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Head and Neck Pathology Mar 2022In the absence of clear pathologic differences, clinical history may differentiate potential primary parotid squamous cell carcinomas (SCC) from metastases. The presence...
In the absence of clear pathologic differences, clinical history may differentiate potential primary parotid squamous cell carcinomas (SCC) from metastases. The presence of an ultraviolet (UV) signature can distinguish between tumors of cutaneous and non-cutaneous origin. This study aimed to investigate rates of UV signature mutations in squamous cell carcinomas of the parotid gland as well as differences in clinical features between tumors of cutaneous and non-cutaneous origin. Clinical and pathologic data were collected from 71 patients with SCC involving the parotid gland, of which 48 had cutaneous, 10 had mucosal, and 13 had no history of SCC. In 34 available cases, genomic DNA was isolated from formalin-fixed paraffin-embedded tissue specimens and sequenced using a targeted hybrid capture 1213 gene panel. Tumor mutational burden and COSMIC (Catalogue of Somatic Mutations in Cancer) mutational signatures were calculated. Most (74%) were UV-positive. Patients with UV-positive tumors were significantly older, white, and had higher rates of sun exposure. Patients with UV-negative tumors had a significantly higher mortality rate and shorter time to death: 6 (67%) died of disease with a median time to death of 9 months compared to 5 (20%) UV-positive patients who died of disease with a median time to death of 32 months. Pathologic features did not significantly vary by clinical history or UV status. The presence of a UV-signature combined with clinical history can be used to determine the primary source of SCC involving the parotid gland. UV-positivity may reflect a less aggressive disease course in an older population.
Topics: Carcinoma, Squamous Cell; Humans; Mutation; Parotid Gland; Parotid Neoplasms; Prognosis; Skin Neoplasms
PubMed: 34160783
DOI: 10.1007/s12105-021-01349-x -
Journal of Radiation Research Jan 2022The present study aimed to reduce the parotid gland dose in the hippocampus avoidance with whole-brain radiotherapy (HA-WBRT) using the helical tomotherapy (HT). Ten...
The present study aimed to reduce the parotid gland dose in the hippocampus avoidance with whole-brain radiotherapy (HA-WBRT) using the helical tomotherapy (HT). Ten patients who had previously undergone WBRT were randomly selected and enrolled in this study. During the treatment planning, two different techniques to the jaw were applied for each patient, namely, 1.0 cm fixed jaw and 2.5 cm dynamic jaw. To efficiently reduce the dose in the bilateral parotid glands, directional block (DB) mode was set. The DB is a function of a treatment planning system for the dose reduction in organs at risk. The standard HA-WBRT plan which did not reduce the parotid gland dose was also designed to compare the plan quality. Compared with the standard HA-WBRT plan, the parotid gland dose could be reduced by approximately 70% without extending the delivery time by adding the parotid gland on the DB mode to the dose constraint. In addition, the differences in dosimetric parameters observed between the plans employing the 1.0 cm fixed jaw and 2.5 cm dynamic jaw were almost negligible. Moreover, delivery time in the 2.5 cm dynamic jaw could be greatly reduced by 60% compared with that in the 1.0 cm fixed jaw.
Topics: Drug Tapering; Hippocampus; Humans; Parotid Gland; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated
PubMed: 34850078
DOI: 10.1093/jrr/rrab107 -
Dento Maxillo Facial Radiology Apr 2023This study aimed to analyze the quantitative fat fraction (FF) of the parotid gland in menopausal females with xerostomia using the iterative decomposition of water and...
Parotid gland evaluation of menopausal women with xerostomia using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) method of MRI: a pilot study.
OBJECTIVES
This study aimed to analyze the quantitative fat fraction (FF) of the parotid gland in menopausal females with xerostomia using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) method.
METHODS
A total 138 parotid glands of 69 menopausal females were enrolled in our study and participants were divided into normal group and xerostomia group. The xerostomia group was divided into those with or without Sjögren's syndrome. Participants underwent IDEAL-IQ sequences of MRI and the stimulated salivary flow test (s-SFR). The unpaired t-test was used to compare the FFs between the normal and xerostomia groups and between the subgroups with and without Sjögren's syndrome. The correlation between FF and s-SFR was analyzed by Pearson's correlation.
