CC BY-NC-ND 4.0 · Ultraschall Med 2023; 44(04): 419-427
DOI: 10.1055/a-1866-4633
Original Article

Contrast-Enhanced Ultrasound and Strain Elastography for Differentiating Benign and Malignant Parotid Tumors

Kontrastverstärkter Ultraschall und Strain-Elastografie zur Differenzierung benigner und maligner Parotistumore
Liuhong Shi
1   Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China (Ringgold ID: RIN89681)
,
Dingting Wu
2   Nutrition Division, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China (Ringgold ID: RIN593059)
,
Xu Yang
3   Pathology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China (Ringgold ID: RIN71069)
,
Caoxin Yan
1   Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China (Ringgold ID: RIN89681)
,
Pintong Huang
1   Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China (Ringgold ID: RIN89681)
› Author Affiliations
Supported by: Medical and Health Research Project of Zhejiang Province 2021KY703
Supported by: Natural Science Foundation of Zhejiang Province LQ20H180011

Abstract

Objectives Preoperative differentiation between benign parotid tumors (BPT) and malignant parotid tumors (MPT) is crucial for treatment decisions. The purpose of this study was to investigate the benefits of combining contrast-enhanced ultrasound (CEUS) and strain elastography (SE) for preoperative differentiation between BPT and MPT.

Methods A total of 115 patients with BPT (n=72) or MPT (n=43) who underwent ultrasound (US), SE, and CEUS were enrolled. US and CEUS features and the elasticity score were evaluated. Receiver operating characteristic curve (ROC) analysis was used to assess the diagnostic performance of SE, CEUS, and SE + CEUS with respect to identifying MPT from BPT.

Results Solitary presentation, larger diameter, irregular shape, ill-defined margin, heterogeneous echogenicity, and calcification on US and higher elasticity score on SE had a significant association with malignancy. MPT also presented an unclear margin, larger size after enhancement, and “fast-in and fast-out” pattern on CEUS. The combination of SE and CEUS was effective for differentiating MPT from BPT (AUC: 0.88, 0.80–0.95), with a sensitivity of 86.0%, specificity of 88.9%, and accuracy of 87.8%, which were significantly higher than the values for SE (AUC: 0.75, 0.66–0.85) and CEUS (AUC: 0.82, 0.73–0.91) alone.

Conclusion The combination of CEUS and SE is valuable for distinguishing MPT from BPT.

Zusammenfassung

Ziel Die präoperative Differenzierung zwischen benignen Parotistumoren (BPT) und malignen Parotistumoren (MPT) ist maßgeblich für die Behandlungsentscheidung. Ziel dieser Studie war es, den Nutzen einer Kombination aus kontrastverstärktem Ultraschall (CEUS) und Strain-Elastografie (SE) zur präoperativen Differenzierung von BPT und MPT zu untersuchen.

Methoden Insgesamt wurden 115 Patienten mit BPT (n=72) oder MPT (n=43) eingeschlossen, die sich einer Ultraschalluntersuchung (US), SE und CEUS unterzogen. US- und CEUS-Merkmale sowie der Elastizitäts-Score wurden ausgewertet. Mit Hilfe der ROC-Analyse (Receiver Operating Characteristic Curve) wurde die diagnostische Leistung von SE, CEUS und SE + CEUS im Hinblick auf die Differenzierung von MPT und BPT bewertet.

Ergebnisse Solitäres Auftreten, größerer Durchmesser, unregelmäßige Form, schlecht definierter Rand, heterogene Echogenität und Verkalkung auf US und ein höherer Elastizitätswert in der SE standen in einem signifikanten Zusammenhang mit Malignität. MPT zeigen auch einen unklaren Rand, einen größeren Umfang nach dem Enhancement und ein „Fast-in und Fast-out“-Muster im CEUS. Die Kombination von SE und CEUS war effektiv, um MPT und BPT zu differenzieren (AUC: 0,88; 0,80–0,95), mit einer Sensitivität von 86,0%, einer Spezifität von 88,9% und einer Genauigkeit von 87,8% – diese Werte waren signifikant höher als die für SE (AUC: 0,75; 0,66–0,85) und CEUS (AUC: 0,82; 0,73–0,91) allein.

Schlussfolgerung Die Kombination von CEUS und SE ist wertvoll, um MPT von BPT zu differenzieren.



