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Cancer Medicine Jun 2024To investigate the added value of extracellular volume fraction (ECV) and arterial enhancement fraction (AEF) derived from enhanced CT to conventional image and clinical...
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.
Topics: Humans; Male; Female; Adenoma, Pleomorphic; Middle Aged; Parotid Neoplasms; Tomography, X-Ray Computed; Diagnosis, Differential; Aged; Adult; Contrast Media; ROC Curve; Retrospective Studies; Adenocarcinoma
PubMed: 38899534
DOI: 10.1002/cam4.7407 -
Indian Journal of Otolaryngology and... Sep 2023Intranodal palisaded myofibroblastoma is a rare benign tumor of the lymph nodes, that arises from smooth muscle cells or myofibroblast, chiefly in the inguinal lymph...
Intranodal palisaded myofibroblastoma is a rare benign tumor of the lymph nodes, that arises from smooth muscle cells or myofibroblast, chiefly in the inguinal lymph nodes. Intranodal palisaded myofibroblastoma of the parotid gland is exceedingly scarce, even more, its recurrent characteristic; which underlines the grave importance of a long, strict monitoring and surveillance plan. Alongside these salient points in this unusual case, we also aim to highlight the peculiar difficulties inevitably faced, given the unfortunate lack of typical pathognomonic clinical and radiological features. We therefore, report a rare case of recurrent intranodal palisaded myofibroblastoma, arising in the felt parotid gland in a 53-year-old male patient, diagnosed by anatomopathological and immunopathological analysis. Described as benign tumor intranodal palisaded myofibroblastoma is a scarce myofibroblastic neoplasm of the lymph nodes. Histological and immunopathological features represent the determining factors for the diagnosis, of this favorable prognosis tumor.
PubMed: 37636792
DOI: 10.1007/s12070-023-03771-9 -
Academic Radiology Jan 2024Salivary gland tumors constitute 2%-6% of all head and neck tumors and are most common in the parotid gland. Magnetic resonance (MR) imaging is the most sensitive...
RATIONALE AND OBJECTIVES
Salivary gland tumors constitute 2%-6% of all head and neck tumors and are most common in the parotid gland. Magnetic resonance (MR) imaging is the most sensitive imaging modality for diagnosis. Tumor type, localization, and relationship with surrounding structures are important factors for treatment. Therefore, parotid gland tumor segmentation is important. Specialists widely use manual segmentation in diagnosis and treatment. However, considering the development of artificial intelligence-based models today, it is seen that artificial intelligence-based automatic segmentation models can be used instead of manual segmentation, which is a time-consuming technique. Therefore, we segmented parotid gland tumor (PGT) using deep learning-based architectures in the paper.
MATERIALS AND METHODS
The dataset used in the study includes 102 T1-w, 102 contrast-enhanced T1-w (T1C-w), and 102 T2-w MR images. After cropping the raw and manually segmented images by experts, we obtained the masks of these images. After standardizing the image sizes, we split these images into approximately 80% training set and 20% test set. Hereabouts, we trained six models for these images using ResNet18 and Xception-based DeepLab v3+. We prepared a user-friendly Graphical User Interface application that includes each of these models.
RESULTS
From the results, the accuracy and weighted Intersection over Union values of the ResNet18-based DeepLab v3+ architecture trained for T1C-w, which is the most successful model in the study, are equal to 0.96153 and 0.92601, respectively. Regarding the results and the literature, it can be seen that the proposed system is competitive in terms of both using MR images and training the models independently for T1-w, T1C-w, and T2-w. Expressing that PGT is usually segmented manually in the literature, we predict that our study can contribute significantly to the literature.
CONCLUSION
In this study, we prepared and presented a software application that can be easily used by users for automatic PGT segmentation. In addition to predicting the reduction of costs and workload through the study, we developed models with meaningful performance metrics according to the literature.
Topics: Humans; Parotid Gland; Artificial Intelligence; Head and Neck Neoplasms; Magnetic Resonance Imaging; Software; Image Processing, Computer-Assisted
PubMed: 37271636
DOI: 10.1016/j.acra.2023.04.028 -
Annals of Plastic Surgery Sep 2023Salivary ductal carcinoma is an extremely rare tumor located in the parotid gland. This case details a salivary ductal carcinoma within the parotid gland of a...