RESULTS
Excellent intra- and interobserver agreement during the measurement of FFs by IDEAL-IQ method (ICC>0.99, respectively). FF value in the xerostomia group was statistically significantly higher than the value in the normal group ( < 0.05). Within the xerostomia group, the average FF value of females with Sjögren's syndrome was higher than that of females without Sjögren's syndrome. However, the difference was not statistically significant ( > 0.05). Within the xerostomia group, FF value correlated negatively with s-SFR ( < 0.05).
CONCLUSIONS
The FF of the parotid gland was higher in the xerostomia group than in the normal group and FF value and s-SFR showed a negative correlation. Analyses of the FF using IDEAL-IQ in menopausal females can be helpful for the quantitative diagnosis of xerostomia.
Topics: Humans; Female; Parotid Gland; Sjogren's Syndrome; Pilot Projects; Water; Xerostomia; Magnetic Resonance Imaging; Menopause
PubMed: 36695352
DOI: 10.1259/dmfr.20220349 -
Japanese Journal of Radiology Jun 2022This study aimed to describe the MRI findings of epithelial-myoepithelial carcinoma (EMC) of the parotid gland.
PURPOSE
This study aimed to describe the MRI findings of epithelial-myoepithelial carcinoma (EMC) of the parotid gland.
MATERIALS AND METHODS
Seven patients (four males and three females) aged 40-86 years (mean age, 64 years) with histologically proven EMC of the parotid gland who underwent surgical resection after preoperative MRI were enrolled. MRI images were retrospectively reviewed and contrasted with pathological findings.
RESULTS
Five patients (71%) had predominantly solid lesions, and two (29%) had predominantly cystic lesions. All seven lesions had well-demarcated margins and capsules without the invasion of adjacent structures. The capsules were incomplete in five lesions (71%) and complete in two (29%). Four lesions (57%) exhibited a multinodular structure with internal septa. Cystic components were observed in three lesions (43%). On T1-weighted images, the solid components were frequently homogeneous (5/7, 71%), and demonstrated isointensity in five lesions (71%) and hypointensity in two (29%) relative to the spinal cord. On T2-weighted images, the solid components were usually heterogeneous (6/7, 86%), and demonstrated hyperintensity in five lesions (71%) and isointensity in two (29%) relative to the spinal cord. The mean apparent diffusion coefficient value of the solid components was 0.967 × 10 mm/s.
CONCLUSION
Parotid gland EMCs usually appeared as predominantly solid lesions with well-demarcated margins and capsules. A multinodular structure with internal septa was characteristics of EMCs.
Topics: Capsules; Carcinoma; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Retrospective Studies
PubMed: 34982376
DOI: 10.1007/s11604-021-01243-0 -
Journal of Cancer Research and... 2020Head-and-neck cancer (HNC) is in close proximity to several critical structures. Intensity-modulated radiation therapy (IMRT) has the potential of generating highly... (Review)
Review
Head-and-neck cancer (HNC) is in close proximity to several critical structures. Intensity-modulated radiation therapy (IMRT) has the potential of generating highly conformal and concave dose distributions around complex target and is ideally suited for HNC treatment. Conventionally, the focus of IMRT for HNC patients has been on prevention of radiation-induced parotid dysfunction. In the present article, we review the potential of IMRT to reduce the risk of posttreatment aspiration and dysphagia and spare submandibular gland. We also discuss the impact of IMRT on overall survival and quality of life (QoL) for HNC patients. Small retrospective and prospective studies show that reducing dose to adjoining organs at risks is feasible and decreases the risk of posttreatment dysphagia and aspiration without compromising local control. IMRT is associated with improved QoL in several important domains including swallowing, dry mouth, sticky saliva, social eating, and opening of the mouth; however, improvement in global QoL is inconsistent. Delivery of IMRT for HNC is associated with improved survival at nasopharyngeal subsite. Small studies demonstrate improved treatment outcomes with swallowing-sparing IMRT. These results now need validation within the prospective multicenter randomized controlled trial setting.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Organ Sparing Treatments; Parotid Gland; Quality of Life; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Treatment Outcome
PubMed: 32719246
DOI: 10.4103/jcrt.JCRT_880_18 -
Asian Journal of Surgery Apr 2023
Topics: Humans; Parotid Gland; Sarcoma; Diagnosis, Differential
PubMed: 36319549
DOI: 10.1016/j.asjsur.2022.10.074 -
International Journal of Oral and... Feb 2020A clinicopathological review of parotid tumours treated surgically in two oral and maxillofacial surgery departments was conducted. The performance of fine needle...