Publication History

Received: 03 February 2022

Accepted after revision: 21 May 2022

Article published online:
02 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Vasconcelos AC, Nör F, Meurer L. et al. Clinicopathological analysis of salivary gland tumors over a 15-year period. Braz Oral Res 2016; 30
  • 2 Fu JY, Wu CX, Shen SK. et al. Salivary gland carcinoma in Shanghai (2003–2012): an epidemiological study of incidence, site and pathology. BMC Cancer 2019; 19: 350
  • 3 Thielker J, Grosheva M, Ihrler S. et al. Contemporary Management of Benign and Malignant Parotid Tumors. Front Surg 2018; 5: 39
  • 4 Gritzmann N, Rettenbacher T, Hollerweger A. et al. Sonography of the salivary glands. Eur Radiol 2003; 13: 964-975
  • 5 Howlett DC. High resolution ultrasound assessment of the parotid gland. Br J Radiol 2003; 76: 271-277
  • 6 Sigrist RMS, Liau J, Kaffas AE. et al. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics 2017; 7: 1303-1329
  • 7 David E, Cantisani V, De Vincentiis M. et al. Contrast-enhanced ultrasound in the evaluation of parotid gland lesions: an update of the literature. Ultrasound 2016; 24: 104-110
  • 8 Cantisani V, David E, Barr RG. et al. US-Elastography for Breast Lesion Characterization: Prospective Comparison of US BIRADS, Strain Elastography and Shear wave Elastography. Ultraschall in Med 2021; 42: 1533-1540
  • 9 Sultan SR, AlKharaiji M, Rajab SH. Diagnosis of parotid gland tumours with Contrast-Enhanced Ultrasound: a systematic review and meta-analysis. Med Ultrason 2021;
  • 10 Adler DD, Carson PL, Rubin JM. et al. Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings. Ultrasound Med Biol 1990; 16: 553-559
  • 11 Itoh A, Ueno E, Tohno E. et al. Breast disease: clinical application of US elastography for diagnosis. Radiology 2006; 239: 341-350
  • 12 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
  • 13 Bradley PJ, McGurk M. Incidence of salivary gland neoplasms in a defined UK population. Br J Oral Maxillofac Surg 2013; 51: 399-403
  • 14 Xi X, Gao L, Wu Q. et al. Differentiation of Thyroid Nodules Difficult to Diagnose With Contrast-Enhanced Ultrasonography and Real-Time Elastography. Front Oncol 2020; 10: 112
  • 15 Lee YJ, Kim SH, Kang BJ. et al. Contrast-Enhanced Ultrasound for Early Prediction of Response of Breast Cancer to Neoadjuvant Chemotherapy. Ultraschall in Med 2019; 40: 194-204
  • 16 Jia W, Luo T, Dong Y. et al. Breast Elasticity Imaging Techniques: Comparison of Strain Elastography and Shear-Wave Elastography in the Same Population. Ultrasound Med Biol 2021; 47: 104-113
  • 17 Mansour N, Bas M, Stock KF. et al. Multimodal Ultrasonographic Pathway of Parotid Gland Lesions. Ultraschall in Med 2017; 38: 166-173
  • 18 Klintworth N, Mantsopoulos K, Zenk J. et al. Sonoelastography of parotid gland tumours: initial experience and identification of characteristic patterns. Eur Radiol 2012; 22: 947-956
  • 19 Wierzbicka M, Kałużny J, Szczepanek-Parulska E. et al. Is sonoelastography a helpful method for evaluation of parotid tumors?. Eur Arch Otorhinolaryngol 2013; 270: 2101-2107
  • 20 Mansour N, Stock KF, Chaker A. et al. Evaluation of parotid gland lesions with standard ultrasound, color duplex sonography, sonoelastography, and acoustic radiation force impulse imaging – a pilot study. Ultraschall in Med 2012; 33: 283-288
  • 21 Zhang YF, Li H, Wang XM. et al. Sonoelastography for differential diagnosis between malignant and benign parotid lesions: a meta-analysis. Eur Radiol 2019; 29: 725-735
  • 22 Wilson SR, Burns PN. Microbubble-enhanced US in body imaging: what role?. Radiology 2010; 257: 24-39
  • 23 Wei X, Li Y, Zhang S. et al. Evaluation of microvascularization in focal salivary gland lesions by contrast-enhanced ultrasonography (CEUS) and Color Doppler sonography. Clin Hemorheol Microcirc 2013; 54: 259-271
  • 24 Yang L, Zhao H, He Y. et al. Contrast-Enhanced Ultrasound in the Differential Diagnosis of Primary Thyroid Lymphoma and Nodular Hashimoto's Thyroiditis in a Background of Heterogeneous Parenchyma. Front Oncol 2021; 10: 597975
  • 25 Dvorak HF. Tumor Stroma, Tumor Blood Vessels, and Antiangiogenesis Therapy. Cancer J 2015; 21: 237-243
  • 26 Yan M, Xu D, Chen L. et al. Comparative Study of Qualitative and Quantitative Analyses of Contrast-Enhanced Ultrasound and the Diagnostic Value of B-Mode and Color Doppler for Common Benign Tumors in the Parotid Gland. Front Oncol 2021; 11: 669542
  • 27 Knopf A, Mansour N, Chaker A. et al. Multimodal ultrasonographic characterisation of parotid gland lesions--a pilot study. Eur J Radiol 2012; 81: 3300-3305
  • 28 Sui X, Liu HJ, Jia HL. et al. Contrast-enhanced ultrasound and real-time elastography in the differential diagnosis of malignant and benign thyroid nodules. Exp Ther Med 2016; 12: 783-791
  • 29 Xiang LH, Yao MH, Xu G. et al. Diagnostic value of contrast-enhanced ultrasound and shear-wave elastography for breast lesions of sub-centimeter. Clin Hemorheol Microcirc 2017; 67: 69-80