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Backgrounds: Preoperative imaging, particularly with magnetic resonance imaging (MRI) and computed tomography (CT) scans, plays a crucial role in distinguishing between benign and malignant parotid gland tumors, while the reliability of Ultrasound-Guided Fine Needle Aspiration (FNA) in diagnosing these masses remains a topic of debate. Methods: This two-center retrospective analysis was conducted on 347 patients with parotid gland tumors who had FNA and preoperative imaging (CT or MRI). All patients underwent surgery and final histopathological examination was available, along with complete medical records between January 2008 and May 2023. Results: Among the 347 patients, 318 (92%) had benign and 10 (3%) had malignant tumors based on FNA, with 19 (5%) unsatisfactory specimens. Final histological diagnosis revealed 303 (87%) benign and 44 (13%) malignant lesions, with a false-negative rate of 10.6% for FNA. Multivariate analysis identified irregular shape and invasion as independent predictors of malignancy in patient with benign or unsatisfactory FNA results. The odds ratio for irregular shape was 3.06 and for invasion was 12.73. Conclusion: Imaging characteristics, such as irregular shape and invasion may indicate towards malignant parotid tumors, even in patients with false-negative benign findings in FNA. [ABSTRACT FROM AUTHOR]

Abstract Backgrounds Preoperative imaging, particularly with magnetic resonance imaging (MRI) and computed tomography (CT) scans, plays a crucial role in distinguishing between benign and malignant parotid gland tumors, while the reliability of Ultrasound-Guided Fine Needle Aspiration (FNA) in diagnosing these masses remains a topic of debate. Methods This two-center retrospective analysis was conducted on 347 patients with parotid gland tumors who had FNA and preoperative imaging (CT or MRI). All patients underwent surgery and final histopathological examination was available, along with complete medical records between January 2008 and May 2023. Results Among the 347 patients, 318 (92%) had benign and 10 (3%) had malignant tumors based on FNA, with 19 (5%) unsatisfactory specimens. Final histological diagnosis revealed 303 (87%) benign and 44 (13%) malignant lesions, with a false-negative rate of 10.6% for FNA. Multivariate analysis identified irregular shape and invasion as independent predictors of malignancy in patient with benign or unsatisfactory FNA results. The odds ratio for irregular shape was 3.06 and for invasion was 12.73. Conclusion Imaging characteristics, such as irregular shape and invasion may indicate towards malignant parotid tumors, even in patients with false-negative benign findings in FNA.

Purpose: A systematic review and meta-analysis were conducted to evaluate the diagnostic precision of radiomics in the differential diagnosis of parotid tumors, considering the increasing utilization of radiomics in tumor diagnosis. Although some researchers have attempted to apply radiomics in this context, there is ongoing debate regarding its accuracy. Methods: Databases of PubMed, Cochrane, EMBASE, and Web of Science up to May 29, 2024 were systematically searched. The quality of included primary studies was assessed using the Radiomics Quality Score (RQS) checklist. The meta-analysis was performed utilizing a bivariate mixed-effects model. Results: A total of 39 primary studies were incorporated. The machine learning model relying on MRI radiomics for diagnosis malignant tumors of the parotid gland, demonstrated a sensitivity of 0.80 [95% CI: 0.74, 0.86], SROC of 0.89 [95% CI: 0.27-0.99] in the validation set. The machine learning model based on MRI radiomics for diagnosis malignant tumors of the parotid gland, exhibited a sensitivity of 0.83[95% CI: 0.76, 0.88], SROC of 0.89 [95% CI: 0.17-1.00] in the validation set. The models also demonstrated high predictive accuracy for benign lesions. Conclusion: There is great potential for radiomics-based models to improve the accuracy of diagnosing benign and malignant tumors of the parotid gland. To further enhance this potential, future studies should consider implementing standardized radiomics-based features, adopting more robust feature selection methods, and utilizing advanced model development tools. These measures can significantly improve the diagnostic accuracy of artificial intelligence algorithms in distinguishing between benign and malignant tumors of the parotid gland. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to summarize the clinical characteristics, treatment, and prognosis of parotid tumors in children and adolescents. Methods: Fifty-three children and adolescents diagnosed with parotid gland tumors were included. Survival was evaluated using the Kaplan-Meier method. Log-rank test and multivariate analysis were used to analyze the association between clinical factors and recurrence. Results: Of the 53 patients, 30 cases were benign and 23 cases were malignant. All patients underwent surgery. Patients with malignant tumors with high-risk factors received radiotherapy or chemotherapy. The median follow-up time was 61 months. Of these, 1 patient with benign tumor and 5 patients with malignant tumors recurred. Of the patients with malignant tumors, 2 developed distant metastases and 2 died. The 5-year overall survival (OS) and 5-year locoregional recurrence-free survival (LRFS) rates for benign tumors were 100.0% and 92.9%, respectively, whereas the 5-year OS and 5-year LRFS rates for malignant tumors were 94.4% and 72.5%, respectively. The log-rank univariate test showed that tumor size >3.5 cm (p = .056), distant metastasis (p = .056), and stage III and IV (p = .032) were associated with recurrence. However, multivariate analysis did not show the above factors to be independent prognostic factors for LRFS. Conclusion: Surgery for benign tumors depends on the location and size. Surgery for malignant parotid tumors depends mainly on the stage, grade, pathological type, and recurrence. Prophylactic lymph node dissection is required for high-grade tumors. Radiotherapy or chemotherapy for children needs more research. Both benign and malignant tumors have high survival rates after active treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Optimum management of the N0 neck is unresolved in parotid salivary gland cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis and its´ clinical use is increasing for head and neck tumors. The object of this study was to establish whether the technique is applicable to detect distribution of sentinel nodes for parotid tumors. Materials and Methods Prosepective observational study in 30 patients with benign or low‐grade T1‐T2N0 malignant tumors in the parotid gland planned for surgical treatment. Distribution of SN was detected with a preoperative ultrasound‐guided peritumoral injection with a technetium‐99 (Tc‐99 m) laballed tracer followed by a SPECT–CT and intraoperative measurement in the neck and parotidal tissue. In patients with cytologically suspected malignant tumor or highly unclerar cytology, SNB was also performed. Results Sentinel nodes (SNs) were detected in 26/30 cases. Out of these, 7 presented with only one SN, whereas multiple sentinel nodes where detected in 19 cases. No SNs were found in neck level 1. SN was detected in level 5 independent of tumor location within the parotid gland. An intraparotidal distribution of SNs was more frequent in larger tumors. Conclusions The use of SN‐technique in the planning of surgical treatment of parotid tumors seems feasible. It may be of clinical value for patients with parotid cancer to enable a more accurate staging and to detect occult metastasis in the SNs within the parotid as well as in the neck, enabaling the possibility to surgically remove all positive SNs at primary surgery and with reduced surgical morbidity.

