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Review
. 2021 Feb 1;21(1):19-32.
doi: 10.17305/bjbms.2020.5028.

Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review

Sebastian Stoia  1 , Grigore Băciuț  1 , Manuela Lenghel  2 , Radu Badea  3 , Csaba Csutak  2 , Georgeta Mihaela Rusu  2 , Mihaela Băciuț  1 , Tiberiu Tamaș  1 , Emil Boțan  4 , Gabriel Armencea  1 , Simion Bran  1 , Cristian Dinu  1
Affiliations
Review

Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review

Sebastian Stoia et al. Bosn J Basic Med Sci. .

Abstract

An accurate preoperative diagnosis of parotid tumors is essential for the selection and planning of surgical treatment. Various modern cross-sectional imaging and cytologic investigations can support the differential diagnosis of parotid tumors. The aim of this study was to achieve a comprehensive and updated review of modern imaging and cytologic investigations used in parotid tumor diagnosis, based on the latest literature data. This literature review could serve as a guide for clinicians in selecting different types of investigations for the preoperative differential diagnosis of parotid tumors. Magnetic resonance imaging (MRI) with its dynamic and advanced sequences is the first-line imaging investigation used in differentiating parotid tumors. Computed tomography (CT) and positron emission tomography (PET)-CT provide limited indications in differentiating parotid tumors. Fine needle aspiration biopsy and core needle biopsy can contribute with satisfactory results to the cytological diagnosis of parotid tumors. Dynamic MRI with its dynamic contrast-enhanced and diffusion-weighted sequences provides the best accuracy for the preoperative differential diagnosis of parotid tumors. CT allows the best evaluation of bone invasion, being useful when MRI cannot be performed, and PET-CT has value in the follow-up of cancer patients. The dual cytological and imaging approach is the safest method for an accurate differential diagnosis of parotid tumors.

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Conflict of interest statement

Conflict of interest statement: The authors declare no conflict of interests

Figures

FIGURE 1
FIGURE 1
Conventional magnetic resonance imaging appearance in a 60-year-old patient with a left parotid gland pleomorphic adenoma. (A and B) T2-weighted image (WI) sequence and short tau inversion recover (STIR)-WI sequence revealing hyperintense signal. (C and D) T1-WI sequence without contrast and T1 contrast-enhanced sequences showing hypointense signal and homogeneous enhancement.
FIGURE 2
FIGURE 2
Conventional magnetic resonance imaging appearance in a 50-year-old patient with a Warthin tumor of the left parotid gland. (A) Non-enhanced T1-weighted image (WI) sequence, with inhomogeneous aspect, with central hyperintense area with hemorrhagic transformation (arrow). (B) T2-WI sequence showing a hypointense central area. (C) T1 contrast-enhanced sequences showing enhancement, slightly inhomogeneous aspect.
FIGURE 3
FIGURE 3
Conventional magnetic resonance imaging appearance in a 70-year-old patient with a malignant tumor of the right parotid gland (carcinoma ex pleomorphic adenoma). (A) T2-weighted image (WI) sequence, (B) short tau inversion recover [STIR], and (C) non-enhanced T1-WI sequences showing an inhomogeneous lesion in the right parotid gland, with infiltrative contour.
FIGURE 4
FIGURE 4
Diffusion-weighted imaging sequences with apparent diffusion coefficient (ADC) map in: (A and B) pleomorphic adenoma with T2-shine through effect and high value of ADC (2,385 × 10-3mm2/s) and (C and D) Warthin tumor with diffusion restriction and low ADC value (0.821 × 10-3mm2/s).
FIGURE 5
FIGURE 5
Diffusion-weighted imaging sequences with apparent diffusion coefficient (ADC) map in a 28-year-old patient with primary lymphoma of the left parotid gland, showing diffusion restriction (A) and very low ADC value (B) (× 10-3mm2/s).
FIGURE 6
FIGURE 6
Dynamic contrast-enhanced magnetic resonance imaging. (A) Pleomorphic adenoma (curve type A – curve number 1 on the presented image); (B) Warthin tumor (curve type B); and (C) malignant tumor (curve type C).
FIGURE 7
FIGURE 7
K-trans values in (A) pleomorphic adenoma (high value – 1.122 min-1), (B) Warthin tumor (very low value – 0.285 min-1), and (C) malignant tumor (intermediate value – 0.569 min-1).
FIGURE 8
FIGURE 8
Contrast-enhanced computed tomography in a 65-year-old patient with histological proven salivary duct carcinoma of the right parotid gland. Multiple calcifications in the tumor lesion (A and B).
FIGURE 9
FIGURE 9
A guide for the preoperative differential diagnosis of parotid tumors using the most recent imaging and cytologic investigations.
See this image and copyright information in PMC

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