使用扩散加权磁共振成像和锝-99m 高锝酸盐闪烁扫描术对腮腺肿瘤进行术前诊断的策略：一项前瞻性研究。
Preoperative Diagnostic Strategy for Parotid Gland Tumors Using Diffusion-Weighted MRI and Technetium-99m Pertechnetate Scintigraphy: A Prospective Study.
作者信息
Kikuchi Masahiro, Koyasu Sho, Shinohara Shogo, Imai Yukihiro, Hino Megumu, Naito Yasushi
机构信息
Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Department of Radiology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
出版信息
PLoS One. 2016 Feb 5;11(2):e0148973. doi: 10.1371/journal.pone.0148973. eCollection 2016.
OBJECTIVE
Fine needle aspiration cytology (FNAC) for diagnosis of a parotid gland tumor is widely used but its sensitivity is low and non-diagnostic rate is relatively high. In contrast, core needle biopsy (CNB) has a higher sensitivity and lower rate of sampling errors but has a higher risk of injury to adjacent organs such as facial nerve than FNAC. Screening of patients with parotid gland tumors to identify cases of pleomorphic adenoma (PA) and Warthin tumor (WT) may allow CNB to be confined to patients without PA and WT. We established an algorithm for preoperative diagnosis and management of parotid gland tumor using diffusion-weighted MRI and 99mTc pertechnetate scintigraphy. This algorithm was developed with the goal of maximal reduction of the number of patients in whom CNB is required. The purpose of the study is to validate our algorithm prospectively.
METHODS
A prospective study was conducted in 71 cases who were newly diagnosed with parotid gland tumor and 53 cases were enrolled in the study. In the algorithm, PA (high apparent diffusion coefficient (ADC) mean≥1.5×10(-3) mm(2)/s) and non-PA (low ADCmean<1.5×10(-3) mm(2)/s) cases are first distinguished based on the ADCmean on diffusion-weighed MRI. Second, among suspected non-PA cases, WT and non-WT are distinguished using technetium-99m pertechnetate scintigraphy. CNB is then performed only in probable non-PA and non-WT cases.
RESULTS
Although CNB was only required in 40% (21/53) of all cases, we made a preoperative histopathological diagnosis with an accuracy of 87% (46/53) and we correctly diagnosed whether a tumor was benign or malignant with an accuracy of 96% (51/53). Preoperative surgical planning had to be changed during surgery in only one case (2%).
CONCLUSIONS
Our algorithm is valuable in terms of clinical practice with highly potential for preoperative diagnosis and with less risk of CNB procedure.
目的
细针穿刺细胞学检查（FNAC）用于腮腺肿瘤诊断虽被广泛应用，但其敏感性较低且非诊断率相对较高。相比之下，粗针活检（CNB）敏感性更高、采样误差率更低，但与FNAC相比，其对面神经等邻近器官造成损伤的风险更高。对腮腺肿瘤患者进行筛查以识别多形性腺瘤（PA）和沃辛瘤（WT）病例，可能使CNB仅适用于无PA和WT的患者。我们利用扩散加权磁共振成像（MRI）和99m锝高锝酸盐闪烁显像建立了一种腮腺肿瘤术前诊断和管理算法。开发该算法的目的是最大程度减少需要进行CNB的患者数量。本研究的目的是对我们的算法进行前瞻性验证。
方法
对71例新诊断为腮腺肿瘤的患者进行了一项前瞻性研究，其中53例纳入研究。在该算法中，首先根据扩散加权MRI上的平均表观扩散系数（ADC）区分PA（平均ADC≥1.5×10⁻³mm²/s）和非PA（平均ADC<1.5×10⁻³mm²/s）病例。其次，在疑似非PA病例中，利用99m锝高锝酸盐闪烁显像区分WT和非WT。然后仅对可能的非PA和非WT病例进行CNB。
结果
虽然所有病例中仅40%（21/53）需要进行CNB，但我们术前组织病理学诊断的准确率为87%（46/53），并且我们正确诊断肿瘤是良性还是恶性的准确率为96%（51/53）。手术过程中仅1例（2%）需要改变术前手术计划。
结论
我们的算法在临床实践中具有重要价值，术前诊断潜力高，且CNB操作风险较低。
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