Background: Optimum management of the N0 neck is unresolved in parotid salivary gland cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis and its´ clinical use is increasing for head and neck tumors. The object of this study was to establish whether the technique is applicable to detect distribution of sentinel nodes for parotid tumors. Materials and Methods: Prosepective observational study in 30 patients with benign or low‐grade T1‐T2N0 malignant tumors in the parotid gland planned for surgical treatment. Distribution of SN was detected with a preoperative ultrasound‐guided peritumoral injection with a technetium‐99 (Tc‐99 m) laballed tracer followed by a SPECT–CT and intraoperative measurement in the neck and parotidal tissue. In patients with cytologically suspected malignant tumor or highly unclerar cytology, SNB was also performed. Results: Sentinel nodes (SNs) were detected in 26/30 cases. Out of these, 7 presented with only one SN, whereas multiple sentinel nodes where detected in 19 cases. No SNs were found in neck level 1. SN was detected in level 5 independent of tumor location within the parotid gland. An intraparotidal distribution of SNs was more frequent in larger tumors. Conclusions: The use of SN‐technique in the planning of surgical treatment of parotid tumors seems feasible. It may be of clinical value for patients with parotid cancer to enable a more accurate staging and to detect occult metastasis in the SNs within the parotid as well as in the neck, enabaling the possibility to surgically remove all positive SNs at primary surgery and with reduced surgical morbidity. [ABSTRACT FROM AUTHOR]

Context: Parotid gland lesions in children requiring surgical management are not common. Neoplastic lesions of the parotid glands are also less common. Parotid tumors in children have different characteristics from those that occur in adults. When they occur in the pediatric age group, malignancy has to be ruled out. Subjects and Methods: This is a retrospective study of children who presented to our institute, a tertiary care referral hospital for children <12 years, with parotid swellings during the 5-year period between April 2018 and March 2023. The children who underwent surgical management for parotid lesions, in the form of parotidectomy, were included in the study. Children who were treated by nonoperative management were excluded from the study. Results: Twelve children were included. Of the 12 children, three (25.0%) children had malignancy, four (33.33%) children had benign tumors, three (25.0%) children had vascular malformations, and the remaining two (16.67%) children had inflammatory etiology. All children underwent superficial/total parotidectomy, depending on the involvement of superficial and/or deep lobe. Of the three malignant parotid tumors, two were of mucoepidermoid carcinoma and one was myoepithelial carcinoma. One of the children with mucoepidermoid carcinoma had recurrence. Conclusions: Facial nerve-sparing parotidectomy is the treatment for neoplastic and inflammatory lesions. Initially, lymphovascular tumors were treated aggressively with parotidectomy. Neck node dissection should be performed only in children with fine-needle aspiration cytology-confirmed nodal metastases during primary surgery. Adjuvant treatment may be required in selected cases. [ABSTRACT FROM AUTHOR]

