Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T20:13:22.322Z Has data issue: false hasContentIssue false
  • English
  • Français

Parotid incidentalomas: a systematic review

Published online by Cambridge University Press:  26 July 2021

CSG Thompson ,
T Nolli  and
M Bannister
CSG Thompson*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Victoria Hospital, Kirkcaldy, Fife, Scotland, UK
T Nolli
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Victoria Hospital, Kirkcaldy, Fife, Scotland, UK
M Bannister
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Victoria Hospital, Kirkcaldy, Fife, Scotland, UK
*
Author for correspondence: Mr C Thompson, Department of Otolaryngology – Head and Neck Surgery, Victoria Hospital, Fife, Scotland, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management.

Methods

A literature search was performed on 25 August 2020 using the keywords ‘incidentaloma’, ‘incidental finding’, ‘parotid’, ‘parotid gland’, ‘salivary gland’ and ‘head and neck’. Articles were reviewed by two authors before their inclusion.

Results

Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy.

Conclusion

If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.

Keywords

IncidentalomaParotid GlandSalivary GlandsPositron-Emission Tomography
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 9 , September 2021 , pp. 765 - 769
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr C Thompson takes responsibility for the integrity of the content of the paper

References

Mirilas, P, Skandalakis, JE. Benign anatomical mistakes: incidentaloma. Am Surg 2002;68:1026–8Google ScholarPubMed
Liu, Y, Ghesani, N, Zuckier, LS. Physiology and pathophysiology of incidence findings detected on 18f-fluorodeoxyglucose positron emission tomography scintigraphy. Semin Nucl Med 2012;40:294–31510.1053/j.semnuclmed.2010.02.002CrossRefGoogle Scholar
Nayan, S, Ramakrishna, J, Gupta, MK. The proportion of malignancy in incidental thyroid lesions on 18-FDG PET study: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2014;151:190–20010.1177/0194599814530861CrossRefGoogle ScholarPubMed
O'Sullivan, JW, Muntinga, T, Grigg, S, Ioannidis, JPA. Prevalence and outcomes of incidental imaging findings: umbrella review. BMJ 2018;361:k238710.1136/bmj.k2387CrossRefGoogle ScholarPubMed
Weiner, C. Anticipate and communicate: ethical management of incidental and secondary findings in the clinical, research and direct-to-consumer contexts. Am J Epidemiol 2014;180:562–4CrossRefGoogle ScholarPubMed
Powell, DK. Patient explanation guidelines for incidentalomas: helping patients not to fear the delayed surveillance. AJR Am J Roentgenol 2014;202:w60210.2214/AJR.13.12337CrossRefGoogle Scholar
Uchida, Y, Minoshima, S, Kawata, T, Motoori, K, Nakano, K, Kazama, T et al. Diagnostic value of FDG PET and salivary gland scintigraphy for parotid tumors. Clin Nucl Med 2005;30:170–610.1097/00003072-200503000-00005CrossRefGoogle ScholarPubMed
Kendi, ATK, Magliocca, KR, Corey, A, Galt, JR, Switchenko, J, Wadsworth, JT et al. Is there a role for PET/CT parameters to characterize benign, malignant and metastatic parotid tumors. AJR Am J Roentgenol 2016;207:635–4010.2214/AJR.15.15590CrossRefGoogle Scholar
Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gotzsche, PC, Ioannidis, JPA et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700CrossRefGoogle ScholarPubMed
Horiuchi, M, Yasuda, S, Shohtsu, A, Ide, M. Four cases of Warthin's tumour of the parotid gland detected with FDG PET. Ann Nucl Med 1998;12:47–5010.1007/BF03165416CrossRefGoogle ScholarPubMed
Holder, WD Jr, White, RL Jr, Zuger, JH, Easton, EJ Jr, Greene, FL. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg 1998;227:764–910.1097/00000658-199805000-00017CrossRefGoogle ScholarPubMed
Basu, S, Houseni, M, Alavi, A. Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Commun 2008;29:367–7310.1097/MNM.0b013e3282f8147aCrossRefGoogle ScholarPubMed
Kiendys, U, Ham, H, Bauters, W, Van den Broecke, C, Deron, P, Goethals, I. F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)-positive parotid incidentaloma: prevalence and clinical significance. Rep Med Imaging 2009;2:1–6Google Scholar
Lee, S-K, Rho, B-H, Won, K-S. Parotid incidentaloma identified by combined F-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 2009;19:2268–74CrossRefGoogle ScholarPubMed
Wang, H-C, Zuo, C-T, Hua, F-C, Zehmin, H, Haibo, T, Jun, Z et al. Efficacy of conventional whole-body 18F-FDG PET/CT in the incidental findings of parotid masses. Ann Nucl Med 2010;24:571–710.1007/s12149-010-0394-6CrossRefGoogle ScholarPubMed
Thomas, R, Sharma, N, Burke, C, Maxwell, D, Howlett, DC. Parotid incidentaloma detected during thoracic PET imaging: how should these lesions be managed? Br J Hosp Med (Lond) 2010;71:292–310.12968/hmed.2010.71.5.47915CrossRefGoogle ScholarPubMed
Seo, JH, Song, BI, Lee, HJ, Kang, S, Jeong, SY, Lee, S-W et al. Significance of focal hypermetabolic lesions of the parotid gland on F-18 FDG PET/CT. J Nucl Med 2010;51:s1236Google Scholar
Colella, G, Tozzi, U, Pagliarulo, V, Bove, P. Warthin tumor: a potential source of diagnostic error. J Craniofac Surg 2010;21:1978–8110.1097/SCS.0b013e3181f50406CrossRefGoogle ScholarPubMed
Klijanienko, J, Petras, S, de Bosschere, L, Paulmier, B, Le Tourneau, C, Rodriguez, J. False-positive FDG PET/CT uptake in Warthin tumor in head and neck oncological patients confirmed by a fine needle aspiration. Diagn Cytopathol 2011;40:282–410.1002/dc.21640CrossRefGoogle ScholarPubMed
Al-Hakami, HA, Makis, W, Anand, S, Mlynarek, A, Black, MJ, Stern, J et al. Head and neck incidentalomas on positron emission tomographic scanning: ignore or investigate? J Otolaryngol Head Neck Surg 2011;40:384–90Google ScholarPubMed
Enomoto, A, Nakahara, H, Uchihashi, T, Tsuji, H, Hamada, S. Fluorodeoxyglucose-positive Warthin tumor in a neck node mimicking metastasis in primary intraosseous left posterior mandibular cancer staging with positron emission tomography/computed tomography. J Oral Maxillofac Surg 2011;69:2052–410.1016/j.joms.2011.01.047CrossRefGoogle Scholar
Park, SB, Choi, JY, Lee, EJ, Yoo, J, Cheon, M, Cho, SK et al. Diagnostic criteria of 18F-FDG PET/CT for differentiating benign from malignant focal hypermetabolic lesions of parotid gland. Nucl Med Mol Imaging 2012;46:95–10110.1007/s13139-012-0135-yCrossRefGoogle Scholar