Salivary ductal carcinoma is an extremely rare tumor located in the parotid gland. This case details a salivary ductal carcinoma within the parotid gland of a 59-year-old man and its management.
Topics: Male; Humans; Middle Aged; Salivary Gland Neoplasms; Parotid Gland; Carcinoma, Ductal; Parotid Neoplasms
PubMed: 37405870
DOI: 10.1097/SAP.0000000000003614 -
Clinical & Experimental Metastasis Oct 2023Many locally advanced and metastatic salivary gland carcinomas (SGC) lack therapeutic targets. Enfortumab vedotin, an antibody-drug conjugate binding to Nectin-4,...
Many locally advanced and metastatic salivary gland carcinomas (SGC) lack therapeutic targets. Enfortumab vedotin, an antibody-drug conjugate binding to Nectin-4, recently gained FDA approval for third-line urothelial carcinoma. Therefore, the aim of this study was to assess the expression of Nectin-4 in primary SGC and corresponding lymph node metastases and to correlate it with clinicopathological data. Immunohistochemical staining for Nectin-4 was performed for patients who had undergone surgery with curative intent for primary SGC of the parotid or submandibular gland in a tertiary referral center between 1990 and 2019. One hundred twenty-two primary SGC and twenty corresponding lymph node metastases were included. Nectin-4 was expressed in 80.3% of primary SGC with a mean Histo(H-)score of 61.2 and in 90.0% of lymph node metastases with a mean H-score of 75.6. A moderate or high Nectin-4 expression was found in 25.9% of salivary duct carcinomas (SaDu) and in 30.7% of adenoid cystic carcinomas (ACC). SaDu patients with a lower T-stage (p = 0.04), no loco-regional lymph node metastases (p = 0.049), no vascular invasion (p = 0.04), and no perineural spread (p = 0.03) showed a significantly higher mean Nectin-4 H-score. There was a statistical tendency towards a more favorable disease-free survival among SaDu patients with a higher Nectin-4 expression (p = 0.09). Nectin-4 is expressed in SGC and therefore represents a potential therapeutic target, especially in entities with a high rate of local recurrence and metastatic spread such as SaDu and ACC.
Topics: Humans; Nectins; Carcinoma, Transitional Cell; Lymphatic Metastasis; Urinary Bladder Neoplasms; Salivary Gland Neoplasms; Biomarkers; Cell Adhesion Molecules
PubMed: 37480387
DOI: 10.1007/s10585-023-10222-w -
European Archives of... May 2024Parotid pleomorphic adenomas present a risk of recurrence, higher when the tumour is a hypocellular subtype. The aim of the study was to determine whether it is possible...
PURPOSE
Parotid pleomorphic adenomas present a risk of recurrence, higher when the tumour is a hypocellular subtype. The aim of the study was to determine whether it is possible to characterize this histological subtype with diffusion and perfusion sequences of the preoperative MRI.
METHODS
This retrospective study included 97 patients operated between 2010 and 2020. Histologic slides review was performed to classify tumours into three histologic subtypes: hypocellular, classical and hypercellular. Univariate and multivariate analyses studied the correlation between histology and diffusion and perfusion MRI parameters obtained with OleaSphere® software.
RESULTS
The hypocellular subtype had higher apparent diffusion coefficient values than the other two subtypes: 2.13 ± 0.23, 1.83 ± 0.42, and 1.61 ± 0.4 × 10 mm/s for hypocellular, classical and hypercellular subtype respectively (p < 0.0001). Multivariate analysis showed that an ADC > 1.88 × 10 mm/s was suggestive of a hypocellular pleomorphic adenoma in 79% of the cases, with a specificity and PPV of 94 and 96% (p < 0.001), respectively.
CONCLUSION
The histological subtype of a pleomorphic adenoma can be predicted preoperatively with ADC values. A prospective and multicentric study on a larger cohort is needed to confirm our results.
Topics: Humans; Adenoma, Pleomorphic; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Prospective Studies; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging; Diagnosis, Differential; Salivary Gland Neoplasms
PubMed: 38498193
DOI: 10.1007/s00405-024-08562-8 -
Neuroradiology May 2024One of the most severe complications in surgery of parotid tumors is facial palsy. Imaging of the intra-parotid facial nerve is challenging due to small dimensions. Our...