Aim of the Study: The objective of this study was to know the various types of parotid tumors and their clinical presentations, surgical management, and post-operative outcome. Material and Methods: Data of 102 patients assessed from hospital records who underwent parotid surgery between the years 2013 and 2018 were obtained. Parameters included age, sex, socio-demographic profile, presenting complaints, examination findings, and cytopathology. Surgical techniques, post-operative complications such as a facial scar, retro-mandibular and pre-auricular depression, facial palsy, Frey's syndrome, and numbness over the ear lobule were analyzed. Result: Out of a total of 102 patients, 54.0% of patients were male, and 45.1% were female. The mean age of patients was 33.30 ± 13.87 years ranging from 7 to 65 years. The most common clinical presentation was swelling in the parotid region (95.1%), and associated symptoms with swelling were pain (17.5%), facial palsy (4.9%), discharging sinus (4.9%), and ulcerative lesions (1%) at the time of presentation. Pleomorphic adenoma was the most common benign neoplasm (76.5%), followed by Warthin's tumors (2.9%). Mucoepidermoid carcinoma was the most common malignant neoplasm (3.9%). After parotid surgery, 35% of patients had a sensory impairment or hypoesthesia of the ear lobule, and 23.28% had temporary facial nerve weakness. 5.0% of patients had permanent facial weakness, and 2.06% of patients had weakness of the marginal mandibular nerve. Conclusion: Pleomorphic adenoma and mucoepidermoid carcinoma are the most common benign and malignant tumors, respectively, and parotidectomy is the treatment of choice, depending on the tumor location. Successful treatment depends on early diagnosis and histopathological and radiological investigations. Sensory impairment and temporary facial nerve paralysis are the most common post-operative complications, which are minimized by proper knowledge of anatomy and meticulous dissection of the facial nerve during parotid surgery. [ABSTRACT FROM AUTHOR]

Context: Parotid gland lesions in children requiring surgical management are not common. Neoplastic lesions of the parotid glands are also less common. Parotid tumors in children have different characteristics from those that occur in adults. When they occur in the pediatric age group, malignancy has to be ruled out. Subjects and Methods: This is a retrospective study of children who presented to our institute, a tertiary care referral hospital for children

Simple Summary: Malignant salivary gland tumors are rare, accounting for 0.05–2 per 100,000 inhabitants worldwide. The parotid gland represents the most frequent cancer site, and both primary and secondary malignant tumors can affect it. Primary cancer includes many histological types, while intraparotid metastases have usually a cutaneous origin. Because of the rarity and heterogeneity of parotid tumors, the prognosis is difficult to assess. The literature focused on specific primary tumors or secondary cancer. The aim of this retrospective observational study was to evaluate the clinical features and prognosis of malignant epithelial tumors of the parotid gland. In particular, a comparison between primary and secondary cancer and survival analyses were performed. Moreover, complications were recorded. Primary and secondary malignant tumors can affect the parotid gland. The aim of this retrospective study was to evaluate the clinical features and prognosis of malignant epithelial tumors of the parotid gland. In particular, a comparison between primary and secondary cancer and survival analyses were performed. Eighteen patients with primary cancer and fifteen with intraparotid metastasis from cutaneous squamous cell carcinoma were included. A chart review was performed to collect clinical data (age, sex, smoking, alcohol consumption, tumor stage, type of surgical procedure, complications, recurrence and death). The majority of primary tumors were early (T1-2 N0, 83%) with mucoepidermoid carcinoma being the most common (33%). Secondary tumors were mostly staged P2 (53%) and N0 (67%). Subjects with secondary tumors were older than those with primary cancer. Post-operative permanent facial palsy was observed in 5 patients (17%) with primary cancer and 9 (60%) with secondary tumors (p = 0.010). Two-year overall survival for primary and secondary parotid cancer was 76.58% and 43.51%, respectively (p = 0.048), while 2-year disease-free survival was 76.05% and 38.50%, respectively (p = 0.152). In conclusion, secondary cancer of the parotid gland has worse survival than primary tumors. In the future, the implementation of multimodality treatment of intraparotid metastases is necessary to improve oncologic outcomes. [ABSTRACT FROM AUTHOR]

The relation between the facial nerve and the retromandibular vein is of paramount clinical significance during the parotid surgery for the protection of all the facial nerve branches as these two anatomic structures are always in close proximity. However, variations in the relationship of the facial nerve with the retromandibular vein, as presented in this paper complicate parotid surgery and increase the potentiality of unexpected bleeding and injury to the facial nerve injury. This study was conducted in a tertiary care teaching hospital. 4 cases with unusual relation of facial nerve and retromandibular vein in parotid surgeries were studied & included in this study. Out of 70 parotid surgeries which were performed, 4 variations of the retromandibular vein in relation to facial nerve were encountered. With a meticulous dissection the facial nerve branches were separated from the retromandibular vein without causing any injury to the neurovascular structures and functional deficit. Knowledge of normal anatomy of the extra cranial facial nerve and its relation with the retromandibular vein along with the probable anatomical variations leads to a safe parotid surgery. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the diagnostic accuracy rates of the patients who underwent an operation for parotid mass, by comparing their fine needle aspiration biopsy (FNAB) cytology results with the final pathology. A total of 136 patient files of those who applied to Otorhinolaryngology clinic due to parotid mass and underwent parotidectomy procedure between 2010 and 2020 at a tertiary center were scanned retrospectively. Database on patient age, gender, preoperative FNAB results, and final surgical histopathology results was created. The mean age of the patients was 48.26 ± 17.37 Superficial parotidectomy was performed to 108 (79.4%) and total parotidectomy to 28 (20.6%) of the patients. The sensitivity of FNAB was found as 85.2%, specificity as 96.2%, positive predictive value as 85.2%, negative predictive value as 96.2% and accuracy as 94.0%. It is found that FNAB has the high specificity and high negative predictive value with high diagnostic accuracy on detecting preoperative malignancy in parotid gland. We think that FNAB is a significant, necessary and safe method in the diagnosis of parotid lesions in preoperative sense. [ABSTRACT FROM AUTHOR]

