Matsuda Eriko, Fukuhara Takahiro, Donishi Ryohei, Kawamoto Katsuyuki, Hirooka Yasuaki, Takeuchi Hiromi
Division of Otolaryngology, Head and Neck Surgery, Department of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.
†Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.
Yonago Acta Med. 2018 Feb 5;60(4):220-226. doi: 10.24563/yam.2017.12.002. eCollection 2017 Dec.
Ultrasonographic homogeneity is an important differential finding between Warthin tumor and pleomorphic adenoma, two types of benign parotid gland tumors, with the former likely to be heterogeneous and the latter homogeneous. However, differences in the performance of ultrasound machines or the homogeneity cut-off level affect the judgment of ultrasonographic homogeneity. Therefore, in this study, we adopted a novel system for classifying the composition of tumors via ultrasonography, using anechoic area as a substitute for differences in homogeneity to differentiate between Warthin tumors and pleomorphic adenomas.
We evaluated 68 tumors that were histopathologically diagnosed as Warthin tumor or pleomorphic adenoma between July 2009 and November 2015. Ultrasonographic images of the tumors were evaluated on the basis of key differentiating features, including features on B-mode imaging and color Doppler imaging. Additionally, the tumors were classified into four groups based on anechoic area, and findings were compared between Warthin tumors and pleomorphic adenomas.
While 38 of the tumors were pleomorphic adenomas, 30 were Warthin tumors. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of Warthin tumors using our novel classification system were 73.3%, 76.3%, 71.0%, 78.4% and 75.0%, respectively. Compared to pleomorphic adenomas, Warthin tumors showed large or sponge-like anechoic areas, rich vascularization and an oval shape even at large tumor sizes, and the difference was significant. On defining Warthin tumor as a tumor demonstrating two or more of the findings noted above, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for its detection were 73.3%, 84.2%, 78.6%, 80.0% and 79.4%, respectively.
Our novel classification system based on anechoic area patterns demonstrated by the tumors had high sensitivity, specificity and diagnostic accuracy for differentiating Warthin tumors from pleomorphic adenomas.
超声图像的均匀性是沃辛瘤和多形性腺瘤这两种腮腺良性肿瘤之间重要的鉴别特征，前者可能表现为不均匀，后者则为均匀。然而，超声设备性能的差异或均匀性的截断水平会影响对超声图像均匀性的判断。因此，在本研究中，我们采用了一种通过超声检查对肿瘤成分进行分类的新系统，以无回声区替代均匀性差异来区分沃辛瘤和多形性腺瘤。
我们评估了2009年7月至2015年11月间经组织病理学诊断为沃辛瘤或多形性腺瘤的68个肿瘤。基于关键鉴别特征，包括B超成像和彩色多普勒成像特征，对肿瘤的超声图像进行评估。此外，根据无回声区将肿瘤分为四组，并比较沃辛瘤和多形性腺瘤的结果。
68个肿瘤中，38个为多形性腺瘤，30个为沃辛瘤。使用我们的新分类系统检测沃辛瘤的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为73.3%、76.3%、71.0%、78.4%和75.0%。与多形性腺瘤相比，沃辛瘤表现出大的或海绵状的无回声区、丰富的血管化以及即使在肿瘤较大时也呈椭圆形，差异具有显著性。将沃辛瘤定义为表现出上述两种或更多特征的肿瘤时，其检测的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为73.3%、84.2%、78.6%、80.0%和79.4%。
我们基于肿瘤无回声区模式的新分类系统在区分沃辛瘤和多形性腺瘤方面具有较高的敏感性、特异性和诊断准确性。