PURPOSE
One of the most severe complications in surgery of parotid tumors is facial palsy. Imaging of the intra-parotid facial nerve is challenging due to small dimensions. Our aim was to assess, in patients with parotid tumors, the ability of high-resolution 3D double-echo steady-state sequence with water excitation (DE3D-WE) (1) to visualize the extracranial facial nerve and its tracts, (2) to evaluate their relationship to the parotid lesion and (3) to compare MRI and surgical findings.
METHODS
A retrospective study was conducted including all patients with parotid tumors, who underwent MRI from April 2022 to December 2023. Two radiologists independently reviewed DE3D-WE images, assessing quality of visualization of the facial nerve bilaterally and localizing the nerve's divisions in relation to the tumor. MRI data were compared with surgical findings.
RESULTS
Forty consecutive patients were included (M:F = 22:18; mean age 56.3 ± 17.4 years). DE3D-WE could excellently visualize the nerve main trunk and the temporofacial division in all cases. The cervicofacial branch was visible in 99% of cases and visibility was good. Distal divisions were displayed in 34% of cases with a higher visibility on the tumor side (p < 0.05). Interrater agreement was high (weighted kappa 0.94 ± 0.01 [95% CI 0.92-0.97]). Compared to surgery accuracy of MRI in localizing the nerve was 100% for the main trunk, 96% for the temporofacial and 89% for the cervicofacial branches.
CONCLUSIONS
Facial nerve MR-neurography represents a reliable tool. DE3D-WE can play an important role in surgical planning of patients with parotid tumors, reducing the risk of nerve injury.
PubMed: 38714544
DOI: 10.1007/s00234-024-03372-5 -
Radiotherapy and Oncology : Journal of... Sep 2023No specific irradiation guidelines have been proposed for parotid lymph node (PLN) metastasis in patients with nasopharyngeal carcinoma (NPC). This study aimed to...
PURPOSE
No specific irradiation guidelines have been proposed for parotid lymph node (PLN) metastasis in patients with nasopharyngeal carcinoma (NPC). This study aimed to explore the dose prescription and target delineation for PLN metastasis in patients with NPC.
METHODS
With the NPC database from a big-data platform, 10,685 patients with primarily diagnosed, non-distant metastatic, histologically proven NPC and treated with intensity modulated radiotherapy (IMRT) at our center from 2008 to 2019 were reviewed and those with PLN metastasis were enrolled in this study. Dosimetry parameters were collected from the dose-volume histograms (DVH). The primary endpoint was overall survival (OS). Least absolute shrinkage and selection operator regression (LASSO) was operated for variable selection. Multivariate Cox regression analysis was applied to identify the independent prognostic factors.
RESULTS
PLN metastases were identified in 275/10685 (2.5%) patients. Of 367 positive PLN, 199 were in superficial intra-parotid, followed by 70 in deep intra-parotid, 54 in subparotid and 44 in subcutaneous pre-auricular. Better survival outcome was observed in PLN-radical IMRT group, compared with PLN-sparing group. In 190 patients received PLN-radical IMRT, multivariate analysis revealed that D95% of level VIII > 55 Gy was an independent beneficial prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and parotid relapse-free survival (PRFS).
CONCLUSION
Based on the distribution pattern of PLN metastasis in NPC and the result of dose-finding study, involving the ipsilateral level VIII into low-risk clinical target volume (CTV2) is recommended for NPC with PLN metastasis.
Topics: Humans; Nasopharyngeal Carcinoma; Radiotherapy, Intensity-Modulated; Nasopharyngeal Neoplasms; Lymphatic Metastasis; Carcinoma; Neoplasm Recurrence, Local; Lymph Nodes; Retrospective Studies; Prognosis; Neoplasm Staging
PubMed: 37423477
DOI: 10.1016/j.radonc.2023.109802 -
Head and Neck Pathology Jun 2024Birt-Hogg-Dube syndrome (BHDS) is an autosomal dominant syndrome with different skin, lung, and renal manifestations. It is diagnosed commonly in the third decade of... (Review)
Review
BACKGROUND
Birt-Hogg-Dube syndrome (BHDS) is an autosomal dominant syndrome with different skin, lung, and renal manifestations. It is diagnosed commonly in the third decade of life, and patients have an increased risk for pneumothorax and renal carcinomas.
