Advertisement

Parotid Warthin's tumor: novel MR imaging score as diagnostic indicator

Published:September 21, 2021DOI:https://doi.org/10.1016/j.clinimag.2021.09.005

      Highlights

      • Differentiation between WTs and other parotid tumors remains challenging.
      • The best MR features of WT included bilaterality, ADC < 905.1, and T1 hyperintensity.
      • MRI score cut-off value of 7 indicated 100% specificity and 100% PPV for WTs.

      Abstract

      Objectives

      Despite known characteristic radiologic and clinical features, differentiation between Warthin's tumor (WT) and other parotid tumors remains challenging. The purpose of this study was to more precisely assess the MR imaging features of WT and to develop a scoring system combining the most specific characteristics.

      Methods

      A total of 208 patients with parotid gland tumors and presurgical MRI were included. Tumors were divided into 5 histological subtypes, and different MRI features were compared between groups. An MRI scoring test was developed including MR parameters that contributed significantly in distinguishing WT from other tumors.

      Results

      The best MRI features for differentiating between WTs from other tumors included bilaterality (P = 0.002), multifocality (P < 0.001), ADC values <905.1 (P < 0.001), and high signal intensity on T1-W images (P < 0.001). Six or more points on the 14-point scoring MRI scale was associated with an area under the curve of 0.99 (Accuracy of 98%), while a cut-off value of 7 indicated 100% specificity and 100% positive predictive value.

      Conclusions

      Ill-defined margins, low T1-W signal, and location in the upper 2/3 of the parotid gland excluded WTs in 100% of cases. The proposed scoring method allows WTs to be distinguished from other tumors with high accuracy.

      Key points

      • Despite known characteristic radiologic and clinical features, differentiation between Warthin's tumor (WT) and other parotid tumors remains challenging.
      • The best MRI features for differentiating between WTs from other tumors included bilaterality, multifocality, ADC values <905.1, and high signal intensity on T1-W images.
      • Six or more points on the 14-point scoring MRI scale was associated with an area under the curve of 0.99, while a cut-off value of 7 indicated 100% specificity and 100% positive predictive value.

      Abbreviations:

      WT (Warthin's tumor), ACC (acinic cell carcinoma), MEC (mucoepidermoid carcinoma), ROC (receiving operating characteristics), AUC (area under the curve), MRI (magnetic resonance imaging), DWI (diffusion-weighted imaging), ADC (apparent diffusion coefficient)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abdel Razek A.A.K.
        • Mukherji S.K.
        State-of-the-art imaging of salivary gland tumors.
        Neuroimaging Clin N Am. 2018; 28: 303-317
        • Minami M.
        • Tanioka H.
        • Oyama K.
        • Itai Y.
        • Eguchi M.
        • Yoshikawa K.
        • et al.
        Warthin tumor of the parotid gland: MR-pathologic correlation.
        AJNR Am J Neuroradiol. 1993; 14: 209-214
        • Maiorano E.
        • Lo Muzio L.
        • Favia G.
        • Piattelli A.
        Warthin's tumour: a study of 78 cases with emphasis on bilaterality, multifocality and association with other malignancies.
        Oral Oncol. 2002; 38: 35-40
        • Peter Klussmann J.
        • Wittekindt C.
        • Florian Preuss S.
        • Al Attab A.
        • Schroeder U.
        • Guntinas-Lichius O.
        High risk for bilateral warthin tumor in heavy smokers–review of 185 cases.
        Acta Otolaryngol. 2006; 126: 1213-1217
        • Ikeda M.
        • Motoori K.
        • Hanazawa T.
        • Nagai Y.
        • Yamamoto S.
        • Ueda T.
        • et al.
        Warthin tumor of the parotid gland: diagnostic value of MR imaging with histopathologic correlation.
        AJNR Am J Neuroradiol. 2004; 25: 1256-1262
        • Habermann C.R.
        • Arndt C.
        • Graessner J.
        • Diestel L.
        • Petersen K.U.
        • Reitmeier F.
        • et al.
        Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible?.
        AJNR Am J Neuroradiol. 2009; 30: 591-596
        • Scianna J.M.
        • Petruzzelli G.J.
        Contemporary management of tumors of the salivary glands.
        Curr Oncol Rep. 2007; 9: 134-138
        • Heller K.S.
        • Attie J.N.
        Treatment of Warthin’s tumor by enucleation.
        Am J Surg. 1988; 156: 294-296
        • Witt R.L.
        The significance of the margin in parotid surgery for pleomorphic adenoma.
        Laryngoscope. 2002; 112: 2141-2154
        • Wang C.W.
        • Chu Y.H.
        • Chiu D.Y.
        • Shin N.
        • Hsu H.H.
        • Lee J.C.
        • et al.
        JOURNAL CLUB: the warthin tumor score: a simple and reliable method to distinguish warthin tumors from pleomorphic adenomas and carcinomas.
        AJR Am J Roentgenol. 2018; 210: 1330-1337
        • Tartaglione T.
        • Botto A.
        • Sciandra M.
        • Gaudino S.
        • Danieli L.
        • Parrilla C.
        • et al.
        Differential diagnosis of parotid gland tumours: which magnetic resonance findings should be taken in account?.
        Acta Otorhinolaryngol Ital. 2015; 35: 314-320
        • Christe A.
        • Waldherr C.
        • Hallett R.
        • Zbaeren P.
        • Thoeny H.
        MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease.
        AJNR Am J Neuroradiol. 2011; 32: 1202-1207
        • Rassekh C.H.
        • Cost J.L.
        • Hogg J.P.
        • Hurst M.K.
        • Marano G.D.
        • Ducatman B.S.
        Positron emission tomography in Warthin’s tumor mimicking malignancy impacts the evaluation of head and neck patients.
        Am J Otolaryngol. 2015; 36: 259-263
        • Ettl T.
        • Schwarz-Furlan S.
        • Gosau M.
        • Reichert T.E.
        Salivary gland carcinomas.
        Oral Maxillofac Surg. 2012; 16: 267-283
        • Sakai O.
        • Nakashima N.
        • Takata Y.
        • Furuse M.
        Acinic cell carcinoma of the parotid gland: CT and MRI.
        Neuroradiology. 1996; 38: 675-679
        • Suh S.I.
        • Seol H.Y.
        • Kim T.K.
        • Lee N.J.
        • Kim J.H.
        • Kim K.A.
        • et al.
        Acinic cell carcinoma of the head and neck: radiologic-pathologic correlation.
        J Comput Assist Tomogr. 2005; 29: 121-126
        • Coudert H.
        • Mirafzal S.
        • Dissard A.
        • Boyer L.
        • Montoriol P.F.
        Multiparametric magnetic resonance imaging of parotid tumors: a systematic review.
        Diagn Interv Imaging. 2021; 102: 121-130
        • Mantsopoulos K.
        • Psychogios G.
        • Agaimy A.
        • Künzel J.
        • Zenk J.
        • Iro H.
        • et al.
        Inflamed benign tumors of the parotid gland: diagnostic pitfalls from a potentially misleading entity.
        Head Neck. 2015; 37: 23-29
        • Patey D.H.
        • Thackray A.C.
        Infected adenolymphoma: a new parotid syndrome.
        Br J Surg. 1970; 57: 569-572
        • Rössle M.
        • Winter W.
        • Ihrler S.
        A rare cause of subacute parotitis. the pathogenetic role of crystals from an infarcted Whartin’s tumour?.
        HNO. 2005; 53: 969-972
        • Franzen A.M.
        • Kaup Franzen C.
        • Guenzel T.
        • Lieder A.
        Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation.
        Eur Arch Otorhinolaryngol. 2018; 275: 2593-2598
        • Kennedy T.L.
        Warthin’s tumor: a review indicating no male predominance.
        Laryngoscope. 1983; 93: 889-891
        • Monk Jr., J.S.
        • Church J.S.
        Warthin’s tumor. A high incidence and no sex predominance in central Pennsylvania.
        Arch Otolaryngol Head Neck Surg. 1992; 118: 477-478
        • Lamelas J.
        • Terry Jr., J.H.
        • Alfonso A.E.
        Warthin’s tumor: multicentricity and increasing incidence in women.
        Am J Surg. 1987; 154: 347-351
        • Cornelius M.E.
        • Wang T.W.
        • Jamal A.
        • Loretan C.G.
        • Neff L.J.
        Tobacco product use among adults - United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1736-1742