Skip to main content
SpringerLink
Log in

Parotid incidentaloma identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography: findings at grayscale and power Doppler ultrasonography and ultrasound-guided fine-needle aspiration biopsy or core-needle biopsy

  • Head and Neck
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Twelve parotid incidentalomas in 10 consecutive subjects (nine with a known malignancy elsewhere and one presumptively healthy subject) identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography (18F-FDG PET/CT) were investigated, with the aim of calculating maximum standardized uptake value (SUVmax) of each FDG-avid focus, and identifying corresponding sonographic and pathologic findings. The results of ultrasound-guided fine-needle aspiration biopsy (FNAB) (n = 9) and core-needle biopsy (CNB) (n = 3) were Warthin tumor in 10 cases, and pleomorphic adenoma and chronic inflammation in one each. SUVmax was 7.0–21.0 g/mL (average 13.7 g/mL) for Warthin tumor, 6.8 g/mL for pleomorphic adenoma, and 7.3 g/mL for chronic inflammation. Each FDG-avid focus corresponded to ovoid (n = 11) or lobulated (n = 1) hypoechoic mass on grayscale ultrasonography (US) and hypervascular mass, except one with chronic inflammation, on power Doppler (PD) US. Parotid incidentaloma identified by 18F-FDG PET/CT during workup of various malignancies elsewhere does not necessarily signify primary or metastatic malignancy, but indicates a high likelihood of benign lesions, particularly Warthin tumor. Such lesions should be evaluated thoroughly by US and ultrasound-guided FNAB or CNB if parotid disease would change the patient’s treatment plan.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Keyes JW Jr, Watson NE Jr, Williams DW 3rd, Greven KM, McGuirt WF (1997) FDG PET in head and neck cancer. AJR Am J Roentgenol 169:1663–1669

    PubMed  Google Scholar 

  2. Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, Altman H, Keidar Z, Israel O (2003) Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 44:1200–1209

    PubMed  Google Scholar 

  3. Kluetz PG, Meltzer CC, Villemagne VL, Kinahan PE, Chander S, Martinelli MA, Townsend DW (2000) Combined PET/CT imaging in oncology. Impact on patient management. Clin Positron Imaging 3:223–230

    Article  PubMed  Google Scholar 

  4. Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, Coleman RE, Wahl R, Paschold JC, Avril N, Einhorn LH, Suh WW, Samson D, Delbeke D, Gorman M, Shields AF (2008) Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med 49:480–508

    Article  PubMed  Google Scholar 

  5. Keyes JW Jr, Harkness BA, Greven KM, Williams DW 3rd, Watson NE Jr, McGuirt WF (1994) Salivary gland tumor: pretherapy evaluation with PET. Radiology 192:99–102

    PubMed  Google Scholar 

  6. Uchida Y, Minoshima S, Kawata T, Motoori K, Nakano K, Kazama T, Uno T, Okamoto Y, Ito H (2005) Diagnostic value of FDG PET and salivary gland scintigraphy for parotid tumors. Clin Nucl Med 30:170–176

    Article  PubMed  Google Scholar 

  7. Shimizu M, Ussmüller J, Hartwein J, Donath K, Kinukawa N (1999) Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:226–233

    Article  PubMed  CAS  Google Scholar 

  8. Zajkowski P, Jakubowski W, Białek EJ, Wysocki M, Osmólski A, Serafin-Król M (2000) Pleomorphic adenoma and adenolymphoma in ultrasonography. Eur J Ultrasound 12:23–29

    Article  PubMed  CAS  Google Scholar 

  9. Gritzmann N (1989) Sonography of the salivary glands. AJR Am J Roentgenol 153:161–166

    PubMed  CAS  Google Scholar 

  10. Cvetinović M, Jović N, Mijatović D (1991) Evaluation of ultrasound in the diagnosis of pathologic processes in the parotid gland. J Oral Maxillofac Surg 49:147–150

    Article  PubMed  Google Scholar 

  11. Schick S, Steiner E, Gahleitner A, Böhm P, Helbich T, Ba-Ssalamah A, Mostbeck G (1998) Differentiation of benign and malignant tumors of the parotid gland: value of pulsed Doppler and color Doppler sonography. Eur Radiol 8:1462–1467

    Article  PubMed  CAS  Google Scholar 

  12. Van den Bruel A, Maes A, De Potter T, Mortelmans L, Drijkoningen M, Van Damme B, Delaere P, Bouillon R (2002) Clinical relevance of thyroid fluorodeoxyglucose-whole body positron emission tomography incidentaloma. J Clin Endocrinol Metab 87:1517–1520