Nguyen, VX, Nguyen, BD, Ram, PC. Bilateral and multifocal Warthin's tumors of parotid glands: PET/CT imaging. Clin Nucl Med 2012;37:175–710.1097/RLU.0b013e318238f244CrossRefGoogle ScholarPubMed
Soubeyran, V, Duc, C, Giger, R, Kishore, S, Constantin, C, Kamel, ME. Prevalence and clinical significance of focal incidentally detected parotid lesions on FDG-PET/CT. Eur J Nucl Med Mol Imaging 2012;39:s202Google Scholar
Ciarallo, A, Makis, W, Gotra, A, Hickeson, M. Significance of incidental parotid gland 18F-FDG uptake on PET/CT and its impact on patient management. J Nucl Med 2012;53:s448Google Scholar
Chopra, A, Ford, A, De Noronha, R, Matthews, S. Incidental findings on positron emission tomography/CT scans performed in the investigation of lung cancer. Br J Radiol 2012;85:e229–3710.1259/bjr/60606623CrossRefGoogle ScholarPubMed
Iwai, T, Baba, J, Shibasaki, M, Omura, S, Hirota, M, Mitsudo, K et al. 18F-Fluorodeoxyglucose-positive Warthin tumor in a contralateral cervical lymph node mimicking metastasis in tongue cancer staging with PET/CT. J Craniofac Surg 2012;23:e507–910.1097/SCS.0b013e318266f750CrossRefGoogle Scholar
Hsieh, T-C, Wu, Y-C, Sun, S-S, Yang, C-F, Kao, C-H. Parotid gland metastasis from squamous cell carcinoma of esophagus detected by FDG PET/CT. Clin Nucl Med 2012;37:1001–2CrossRefGoogle ScholarPubMed
Lin, L-F, Shen, DHY, Tsai, W-C, Hou, C-H, Cheng, C-Y, Chen, C-Y. ‘Quasi-symmetric’ FDG avidity of bilateral salivary glands in Mikulicz disease yielding false-positive staging in lung cancer. Clin Nucl Med 2012;37:1102–410.1097/RLU.0b013e31826c0c35CrossRefGoogle ScholarPubMed
Sebro, R, Aparici, CM, Pampaloni, MH. Frequency and clinical implications of incidental new primary cancers detected on true whole-body 18F-FDG PET/CT. Nucl Med Commun 2013;34:333–9CrossRefGoogle ScholarPubMed
Gobel, Y, Valette, G, Abgral, R, Clodic, C, Mornet, E, Potard, G et al. Interpretation of suspect head and neck fixations seen on PET/CT in lung cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2014;131:217–21CrossRefGoogle ScholarPubMed
Goodfellow, H, Viney, Z, Hughes, P, Rankin, S, Rottenberg, G, Hughes, S et al. Role of fluorodeoxyglucose positron emission tomography (FDG PET)-computed tomography (CT) in the staging of bladder cancer. BJU Int 2014;114:389–95Google ScholarPubMed
Campos-Gómez, S, Flores-Arredondo, JH, Dorantes-Heredia, R, Chapra-Ibargüengoitia, M, de la Peῆa-Lopez, R. Case report: anti-hormonal therapy in the treatment of ductal carcinoma of the parotid gland. BMC Cancer 2012;14:70110.1186/1471-2407-14-701CrossRefGoogle Scholar
Liu, Y. Chronic sialadenitis with marked lymphadenopathy mimicking lymphoma on FDG PET/CT. Clin Nucl Med 2014;39:738–910.1097/RLU.0000000000000473CrossRefGoogle ScholarPubMed
Bothe, C, Fernandez, A, Garcia, J, Lopez, M, León, X, Quer, M et al. Parotid incidentaloma identified by positron emission/computed tomography: when to consider diagnoses other than Warthin tumor. Int Arch Otorhinolaryngol 2015;19:112–15Google ScholarPubMed
Seo, YL, Yoon, DY, Baek, S, Lim, KJ, Yun, EJ, Cho, YK et al. Incidental focal FDG uptake in the parotid glands on PET/CT in patients with head and neck malignancy. Eur Radiol 2015;25:171–710.1007/s00330-014-3397-1CrossRefGoogle ScholarPubMed