A 56-year-old man presented with a 10-year history of gradually enlarging left pre-auricular mass. No biopsies were done. He underwent superficial parotidectomy which showed an enlarged parotid gland measuring 6 x 5.5 x 2 cm with a 0.5 x 0.2 x 0.2 cm discrete, cream-brown, ovoid intraparenchymal solid nodule. The latter was the lesion of interest. Microscopic examination of the nodule shows a well-circumscribed, encapsulated proliferation of closely packed tubular ducts surrounded by non-neoplastic, otherwise histologically unremarkable lobules of serous acini with an intact ductal system. (Figure 1) The tubules within the nodule are lined by simple cuboidal cells having bland, uniform, round nuclei and moderate amounts of eosinophilic cytoplasm. (Figure 2) In some of these tubules, serous acinar cells containing coarse basophilic granules partly line the lumina, adjacent to or around the cuboidal cells. (Figure 3) Based on the morphological features, a diagnosis of intercalated duct adenoma (IDA) was rendered, occurring in a background that is suggestive of sialadenosis. Intercalated duct adenomas are mostly asymptomatic, benign neoplasms identified incidentally in salivary glands removed for diverse lesions of either benign or malignant etiology.1-4 They are most often found in the parotid gland of adults ranging from 41 to 73 years (mean 57 years) with a female-to-male ratio of 3:2.1,2 They belong to a group of ductal proliferations known as intercalated duct lesions (IDL) which are composed of compact proliferation of tubular ducts that are lined by cuboidal ductal cells. Scattered tubules have serous acinar cells complexed with the ductal cells, while others have inconspicuous myoepithelial cells that surround them. Intercalated duct lesions are arbitrarily divided into IDA – if encapsulated and discretely separated from adjacent acinar units, and intercalated duct hyperplasia (IDH) - if unencapsulated and blending into the adjacent acinar units.3-5 The ductal cells of IDA resemble those of non-neoplastic intercalated ducts on immunohistochemistry, staining diffusely with CK7 and S100, and focally for ER and lysozyme while CK14 and Calponin highlight the thin myoepithelial cells surrounding the ductal cells.1,3,4 Immunohistochemical stains for myoepithelial cells were not requested as we felt that the participation of acinar cells in a characteristic manner was sufficiently diagnostic of the entity. Important benign differential diagnoses of IDA include striated duct adenoma, canalicular adenoma and basal cell adenoma.2,3 Striated duct adenoma and canalicular adenoma can both be distinguished from IDA due to lack of myoepithelial and acinar cells; the latter is also more commonly found in the minor salivary glands.2,3 Basal cell adenoma and adenocarcinoma on the other hand are challenging differential diagnoses due to significant overlaps in morphology. They tend to be larger (usually >10 mm) with prominent bilayering of luminal cells and distinct basaloid abluminal cells that show palisading. Basal cell adenocarcinoma importantly demonstrates an invasive growth pattern.3,5 IDA on the other hand are small and infrequently seen macroscopically, most often measuring less than 5 mm in diameter.2 Both IDA and IDL in general have an excellent prognosis upon complete surgical excision and recurrences are not reported. However, IDA’s frequent co-occurrence with other salivary gland tumors has led to it being hypothesized as a potential precursor of salivary gland tumors, particularly of epithelial-myoepithelial carcinomas.1-2 Its coexistence with sialadenosis has not been previously reported. The diagnosis of IDA in conjunction with other salivary gland pathologies is therefore important to further elucidate the clinical, histopathological, and possible molecular nature and relationships of this lesion.