METHODS
Articles published in PubMed, and Medline from 1977 to September 2023, were included in the systematic review. Inclusion criteria were applied to case reports, case series, and a retrospective cohort study, describing clinical, histopathological, and genetic findings in patients with BHDS with oral and/or parotid lesions.
RESULTS
Sixteen families/individuals with BHDS were identified for analysis. Patients ranged in age from 20 to 74 years, with an average of 49.4 years. Males were affected 52.2% of the time and females, 39.1%. Skin fibrofolliculomas were reported in 87% of cases, and oral lesions were documented in 47.8%. Parotid tumors were documented in 43.5% of patients, 30.4% of which were oncocytomas, 4.3% bilateral oncocytomas, and 4.3% "oncocytic carcinoma".
CONCLUSIONS
Because BHDS is uncommon, its spectrum of clinical manifestations may be underrecognized, especially as the disease is mostly reported at advanced stage. And some of the patients with BHDS may have oncocytic parotid tumors and oral lesions. In this regard, patients presenting these lesions and other indications of BHDS should be considered for renal screening.
Topics: Humans; Birt-Hogg-Dube Syndrome; Salivary Gland Neoplasms; Middle Aged; Adult; Male; Female; Aged; Young Adult
PubMed: 38896302
DOI: 10.1007/s12105-024-01657-y -
Radiotherapy and Oncology : Journal of... Aug 2023Diffusion-weighted imaging (DWI) on MRI-linear accelerator (MR-linac) systems can potentially be used for monitoring treatment response and adaptive radiotherapy in head...
Prospective evaluation of in vivo and phantom repeatability and reproducibility of diffusion-weighted MRI sequences on 1.5 T MRI-linear accelerator (MR-Linac) and MR simulator devices for head and neck cancers.
INTRODUCTION
Diffusion-weighted imaging (DWI) on MRI-linear accelerator (MR-linac) systems can potentially be used for monitoring treatment response and adaptive radiotherapy in head and neck cancers (HNC) but requires extensive validation. We performed technical validation to compare six total DWI sequences on an MR-linac and MR simulator (MR sim) in patients, volunteers, and phantoms.
METHODS
Ten human papillomavirus-positive oropharyngeal cancer patients and ten healthy volunteers underwent DWI on a 1.5 T MR-linac with three DWI sequences: echo planar imaging (EPI), split acquisition of fast spin echo signals (SPLICE), and turbo spin echo (TSE). Volunteers were also imaged on a 1.5 T MR sim with three sequences: EPI, BLADE (vendor tradename), and readout segmentation of long variable echo trains (RESOLVE). Participants underwent two scan sessions per device and two repeats of each sequence per session. Repeatability and reproducibility within-subject coefficient of variation (wCV) of mean ADC were calculated for tumors and lymph nodes (patients) and parotid glands (volunteers). ADC bias, repeatability/reproducibility metrics, SNR, and geometric distortion were quantified using a phantom.
RESULTS
In vivo repeatability/reproducibility wCV for parotids were 5.41%/6.72%, 3.83%/8.80%, 5.66%/10.03%, 3.44%/5.70%, 5.04%/5.66%, 4.23%/7.36% for EPI, SPLICE, TSE, EPI, BLADE, RESOLVE. Repeatability/reproducibility wCV for EPI, SPLICE, TSE were 9.64%/10.28%, 7.84%/8.96%, 7.60%/11.68% for tumors and 7.80%/9.95%, 7.23%/8.48%, 10.82%/10.44% for nodes. All sequences except TSE had phantom ADC biases within ± 0.1x10 mm/s for most vials (EPI, SPLICE, and BLADE had 2, 3, and 1 vials out of 13 with larger biases, respectively). SNR of b = 0 images was 87.3, 180.5, 161.3, 171.0, 171.9, 130.2 for EPI, SPLICE, TSE, EPI, BLADE, RESOLVE.
CONCLUSION
MR-linac DWI sequences demonstrated near-comparable performance to MR sim sequences and warrant further clinical validation for treatment response assessment in HNC.
Topics: Humans; Reproducibility of Results; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging; Head and Neck Neoplasms; Echo-Planar Imaging
PubMed: 37211282
DOI: 10.1016/j.radonc.2023.109717