Makis, W, McCann, K, McEwan, AJB. Incidental acinic cell carcinoma of the parotid gland discordant on 123I-MIBG, 111In-octreotide and 18F-FDG PET/CT in a patient with neuroendocrine tumor of the cecum. Clin Nucl Med 2015;40:676–810.1097/RLU.0000000000000716CrossRefGoogle Scholar
Mabray, MC, Behr, SC, Naeger, DM, Flavell, RR, Glastonbury, CM. Predictors of pathologic outcome of focal FDG uptake in the parotid gland identified on whole-body FDG PET imaging. Clin Imaging 2015;39:1073–910.1016/j.clinimag.2015.07.005CrossRefGoogle ScholarPubMed
Romero, M, González-Fontal, GR, Duarte, M, Saavedra, C, Henao-Martínez, AF. Small clonal B-cell population in the bone marrow as a possible tool in the diagnosis of occult primary parotid lymphoma. Colomb Med (Cali) 2016;47:59–62CrossRefGoogle Scholar
Makis, W, Ciarallo, A, Gotra, A. Clinical significance of parotid gland incidentalomas on 18F-FDG PET/CT. Clin Imaging 2015;39:667–71CrossRefGoogle Scholar
Kong, E, Chun, K, Cho, I. Incidentally detected carcinoma ex pleomorphic adenoma of parotid gland by F-18 FDG PET/CT. Nucl Med Mol Imaging 2016;50:95–710.1007/s13139-015-0346-0CrossRefGoogle ScholarPubMed
Conrad, F, Winkens, T, Kaatz, M, Goetze, S, Freesmeyer, M. Retrospective chart analysis of incidental findings detected by 18F-fluorodeoxyglucose-PET/CT in patients with cutaneous malignant melanoma. J Dtsch Dermatol Ges 2016;14:807–16Google Scholar
Aksoy, SY, Özdemir, E, Sentürk, A, Türkölmez, S. A case of sarcoidosis diagnosed by positron emission tomography/computed tomography. Indian J Nucl Med 2016;31:198–200CrossRefGoogle ScholarPubMed
Takashi, Y, Kinoshita, Y, Ito, N, Taguchi, M, Takahashi, M, Egami, N et al. Tumor-induced osteomalacia caused by a parotid tumor. Intern Med 2017;56:535–9CrossRefGoogle ScholarPubMed
He, Q, Xu, Z, Zhang, B, Hu, W, Zhang, X. Tumor-induced osteomalacia caused by a parotid basal cell adenoma detected by 68Ga-DOTANOC PET/CT. Clin Nucl Med 2018;43:e198–9CrossRefGoogle ScholarPubMed
Laurens, ST, Netea-Maier, RT, Aarntzen, EJHG. 68Ga-DOTA-TOC uptake in pleomorphic adenoma. Clin Nucl Med 2018;43:524–510.1097/RLU.0000000000002133CrossRefGoogle ScholarPubMed
Kiyohara, T, Nakamaru, S, Miyamoto, M, Shijimaya, T, Nagano, N, Makimura, K et al. Indeterminate dendritic cell neoplasm accompanied by eosinophilic pneumonia successfully treated by systemic steroid therapy: report of the first case with muscular and parotid involvement and review of published work. J Dermatol 2018;45:1444–7CrossRefGoogle ScholarPubMed
Barbara, R-R, Pawaroo, D, Beadsmoore, C, Hujairi, N, Newman, D. Parotid incidentalomas on positron emission tomography: what is their clinical significance? Nucl Med Commun 2019;40:264–910.1097/MNM.0000000000000961CrossRefGoogle ScholarPubMed
Üstün, F, Taştekin, E, Taş, A, Altun, GD. The clinical significance of incidental parotid uptake in a PET/CT study: a diagnostic algorithm. Curr Med Imaging Rev 2019;15:326–3310.2174/1573405614666171213160244CrossRefGoogle Scholar
Bitar, R, Martiniova, L, Bell, D, Ravizzini, G. Incidental 18F-Fluciclovine uptake in a Warthin tumor of the parotid gland in a patient undergoing PET/CT imaging for biochemical recurrent prostate cancer. Clin Nucl Med 2020;45:e208–10CrossRefGoogle Scholar