Tumors of the parotid gland can be challenging if left untreated. We report three cases of patients with initial clinical and therapeutic manifestations of neglected parotid tumours in Madagascar: two women and one man aged 42, 47 and 51 years, with tumours that had been developing for 4, 7 and 11 years respectively. One patient was suspected to have malignant tumour due to skin necrosis. The diagnosis was then confirmed by cytopuncture. After obtaining the informed consent, total parotidectomy was performed in all patients. Facial nerve sacrifice with cervical lymph node dissection was established in the patient with a malignant tumour. No intraoperative adverse events were reported. Parotid tumors can becomecancerous without proper treatment. Socioeconomic factors are involved in delayed consultation. However, early consultation in patients with parotid tumors would prevent management risks. [ABSTRACT FROM AUTHOR]

Aim of the Study: The aim of the study is to compare the esthetic outcome of extended cervicomastoid approach with reconstruction with conventional approach (modified Blair's incision) for parotid surgery. Materials and Methods: 48 patients were enrolled and grouped into A: surgery through extended cervicomastoid incision with sternocleidomastoid reconstruction and B: surgery through modified Blair's incision. After parotid surgery, patients were followed up to 6 months on the basis of flap ischemia, patient satisfaction, and cosmesis (visual analog scale [VAS]). Results: In our study, preauricular depression over the face was present in 4.2% and 95.8% patients Group A and B at 6 months, respectively (P < 0.001) and retromandibular depression (70.8%) in Group B (P < 0.001). Subjective Frey's syndrome was present in 8.3% of patients of Group B (P > 0.05). The mean value of VAS between the two groups was 1.08 ± 0.28 and 3.29 ± 0.62 at 6 months (P = 0.001) while mean change was significantly (P = 0.03) higher in Group A (1.00 ± 0.00) as compared to Group B (0.20 ± 0.72) from postoperative to 6 months, respectively. Patient of Group A had good satisfaction level (62.5% and 91.7%) at 6 weeks and 6 months while Group B patients had fair satisfaction level (87.5%) at 6 weeks and poor satisfaction level 79.2% at 6 months. Conclusion: Parotidectomy through extended cervicomastoid incision with sternocleidomastoid flap reconstruction experienced lower rates of postoperative complications, flap necrosis, and gustatory sweating in comparison to cervicomastoid facial approach, and thus, the previous incision is esthetically superior that allows cheek contour reconstruction with no increase in operative time or postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: This 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). Methods: This 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. Results: Among 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). Conclusion: Multiphasic 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. [ABSTRACT FROM AUTHOR]

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.

Carcinosarcoma is a biphasic malignant tumor composed of both carcinomatous and sarcomatous components. First cited in 1951 [1], there have been few cases of this malignant mixed tumor described in the literature. The typical patient presentation is that of an enlarging facial mass in the area of the parotid gland. Systemic symptoms are often absent. Time to initial presentation ranges from months to years. Physical examination findings include swelling and enlargement in the area of the parotid gland, facial nerve deficits, and possible cervical lymphadenopathy. Routine laboratory values (eg, blood counts and electrolytes) usually remain normal, however, nonspecific inflammatory markers (eg, erythrocyte sedimentation rate) may be elevated.Often times the first step in diagnostic evaluation is computed tomography scan with intravenous contrast. Computed tomography of the head/neck can identify malignant features such as poorly defined margins and calcifications. Magnetic resonance imaging is often performed to better evaluate for soft tissue and perineural invasion. It is important to note that these tumors can be mistaken for abscesses on imaging [2]. Ultimately pathological evaluation with immunohistochemical analysis is required to confirm the diagnosis.We present a case of a 70-year-old male who initially presented with a painless neck mass. To the best of our knowledge, this is the first case of mucoepidermoid carcinoma associated with carcinosarcoma reported in the parotid gland.

Abstract Background Our study aims to develop and validate diagnostic models of the common parotid tumors based on whole-volume CT textural image biomarkers (IBMs) in combination with clinical parameters at a single institution. Methods The study cohort was composed of 51 pleomorphic adenoma (PA) patients and 42 Warthin tumor (WT) patients. Clinical parameters and conventional image features were scored retrospectively and textural IBMs were extracted from CT images of arterial phase. Independent-samples t test or Chi-square test was used for evaluating the significance of the difference among clinical parameters, conventional CT image features, and textural IBMs. The diagnostic performance of univariate model and multivariate model was evaluated via receiver operating characteristic (ROC) curve and area under ROC curve (AUC). Results Significant differences were found in clinical parameters (age, gender, disease duration, smoking), conventional image features (site, maximum diameter, time-density curve, peripheral vessels sign) and textural IBMs (mean, uniformity, energy, entropy) between PA group and WT group (P

Purpose: A systematic review and meta-analysis were conducted to evaluate the diagnostic precision of radiomics in the differential diagnosis of parotid tumors, considering the increasing utilization of radiomics in tumor diagnosis. Although some researchers have attempted to apply radiomics in this context, there is ongoing debate regarding its accuracy., Methods: Databases of PubMed, Cochrane, EMBASE, and Web of Science up to May 29, 2024 were systematically searched. The quality of included primary studies was assessed using the Radiomics Quality Score (RQS) checklist. The meta-analysis was performed utilizing a bivariate mixed-effects model., Results: A total of 39 primary studies were incorporated. The machine learning model relying on MRI radiomics for diagnosis malignant tumors of the parotid gland, demonstrated a sensitivity of 0.80 [95% CI: 0.74, 0.86], SROC of 0.89 [95% CI: 0.27-0.99] in the validation set. The machine learning model based on MRI radiomics for diagnosis malignant tumors of the parotid gland, exhibited a sensitivity of 0.83[95% CI: 0.76, 0.88], SROC of 0.89 [95% CI: 0.17-1.00] in the validation set. The models also demonstrated high predictive accuracy for benign lesions., Conclusion: There is great potential for radiomics-based models to improve the accuracy of diagnosing benign and malignant tumors of the parotid gland. To further enhance this potential, future studies should consider implementing standardized radiomics-based features, adopting more robust feature selection methods, and utilizing advanced model development tools. These measures can significantly improve the diagnostic accuracy of artificial intelligence algorithms in distinguishing between benign and malignant tumors of the parotid gland., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023434931., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rao, Ma, Wang, Xiao, Wu, Shi, Guo and Fan.)

