Two-Phase Helical Computed Tomography Study of Salivary Gland Warthin Tumors: A Radiologic Findings and Surgical Applications

Abstract

ObjectivesThe goal of this study was to define the radiologic characteristics of two-phase computed tomography (CT) of salivary gland Warthin tumors and to compare them to pleomorphic adenomas. We also aimed to provide a foundation for selecting a surgical method on the basis of radiologic findings.MethodsWe prospectively enrolled 116 patients with parotid gland tumors, who underwent two-phase CT preoperatively. Early and delayed phase scans were obtained, with scanning delays of 30 and 120 seconds, respectively. The attenuation changes and enhancement patterns were analyzed. In cases when the attenuation changes were decreased, we presumed Warthin tumor preoperatively and performed extracapsular dissection. When the attenuation changes were increased, superficial parotidectomy was performed on the parotid gland tumors. We analyzed the operation times, incision sizes, complications, and recurrence rates.ResultsAttenuation of Warthin tumors was decreased from early to delayed scans. The ratio of CT numbers in Warthin tumors was also significantly different from other tumors. Warthin tumors were diagnosed with a sensitivity of 96.1% and specificity of 97% using two-phase CT. The mean operation time was 38 minutes and the mean incision size was 36.2 mm for Warthin tumors. However, for the other parotid tumors, the average operation time was 122 minutes and the average incision size was 91.8 mm (P<0.05).ConclusionSalivary Warthin tumor has a distinct pattern of contrast enhancement on two-phase CT, which can guide treatment decisions. The preoperative diagnosis of Warthin tumor made extracapsular dissection possible instead of superficial parotidectomy.

Endoscope‐assisted transoral accessory parotid mass excision: Multicenter prospective observational study

“…Third, other surgical methods have been used to excise pleomorphic adenomas. Some authors have validated the use of extracapsular dissections for benign lesions, whereas others have suggested superficial parotidectomies as a suitable method for pleomorphic adenoma excisions because of the recurrence risk caused by the pseudopods of the tumor . However, ectopic parotid masses are somewhat different.…”

Utility of clinical features with fine needle aspiration biopsy for diagnosis of Warthin tumor

“…Despite the high PPV found however, two tumors initially classified as WT in our study were malignant at resection, highlighting one of the reasons why many surgeons still recommend performing a parotidectomy. Other studies have also found that the majority of the cases misdiagnosed as WT turn out to be malignant [4], which may be why most research to date on the management of WT only examine various extents of surgery without including conservative management [15, 16]. Acinic cell carcinoma and mucoepidermoid carcinoma are well-known pitfalls in the diagnosis of WT on FNAB [17–19].…”

Endoscope‐assisted transoral accessory parotid mass excision

“…In considering the surgical methods for pleomorphic adenoma, some authors have validated the use of extracapsular dissection for benign lesions, whereas others have suggested superficial parotidectomy as a suitable method for pleomorphic adenoma because of the recurrence caused by the pseudopod of the tumor . However, the ectopic parotid masses are somewhat different.…”