    Article  PubMed  Google Scholar 

  13. King DL, Stack BC Jr, Spring PM, Walker R, Bodenner DL (2007) Incidence of thyroid carcinoma in fluorodeoxyglucose positron emission tomography-positive thyroid incidentalomas. Otolaryngol Head Neck Surg 137:400–404

    Article  PubMed  Google Scholar 

  14. Horiuchi M, Yasuda S, Shohtsu A, Ide M (1998) Four cases of Warthin’s tumor of the parotid gland detected with FDG PET. Ann Nucl Med 12:47–50

    Article  PubMed  CAS  Google Scholar 

  15. Rubello D, Nanni C, Castellucci P, Rampin L, Farsad M, Franchi R, Mariani G, Menaldo G, Fanti S (2005) Does 18F-FDG PET/CT play a role in the differential diagnosis of parotid masses. Panminerva Med 47:187–189

    PubMed  CAS  Google Scholar 

  16. Basu S, Houseni M, Alavi A (2008) Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Commun 29:367–373

    Article  PubMed  CAS  Google Scholar 

  17. Wittich GR, Scheible WF, Hajek PC (1985) Ultrasonography of the salivary glands. Radiol Clin North Am. 23:29–37

    PubMed  CAS  Google Scholar 

  18. Renehan A, Gleave EN, Hancock BD, Smith P, McGurk M (1996) Long-term follow-up of over 1000 patients with salivary gland tumours treated in a single centre. Br J Surg 83:1750–1754

    Article  PubMed  CAS  Google Scholar 

  19. Okamura T, Kawabe J, Koyama K, Ochi H, Yamada R, Sakamoto H, Matsuda M, Ohashi Y, Nakai Y (1998) Fluorine-18 fluorodeoxyglucose positron emission tomography imaging of parotid mass lesions. Acta Otolaryngol Suppl 538:209–213

    Article  PubMed  CAS  Google Scholar 

  20. Bialek EJ, Jakubowski W, Zajkowski P, Szopinski KT, Osmolski A (2006) US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls. Radiographics 26:745–763

    Article  PubMed  Google Scholar 

  21. Kim J, Kim EK, Park CS, Choi YS, Kim YH, Choi EC (2004) Characteristic sonographic findings of Warthin's tumor in the parotid gland. J Clin Ultrasound 32:78–81

    Article  PubMed  Google Scholar 

  22. Wong DS, Li GK (2000) The role of fine-needle aspiration cytology in the management of parotid tumors: a critical clinical appraisal. Head Neck 22:469–473

    Article  PubMed  CAS  Google Scholar 

  23. Stewart CJ, MacKenzie K, McGarry GW, Mowat A (2000) Fine-needle aspiration cytology of salivary gland: a review of 341 cases. Diagn Cytopathol 22:139–146

    Article  PubMed  CAS  Google Scholar 

  24. Bartels S, Talbot JM, DiTomasso J, Everts EC, Andersen PE, Wax MK, Cohen JI (2000) The relative value of fine-needle aspiration and imaging in the preoperative evaluation of parotid masses. Head Neck 22:781–786

    Article  PubMed  CAS  Google Scholar 

  25. Zbären P, Schär C, Hotz MA, Loosli H (2001) Value of fine-needle aspiration cytology of parotid gland masses. Laryngoscope 111:1989–1992

    Article  PubMed  Google Scholar 

  26. Wan YL, Chan SC, Chen YL, Cheung YC, Lui KW, Wong HF, Hsueh C, See LC (2004) Ultrasonography-guided core-needle biopsy of parotid gland masses. AJNR Am J Neuroradiol 25:1608–1612

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu, 700-712, South Korea

    Sang Kwon Lee & Byung Hak Rho

  2. Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea

    Kyoung Sook Won

Authors
  1. Sang Kwon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Byung Hak Rho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyoung Sook Won
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang Kwon Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, S.K., Rho, B.H. & Won, K.S. Parotid incidentaloma identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography: findings at grayscale and power Doppler ultrasonography and ultrasound-guided fine-needle aspiration biopsy or core-needle biopsy. Eur Radiol 19, 2268–2274 (2009). https://doi.org/10.1007/s00330-009-1407-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-009-1407-5

Keywords

Search

Navigation