Objectives: The objective of this study is to summarize the clinical characteristics, treatment, and prognosis of parotid tumors in children and adolescents., Methods: Fifty-three children and adolescents diagnosed with parotid gland tumors were included. Survival was evaluated using the Kaplan-Meier method. Log-rank test and multivariate analysis were used to analyze the association between clinical factors and recurrence., Results: Of the 53 patients, 30 cases were benign and 23 cases were malignant. All patients underwent surgery. Patients with malignant tumors with high-risk factors received radiotherapy or chemotherapy. The median follow-up time was 61 months. Of these, 1 patient with benign tumor and 5 patients with malignant tumors recurred. Of the patients with malignant tumors, 2 developed distant metastases and 2 died. The 5-year overall survival (OS) and 5-year locoregional recurrence-free survival (LRFS) rates for benign tumors were 100.0% and 92.9%, respectively, whereas the 5-year OS and 5-year LRFS rates for malignant tumors were 94.4% and 72.5%, respectively. The log-rank univariate test showed that tumor size >3.5 cm ( p  = .056), distant metastasis ( p  = .056), and stage III and IV ( p  = .032) were associated with recurrence. However, multivariate analysis did not show the above factors to be independent prognostic factors for LRFS., Conclusion: Surgery for benign tumors depends on the location and size. Surgery for malignant parotid tumors depends mainly on the stage, grade, pathological type, and recurrence. Prophylactic lymph node dissection is required for high-grade tumors. Radiotherapy or chemotherapy for children needs more research. Both benign and malignant tumors have high survival rates after active treatment., Level of Evidence: Level 2., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Objective: The objective of this study was to create and verify a machine learning-driven predictive model to forecast the likelihood of facial nerve impairment in patients with parotid tumors following surgery. Methods: We retrospectively collected data from patients with parotid tumors between 2013 and 2023 to develop a prediction model for postoperative facial nerve dysfunction using 5 ML techniques: Logistic Regression (Logit), Random Forest (RF), XGBoost (XGB), Artificial Neural Network (ANN), and Support Vector Machine (SVM). Predictor variables were screened using binomial-LASSO regression. Results: The study had a total of 403 participants, out of which 56 individuals encountered facial nerve damage after the surgery. By employing binomial-LASSO regression, we have successfully identified 8 crucial predictive variables: tumor kind, tumor pain, surgeon's experience, tumor volume, basophil percentage, red blood cell count, partial thromboplastin time, and prothrombin time. The models utilizing ANN and Logit achieved higher area under the curve (AUC) values, namely 0.829, which was significantly better than the SVM model that had an AUC of 0.724. There were no noticeable disparities in the AUC values between the ANN and Logit models, as well as between these models and other techniques like RF and XGB. Conclusion: Using machine learning, our prediction model accurately predicts the likelihood that patients with parotid tumors may experience facial nerve damage following surgery. By using this model, doctors can assess patients' risks more accurately before to surgery, and it may also help optimize postoperative treatment techniques. It is anticipated that this tool would enhance patients' quality of life and therapeutic outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Layer-stacking irradiation (LSI) results in the accumulation of multiple small spread-out Bragg peaks along the beam direction. Although the superiority of LSI to conventional passive irradiation (CPI) regarding normal tissue sparing is theoretically evident, the clinical benefit of LSI has not been demonstrated. Here, we compared LSI with CPI using the same treatment planning-computed tomography images used for carbon ion radiotherapy (CIRT).Methods: Twenty-one parotid tumors were analyzed. The clinical target volume (CTV) 1 and CTV2 encompassed the parotid grand and the tumor, respectively. CTV1 and CTV2 received 36 Gy (RBE: relative biological effectiveness) in nine fractions and 64 Gy (RBE) in 16 fractions, respectively, using either LSI or CPI. CTV coverage was assessed by DX%, which is the dose covering at least X% of the target volume. Skin dose was assessed by SX, which is the skin surface area receiving at least X Gy (RBE).Results: For CTV1 and CTV2, there were no significant differences in D2% between LSI and CPI. D50% and D98% were slightly higher for CPI; however, the absolute difference between the two methods was