A clinicopathological review of parotid tumours treated surgically in two oral and maxillofacial surgery departments was conducted. The performance of fine needle aspiration cytology (FNAC) was also assessed. This retrospective study included 250 consecutive patients treated surgically for parotid gland-related tumours. Benign tumours (n=211, 84.4%) were more prevalent than malignancies (n=39, 15.6%). A predominance of pleomorphic adenoma (48.8%) was identified, and epithelial-myoepithelial carcinoma (3.6%) was the most common malignant tumour. Overall, the sensitivity and specificity of FNAC were 64% and 99%, respectively. Subgrouping resulted in sensitivity and specificity of 50% and 100% for clinically assisted FNAC versus, 72% and 99% for ultrasound guidance. Surgically, 31.6% underwent complete superficial parotidectomy and 28.4% underwent extracapsular dissection. Overall, facial nerve palsy was the most prevalent postoperative complication, affecting 29.2% (70/240); loss of function was transient in 21.2% (51/240) and permanent in 7.9% (19/240). Extracapsular dissection and superficial parotidectomy with facial nerve preservation were the treatments of choice when a benign tumour was suspected. Facial nerve palsy was quite frequent; treatment options however are scarce. Preoperative diagnostic workup using imaging and ultrasound-guided FNAC was essential in identifying malignancy so that surgical planning could be adapted.
Topics: Adenoma, Pleomorphic; Humans; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Salivary Glands
PubMed: 31375455
DOI: 10.1016/j.ijom.2019.03.963 -
Annals of Medicine Dec 2023Surgery, the treatment of choice for parotid pleomorphic adenoma (PA), is associated with facial nerve palsy and decreased quality of life. Re-operation for PA...
BACKGROUND
Surgery, the treatment of choice for parotid pleomorphic adenoma (PA), is associated with facial nerve palsy and decreased quality of life. Re-operation for PA recurrence (rPA) significantly increases these risks and constitutes a dilemma for both patient and surgeon. Factors influencing the success of re-operation, as well as the self-reported satisfaction of both sides, have yet to be addressed in the literature. This study aims to improve upon the decision-making schedule in PA re-operations, based on patient expectations, imaging, and concordance with the first operative report (FOpR).
METHODS
Seventy-two rPAs treated in a single tertiary center were collected and analyzed. The FOpRs and pre-operative imaging were divided according to defined criteria into accurate and non-accurate categories. The re-operative field and course were categorized as anticipated or unanticipated. The re-operation was categorized as satisfactory or unsatisfactory for both the patient and the surgeon.
RESULTS
The accuracy of FOpRs and pre-operative imaging was 36.1% and 69.4%, respectively. Re-operative courses were: 36.1% anticipated and 63.9% unanticipated. The most frequently omitted data were: presence of satellite tumors (9.7%), and amount of removed parenchyma (9.7%). Variables that most commonly affected FOpR non-accuracy were: tumor size (Chi2(1)=59.92; < 0.001) and capsule condition (Chi2(1)=29.11; < 0.001). There was no significant relationship between FOpR accuracy and re-operative course (Chi2(1)=1.14; = 0.286), patient satisfaction (Chi2(1)=1.94; = 0.164) or surgeon satisfaction (Chi2(1)=0.04; = 0.837). Pre-operative imaging (Chi2(1)=36.73; < 0.001) had the greatest impact on surgeon satisfaction.
CONCLUSION
Accurate pre-operative imaging impacted surgeon satisfaction. The impact of the FOpR on re-operation technicalities and patient satisfaction was minor. Imaging precision should be improved to streamline the decision-making process of PA re-operation. This article proposes suggestions for a future decision-making algorithm as a starting point for a prospective study.Key messagesAccurate pre-operative imaging impacts both surgeon and patient satisfaction.There is no significant relationship between the accuracy of the first operative report and surgeon and patient satisfaction.There is a statistically significant relationship between patient and surgeon satisfaction.
Topics: Humans; Adenoma, Pleomorphic; Parotid Gland; Prospective Studies; Quality of Life; Surgeons
PubMed: 36880798
DOI: 10.1080/07853890.2023.2171106 -
The British Journal of Radiology Dec 2021To investigate whether MRI-based texture analysis improves diagnostic performance for the diagnosis of parotid gland tumors compared to conventional radiological...
