant parotid gland tumors (n = 180, 18.1%).RESULTS: Pleomorphic adenoma is the most common benign tumor and mucoepidermoid carcinoma is the most common malignant tumor. The patients with malignant parotid gland tumors were older than the patients with benign lesions. The duration of symptoms was longer in patients with benign parotid gland tumors compared to those with malignant lesions. The size of the malignant tumors was larger than that of the benign lesions. Preoperative fine-needle aspiration cytology had a diagnostic sensitivity of 50.3%, diagnostic specificity of 98.7%, a positive predictive value of 89.5%, a negative predictive value of 89.9%, and accuracy of 89.9% for diagnosing malignant parotid gland tumors. For benign parotid gland tumors, superficial parotidectomy was most frequently performed, and for malignant parotid gland tumors, total parotidectomy was most frequently performed. Facial palsy was observed in 19.4% of the patients with malignant parotid gland tumors compared to 5.4% of those with benign tumors.CONCLUSION: The clinical features of benign and malignant parotid gland tumors showed differences in age, symptoms, duration of symptoms, size and site of the parotid tumors, surgical procedures, and postoperative facial nerve palsy.

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Comparative analysis of benign and malignant parotid gland tumors: A retrospective study of 992 patients

Jung

et al. 2022

Preprint

“…Surgery is the primary treatment for parotid tumors, but the clinical choices of surgical methods for benign parotid tumors (BPTs) and malignant parotid tumors (MPTs) are quite different. Local or superficial parotidectomy is the main treatment for BPTs, while more aggressive approaches are used in MPTs, including total or subtotal parotidectomy, even facial nerve resection, or postoperative chemoradiation (2)(3)(4). Therefore, accurate preoperative identification is critical to the choice of treatment and prognosis for patients.…”

Section: Introductionmentioning

confidence: 99%

“…Salivary gland tumors are relatively rare and most commonly occur in parotid glands, with benign tumors accounting for about 75% ( 1 , 2 ). Surgery is the primary treatment for parotid tumors, but the clinical choices of surgical methods for benign parotid tumors (BPTs) and malignant parotid tumors (MPTs) are quite different.…”

Section: Introductionmentioning

confidence: 99%

Multiphasic CT-Based Radiomics Analysis for the Differentiation of Benign and Malignant Parotid Tumors

Wang

et al. 2022

Front. Oncol.

ObjectiveThis study aims to investigate the value of machine learning models based on clinical-radiological features and multiphasic CT radiomics features in the differentiation of benign parotid tumors (BPTs) and malignant parotid tumors (MPTs).MethodsThis retrospective study included 312 patients (205 cases of BPTs and 107 cases of MPTs) who underwent multiphasic enhanced CT examinations, which were randomly divided into training (N = 218) and test (N = 94) sets. The radiomics features were extracted from the plain, arterial, and venous phases. The synthetic minority oversampling technique was used to balance minority class samples in the training set. Feature selection methods were done using the least absolute shrinkage and selection operator (LASSO), mutual information (MI), and recursive feature extraction (RFE). Two machine learning classifiers, support vector machine (SVM), and logistic regression (LR), were then combined in pairs with three feature selection methods to build different radiomics models. Meanwhile, the prediction performances of different radiomics models based on single phase (plain, arterial, and venous phase) and multiphase (three-phase combination) were compared to determine which model construction method and phase were more discriminative. In addition, clinical models based on clinical-radiological features and combined models integrating radiomics features and clinical-radiological features were established. The prediction performances of the different models were evaluated by the area under the receiver operating characteristic (ROC) curve (AUC) and the drawing of calibration curves.ResultsAmong the 24 established radiomics models composed of four different phases, three feature selection methods, and two machine learning classifiers, the LASSO-SVM model based on a three-phase combination had the optimal prediction performance with AUC (0.936 [95% CI = 0.866, 0.976]), sensitivity (0.78), specificity (0.90), and accuracy (0.86) in the test set, and its prediction performance was significantly better than with the clinical model based on LR (AUC = 0.781, p = 0.012). In the test set, the combined model based on LR had a lower AUC than the optimal radiomics model (AUC = 0.933 vs. 0.936), but no statistically significant difference (p = 0.888).ConclusionMultiphasic CT-based radiomics analysis showed a machine learning model based on clinical-radiological features and radiomics features has the potential to provide a valuable tool for discriminating benign from malignant parotid tumors.

Ability for fine needle aspiration and frozen section to predict extent of parotidectomy

Ali,

Sankar,

Stickney

et al. 2023

Head & Neck

IntroductionSeveral diagnostic modalities with various sensitivity and specificities can be used to evaluate a parotid mass. The aims of this project were to compare the diagnostic actionability, accuracy, and ability to accurately predict extent of surgery for FNA and frozen section during the evaluation of a parotid mass.MethodsA retrospective chart review of patients who underwent parotidectomy for a parotid mass from January 1, 2015 to January 30, 2022 was conducted. Actionability was defined as a pathology diagnosis or the histologic grade of a lesion, as this provided clear and useful information for the surgeon to act upon. Diagnostic accuracy was determined by comparing FNA and frozen section results to final pathology. Accuracy of extent of surgery was determined by comparing predicted extent of surgery from the FNA or frozen section result to the extent of surgery predicted by the final pathology.ResultsA total of 626 patients were included in this study. FNA was obtained in 396 (63%) patients, while all neoplasms were evaluated by frozen section analysis. FNA diagnosis was actionable in 318 (80%), while frozen section diagnosis was actionable in 616 (98%) patients. Exactly 294 (92.5%) FNA diagnoses were accurate compared with 600 (98%) frozen section diagnoses. The FNA diagnosis predicted appropriate extent of surgery in 294 (74%) while the frozen section diagnosis predicted appropriate extent of surgery in 600 (96%). Among the 396 patients with FNA, frozen section was significantly more likely to accurately predict appropriate extent of surgery compared with FNA (p < 0.001).ConclusionFrozen section is more likely to yield actionable and accurate results compared with FNA. Additionally, frozen section is better than FNA in predicting the appropriate extent of surgery.