Background: Layer-stacking irradiation (LSI) results in the accumulation of multiple small spread-out Bragg peaks along the beam direction. Although the superiority of LSI to conventional passive irradiation (CPI) regarding normal tissue sparing is theoretically evident, the clinical benefit of LSI has not been demonstrated. Here, we compared LSI with CPI using the same treatment planning-computed tomography images used for carbon ion radiotherapy (CIRT). Methods: Twenty-one parotid tumors were analyzed. The clinical target volume (CTV) 1 and CTV2 encompassed the parotid grand and the tumor, respectively. CTV1 and CTV2 received 36 Gy (RBE: relative biological effectiveness) in nine fractions and 64 Gy (RBE) in 16 fractions, respectively, using either LSI or CPI. CTV coverage was assessed by DX%, which is the dose covering at least X% of the target volume. Skin dose was assessed by SX, which is the skin surface area receiving at least X Gy (RBE). Results: For CTV1 and CTV2, there were no significant differences in D2% between LSI and CPI. D50% and D98% were slightly higher for CPI; however, the absolute difference between the two methods was <3%. S10–S60 (in increments of 10) were significantly lower for LSI than for CPI (P < 0.001 for all parameters). LSI was associated with a significant trend toward dose reduction at the skin area irradiated with a higher dose by CPI (P < 0.001). Conclusions: LSI achieved better skin sparing than CPI without sacrificing target volume coverage in parotid tumor patients. [ABSTRACT FROM AUTHOR]

Aim: To differentiate Warthin tumors (WTs) and pleomorphic adenomas (PAs) measuring heterogeneity of intravoxel incoherent motion (IVIM) and dynamic-contrast enhanced-magnetic resonance imaging biomarkers. Methods: Volumes of interest were traced on 18 WT and 18 PA in 25 patients. For each IVIM and dynamic-contrast enhanced biomarker, histogram parameters were calculated and then compared using the Wilcoxon-signed-rank test. Receiver operating characteristic curves and multivariate analysis were employed to identify the parameters and their pairs with the best accuracy. Results: Most of the biomarkers exhibited significant difference (p < 0.05) between PA and WT for histogram parameters. Time to peak median and skewness, and D* median and entropy showed the highest area under the curve. No meaningful improvement of accuracy was obtained using two features. Conclusion: IVIM and dynamic-contrast enhanced histogram descriptors may help in the classification of WT and PA. [ABSTRACT FROM AUTHOR]

Background: Our study aims to develop and validate diagnostic models of the common parotid tumors based on whole-volume CT textural image biomarkers (IBMs) in combination with clinical parameters at a single institution. Methods: The study cohort was composed of 51 pleomorphic adenoma (PA) patients and 42 Warthin tumor (WT) patients. Clinical parameters and conventional image features were scored retrospectively and textural IBMs were extracted from CT images of arterial phase. Independent-samples t test or Chi-square test was used for evaluating the significance of the difference among clinical parameters, conventional CT image features, and textural IBMs. The diagnostic performance of univariate model and multivariate model was evaluated via receiver operating characteristic (ROC) curve and area under ROC curve (AUC). Results: Significant differences were found in clinical parameters (age, gender, disease duration, smoking), conventional image features (site, maximum diameter, time-density curve, peripheral vessels sign) and textural IBMs (mean, uniformity, energy, entropy) between PA group and WT group (P<0.05). ROC analysis showed that clinical parameter (age) and quantitative textural IBMs (mean, energy, entropy) were able to categorize the patients into PA group and WT group, with the AUC of 0.784, 0.902, 0.910, 0.805, respectively. When IBMs were added in clinical model, the multivariate models including age-mean and age-energy performed significantly better than the univariate models with the improved AUC of 0.940, 0.944, respectively (P<0.001). Conclusions: Both clinical parameter and CT textural IBMs can be used for the preoperative, noninvasive diagnosis of parotid PA and WT. The diagnostic performance of textural IBM model was obviously better than that of clinical model and conventional image model in this study. While the multivariate model consisted of clinical parameter and textural IBM had the optimal diagnostic performance, which would contribute to the better selection of individualized surgery program. [ABSTRACT FROM AUTHOR]

Punch biopsy results in misdiagnosis of clinically unsuspected giant pilomatrixoma located over the parotid gland. This study presents a case of pilomatrixoma that was misdiagnosed as a malignant epithelial tumor using punch biopsy. A 25-year-old male was admitted to our clinic for the evaluation of a mass measuring 7×8×8 cm located over the parotid gland. The patient had previously undergone punch biopsy at another clinic because of a lesion in the parotid gland. Punch biopsy revealed a malignant epithelial tumor. The patient underwent excisional biopsy at our clinic. After the biopsy, the residual skin defect was treated using full-thickness skin grafts. The facial nerve and parotid gland were preserved during the biopsy. Histopathological examination of the excisional biopsy material revealed pilomatrixoma. Punch biopsy may result in misdiagnosis of skin lesions in the parotid gland. A differential diagnosis for benign tumors such as pilomatrixoma is essential prior to an aggressive surgical intervention of the parotid gland.