Wang, G, Lau, EW, Shakher, R, Rischin, D, Ware, RE, Hong, E et al. How do oncologists deal with incidental abnormalities on whole-body fluorine-18 fluorodeoxyglucose PET/CT? Cancer 2007;109:117–24CrossRefGoogle ScholarPubMed
Sone, Y, Sobajima, A, Kawachi, T, Kohara, S, Kato, K, Naganawa, S. Ability of 18-fludeoxyglucose positron emission tomography/CT to detect incidental cancer. Br J Radiol 2014;87:20140030CrossRefGoogle ScholarPubMed
Treglia, G, Bertagna, F, Sadeghi, R, Muoio, B, Giovanella, L. Prevalence and risk of malignancy of focal incidental uptake detected by fluorine-18-fluorodeoxyglucose positron emission tomography in the parotid gland: a meta-analysis. Eur Arch Otorhinolaryngol 2015;272:3617–2610.1007/s00405-014-3308-8CrossRefGoogle ScholarPubMed
Thielker, J, Grosheva, M, Ihrler, S, Wittig, A, Guntinas-Lichius, O. Contemporary management of benign and malignant parotid tumors. Front Surg 2018;5:39CrossRefGoogle ScholarPubMed
Luers, JC, Guntinas-Lichius, O, Klussmann, JP, Küsgen, C, Beutner, D, Grosheva, M. The incidence of Warthin tumours and pleomorphic adenomas in the parotid gland over a 25-year period. Clin Otolaryngol 2016;41:793–7CrossRefGoogle Scholar
Kotwall, CA. Smoking as an etiologic factor in the development of Warthin's tumor of the parotid gland. Am J Surg 1992;164:646–7CrossRefGoogle ScholarPubMed
Eneroth, CM. Salivary gland tumors in the parotid gland, submandibular gland and the palate region. Cancer 1971;27:1415–1810.1002/1097-0142(197106)27:6<1415::AID-CNCR2820270622>3.0.CO;2-X3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Bradley, PJ, McGurk, M. Incidence of salivary gland neoplasms in a defined UK population. Br J Oral Maxillofac Surg 2013;51:399–403CrossRefGoogle Scholar
Pinkston, JA, Cole, P. Incidence rates of salivary gland tumors: results from a population-based study. Otolaryngol Head Neck Surg 1999;120:834–4010.1016/S0194-5998(99)70323-2CrossRefGoogle ScholarPubMed
Britt, CJ, Stein, AP, Patel, PN, Harari, PM, Hartig, GK. Incidental parotid neoplasms: pathology and prevalence. Otolaryngology Head Neck Surg 2015;153:566–810.1177/0194599815586764CrossRefGoogle ScholarPubMed
Eneroth, CM. Facial nerve paralysis. A criterion of malignancy in parotid tumors. Arch Otolaryngol 1972;95:300–410.1001/archotol.1972.00770080494002CrossRefGoogle ScholarPubMed
Eveson, JW, Cawson, RA. Salivary gland tumors. A review of 2410 cases with particular reference to histological types, site, age and sex distribution. J Pathol 1985;146:51–8CrossRefGoogle ScholarPubMed
Son, E, Panwar, A, Mosher, CH, Lydiatt, D. Cancers of the major salivary glands. J Oncol Pract 2018;14:99–10810.1200/JOP.2017.026856CrossRefGoogle Scholar
Howlett, DC, Menezes, LJ, Lewis, K, Moody, AB, Violaris, N, Williams, MD. Sonographically guided core biopsy of a parotid mass. AJR Am J Roentgenol 2007;188:223–710.2214/AJR.05.1549CrossRefGoogle ScholarPubMed
Kim, HJ, Kim, JS. Ultrasound-guided core needle biopsy in salivary glands: a meta-analysis. Laryngoscope 2018;128:118–2510.1002/lary.26764CrossRefGoogle ScholarPubMed
Haldar, S, Sinnott, JD, Tekeli, KM, Turner, SS, Howlett, DC. Biopsy of parotid masses: review of current techniques. World J Radiol 2016;8:501–510.4329/wjr.v8.i5.501CrossRefGoogle ScholarPubMed