OBJECTIVE
To investigate whether MRI-based texture analysis improves diagnostic performance for the diagnosis of parotid gland tumors compared to conventional radiological approach.
METHODS
Patients with parotid gland tumors who underwent salivary glands MRI between 2008 and 2019 were retrospectively selected. MRI analysis included a qualitative assessment by two radiologists (one of which subspecialized on head and neck imaging), and texture analysis on various sequences. Diagnostic performances including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of qualitative features, radiologists' diagnosis, and radiomic models were evaluated.
RESULTS
Final study cohort included 57 patients with 74 tumors (27 pleomorphic adenomas, 40 Warthin tumors, 8 malignant tumors). Sensitivity, specificity, and AUROC for the diagnosis of malignancy were 75%, 97% and 0.860 for non-subspecialized radiologist, 100%, 94% and 0.970 for subspecialized radiologist and 57.2%, 93.4%, and 0.927 using a MRI radiomics model obtained combining texture analysis on various MRI sequences. Sensitivity, specificity, and AUROC for the differential diagnosis between pleomorphic adenoma and Warthin tumors were 81.5%, 70%, and 0.757 for non-subspecialized radiologist, 81.5%, 95% and 0.882 for subspecialized radiologist and 70.8%, 82.5%, and 0.808 using a MRI radiomics model based on texture analysis of weighted sequence. A combined radiomics model obtained with all MRI sequences yielded a sensitivity of 91.5% for the diagnosis of pleomorphic adenoma.
CONCLUSION
MRI qualitative radiologist assessment outperforms radiomic analysis for the diagnosis of malignancy. MRI predictive radiomics models improves the diagnostic performance of non-subspecialized radiologist for the differential diagnosis between pleomorphic adenoma and Warthin tumor, achieving similar performance to the subspecialized radiologist.
ADVANCES IN KNOWLEDGE
Radiologists outperform radiomic analysis for the diagnosis of malignant parotid gland tumors, with some MRI qualitative features such as ill-defined margins, perineural spread, invasion of adjacent structures and enlarged lymph nodes being highly specific for malignancy. A radiomic model based on texture analysis of weighted images yields higher specificity for the diagnosis of pleomorphic adenoma compared to a radiologist non-subspecialized in head and neck radiology, thus minimizing false-positive pleomorphic adenoma diagnosis rate and reducing unnecessary surgical complications.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Diagnosis, Differential; Evaluation Studies as Topic; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Young Adult
PubMed: 34591597
DOI: 10.1259/bjr.20210340 -
HNO Apr 2023Handling of the facial nerve during surgery for parotid cancer is relevant for the patient's long-term quality of life. In about two thirds of cases, the facial nerve is... (Review)
Review
Handling of the facial nerve during surgery for parotid cancer is relevant for the patient's long-term quality of life. In about two thirds of cases, the facial nerve is not affected by the tumor. In these cases, in addition to complete tumor resection, identification and preservation of the facial nerve are important components of a successful operation. If the nerve is infiltrated by the tumor, the affected part must be resected during radical parotidectomy. When possible, primary nerve reconstruction leads to the best long-term cosmetic and functional outcomes. Individual selection of the optimal treatment concept is based on clinical examination of facial muscle mobility, preoperative imaging to understand the positional relationship between tumor and nerve, and on the basis of an electrophysiological examination of nerve function. Intraoperatively, standardized dissection helps to identify and preserve the facial nerve. If radical parotidectomy is indicated, in addition to one-step reconstruction, preoperative diagnostic tests can help to plan postoperative adjuvant therapy. The aim of rehabilitation is restoration of facial tone, facial symmetry, and movement of the paralyzed face. Restoration of eye closure is of high importance. The surgical treatment of facial paralysis has seen many improvements in recent years. The present work provides an overview of the most recent advances in diagnostics, surgical techniques, and further possibilities for preventing damage to the normal facial nerve during parotid cancer treatment. Furthermore, the options for rehabilitation of the tumor-infiltrated facial nerve in the context of treatment of salivary gland malignancies are described.
Topics: Humans; Facial Nerve; Parotid Neoplasms; Quality of Life; Facial Paralysis; Parotid Gland; Postoperative Complications
PubMed: 35288765
DOI: 10.1007/s00106-022-01148-y