This study aimed to determine the diagnostic value of fine needle aspiration biopsy (FNAB) and of its contribution to the management of parotid tumors. We conducted a retrospective study of 47 patients who had undergone parotidectomy as well as preoperative fine needle aspiration biopsy. The study highlighted that eighty one percent of patients had a benign tumor while 19% of patients had a malignant tumor. The sensitivity and specificity of FNAB were 78% and 92% respectively. Parotid tumors were correctly classified as malignant or benign in 89% of cases, overall accuracy was 64.4%. FNAB is a reliable examination providing preoperative informations about the treatment plan and the postoperative course. [ABSTRACT FROM AUTHOR]

Salivary gland neoplasms are extremely rare in children and comprise less than 1% of all pediatric neoplasms. Benign neoplasms account for 60% of these salivary tumors in children. They are most commonly vascular in origin with parotid glands being affected commonly. Pleomorphic adenoma is common in adults; it is extremely rare in pediatric age group. We report a 9 year old girl with a parotid region swelling; suspected to be a pleomorphic adenoma of the superficial lobe of parotid. However, it was arising from the deep lobe & hence was managed with an enucleation of the tumor with no evidence of recurrence after 3 years of follow up.

Purpose: In this work, we aimed to propose an automatic classification scheme based on the parameters derived from apparent diffusion coefficient (ADC)-maps for discriminating benign and malignant parotid tumors. Methods: MRI was carried out prospectively on 41 patients presented with parotid tumors who underwent surgery and post-surgical histopathological assessment was provided for them (32 benign, 9 malignant). Based on anatomical images, regions of interest (ROIs) were selected on the most solid parts of tumors on ADC-maps. Three quantitative parameters, namely ADC-Mean, ADC-Max and ADC-Mean were calculated. Automatic classification of parotid tumors using ADC parameters was performed and assessed employing two different classifiers, namely, linear discriminant analysis (LDA) and quadratic discriminant analysis (QDA). Results: Following statistical analysis, it was indicated that the ADC values in benign tumors are significantly higher than malignant tumors. ADC-Mean, and -Max presented statistically significant differences among benign and malignant parotid tumors (p

BackgroundThe recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy.MethodsA systematic review was undertaken to clarify the surgical and pathological variables related to PA recurrence. Inclusion criteria were as follows: English literature, and prospective or retrospective studies. Exclusion criteria were as follows: single case reports, reviews, and lack of PA recurrence data.ResultsPathology-related variables associated with recurrence include the histological subtype, the thickness and incompleteness of the tumor capsule, pseudopodia, and satellite nodules. Surgery-related variables associated with recurrence are the presence of intact margins and tumor puncture or spillage. Other factors are the size of the tumor and the age of patient. Myxoid subtypes of PA tend to have incomplete and thinner capsules and to recur more frequently. Surgical variables related to recurrence include positive margins and tumor spillage.ConclusionMyxoid and/or large PA, especially in young patients, should be approached more cautiously to avoid recurrences.

Parotid pleomorphic adenoma (PPA) is a benign tumor frequently found in parotid salivary gland. This tumor has various biological behaviors including recurrence after surgery, ability to transform into the malignant form, and occasionally, metastasizes to lymph nodes or other organs. For this PPA tumor, it is appropriate to look for alternative therapy forms other than surgery which is assumed to be the cause of the high tumor recurrence. Other alternatives may include hormonal therapy that needs baseline data on estrogen-receptor expression by PPA tumor cells. To collect the baseline data, a laboratory experimental retrospective study on immunohistochemical study using LsAB/labelled strepavidine-biotine technique of estrogen receptor (ER) receptor on 50 PPA tumor samples at the Anatomic Pathology Department of the Faculty of Medicine, Padjadjaran University/Hasan Sadikin General Hospital during 1998–1999 has been conducted. The observation is focused on the grouping of ER immunoexpression level spread by PPA tumor cells: 0=negative; +1=focal (>20%); +2=heterogeneous (20–50%); and +3=diffuse (>50% immunoreactive tumor cells). The results showed that 40/50 PPA tumor samples (80%) were immunoreactive towards ER with an immunoexpression composition of: 67.5% heterogeneous (27/40) and 32.5% diffuse (13/40). A homogenous smear pattern was observed in tumor cell nucleus. Ten cases showed negative results (8 cases negative and 2 cases focal). The positive PPA tumor tissue components included ductal /tubuloductal epithels, mixomatose and hypercellullar areas. In conclusion, PPA tumor plays the role as target of estrogen hormone and there is a high possibility that it is responsive to hormonal therapy.

Salivary gland neoplasms are extremely rare in children and comprise less than 1% of all pediatric neoplasms. Benign neoplasms account for 60% of these salivary tumors in children. They are most commonly vascular in origin with parotid glands being affected commonly. Pleomorphic adenoma is common in adults; it is extremely rare in pediatric age group. We report a 9 year old girl with a parotid region swelling; suspected to be a pleomorphic adenoma of the superficial lobe of parotid. However, it was arising from the deep lobe & hence was managed with an enucleation of the tumor with no evidence of recurrence after 3 years of follow up. [ABSTRACT FROM AUTHOR]