The Diagnostic Value of B-Mode Sonography in Differentiation of Malignant and Benign Tumors of the Parotid Gland

Document Type: Original


1 Department of Otorhinolaryngology, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran.


Different imaging modalities are used to evaluate salivary gland diseases, including tumors. Ultrasonography (US) is the preferred method on account of its ease of use, affordability, safety profile, and good tolerance among patients. The aim of this study was to evaluate the role of US in differentiating malignant from benign parotid tumors, in the context of previous controversy in the literature on this subject.
Materials and Methods:
A cross-sectional study was performed in patients who presented to Qaem Medical Center with parotid masses and who were candidates for parotidectomy between June 2013 and January 2015. Patients were initially referred for a diagnostic US of the parotid. US examinations were performed and sonographic features were reported. The tumors were then classified as benign or malignant on the basis of literature descriptions of the US features of parotid tumors, and were next diagnosed pathologically. The sensitivity, specificity, positive predictive value, and negative predictive value of US for the purpose of differentiating malignant from benign tumors were then calculated.
Twenty-eight patients (aged 18–92 years) underwent US of parotid masses. Twenty-three tumors were diagnosed as benign and five were diagnosed as malignant. The final histopathologic examination showed 21 benign and seven malignant tumors. The sensitivity, specificity, positive predictive value, and negative predictive value of US for differentiating malignant from benign tumors were calculated as 57%, 95%, 80%, and 87%, respectively.
US has a high specificity in differentiating between malignant and benign tumors. However, fine needle aspiration or core needle biopsy is advocated for an exact diagnosis.


Main Subjects

1. Rabinov JD. Imaging of salivary gland pathology. RadiolClin North Am 2000; 38:1047–57.

2.Yousem DM, Kraut MA, Chalian AA. Major salivary gland imaging. Radiology 2000; 216: 19–29.

3. Silvers AR, Som PM. Salivary glands. RadiolClin North Am 1998;36: 941–66.

4.  Bryan R, Miller R, Ferreyro R, and Sessions R. Computed tomography of the major salivary glands. Am J Roentgenol 1982; 139:547–54.

5.Alyas F, Lewis K, Williams M, et al. Diseases of the submandibular gland as demonstrated using high resolution ultrasound. Br J Radiol 2005; 78:362–9.

6. Ridder GJ, Richter B, Disko U, Sander A. Gray-scale sonographic evaluation of cervical lymphadenopathy in cat-scratch disease. J Clin Ultrasound 2001; 29:140–5.

7. Ying M, Ahuja A, Metreweli C. Diagnostic accuracy of sonographic criteria for evaluation of cervical lymphadenopathy. J Ultrasound Med 1998; 17: 437–45.

8. Ying M, Ahuja A. Sonography of neck lymph nodes. I. Normal lymph nodes. ClinRadiol 2003; 58: 351–8.

9. Katz P. New applications of echography in maxillo-facial pathology. Inf Dent 1990;72:2593–8.

10. Wittich GR, Scheible WF, Hajek PC. Ultrasonography of the salivary glands. RadiolClin North Am 1985; 23:29–37.

11. Rinast E, Gmelin E, Hollands-Thorn B. Digital subtraction sialography, conventional sialography, high-resolution ultrasonography and computed tomography in the diagnosis of salivary gland diseases. Eur J Radiol 1989; 9: 224–30.

12. Akin I, Esmer N, Gerceker M, Aytac S, Erden I, Akan H. Sialographic and ultrasonographic analyses of major salivary glands. ActaOtolaryngolStockh 1991; 111:600–6.

13. Cvetinovic M, Jovic N, Mijatovic D. Evaluation of ultrasound in the diagnosis of pathologic processes in the parotid gland. J Oral MaxillofacSurg 1991;49:

14. Gritzmann N. Sonography of the extrathyroidal cervical soft tissues, the salivary glands and floor of the mouth. Eur J Ultrasound 1994;1:9–21.

15. Sriskandan N, Hannah A, Howlett DC. A study to evaluate the accuracy of ultrasound in the diagnosis of parotid lumps and to review the sonographic features of parotid lesions- results in 220 patients. ClinRadiol 2010; 65: 366–72.

16. Raja V, China C, Masaki KH, Nakano G. Unusual presentations of uncommon tumors: case 1. Benign metastasizing pleomorphic adenoma. J ClinOncol 2002; 20: 2400–3.

17. Zajkowski P, Jakubowski W, Białek EJ, Wysocki M, Osmólski A, Serafin-Król M. Pleomorphic adenoma and adenolymphoma in ultrasonography. Eur J Ultrasound 2000;12:23–2.

18.Yasumoto M, Yoshimura R, Sunaba K, Shibuya H. Sonographic appearances of malignant lymphoma of the salivary glands. J Clin Ultrasound 2001; 29: 491–8.

19. Ballerini G, Mantero M, Sbrocca M. Ultrasonic pattern of parotid masses. J Clin Ultrasound 1984; 12: 273–7.

20. Bialek EJ, Jakubowski W, Karpinska G. Role of ultrasonography in diagnosis and differentiation of pleomorphic adenomas: work in progress. Arch Otolaryngol Head Neck Surg 2003; 129:929–33.

21. Schick S, Steiner E, Gahleitner A, Böhm P, Helbich T, Ba-Ssalamah A et al. Differentiation of benign and malignant tumors of the parotid gland: value of pulsed Doppler and color Doppler sonography. EurRadiol 1998;8:1462–7.

22. Shimizu M, Ussmüller J, Hartwein J, Donath K, Kinukawa N. Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 1999;88:226–33.

23. Shimizu M, Ussmüller J, Donath K, Yoshiura K, Ban S, Kanda S et al.Sonographic analysis of recurrent parotitis in children: a comparative study with sialographic findings. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 1998;86: 606–15.

24. ZajkowskiP, Jakubowski W, Bialek EJ, Wysocki M, Osmólski A, Serafin-Król M. Pleomorphic adenoma and adenolymphoma in ultrasonography. Eur J Ultrasound2000;12:23–9.

25.Yu GY, Ma DQ, Zhang Y, g X, Cai ZG, Gao Y et al. Multiple primary tumours of the parotid gland. Int J Oral MaxillofacSurg 2004;33:531–534.

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

27. Wong KT, Ahuja AT, King AD, Yuen EH, Yu SC. Vascular lesions of parotid gland in adult patients: diagnosis with high-resolution ultrasound and MRI. Br J Radiol2004; 77: 600–6.

28.Gritzmann N, Rettenbacher T, Hollerweger A, Macheiner P, Hubner E. Sonography of the salivary glands. EurRadiol2003; 13:964–75.

29. ChikuiT, Yonetsu K, Yoshiura K. Imaging findings of lipomas in the orofacial region with CT, US, and MRI. Oral Surg Oral Med Oral Pathol Oral RadiolEndod1997;84:88–95.

30. Joe VQ, Westessan PL. Tumors of the parotid gland: MR imaging characteristics of various histological types. Am J Roentgenol 1994;163:433–8.

31. Bradley MJ, Durham LH, Lancer JM. The role of colour flow Doppler in the investigation of salivary gland tumor. ClinRadiol 2000;55:759–62.

32. Howlet DC. High resolution ultrasound assessment of the parotid gland. BJR 2003;76:271–7.

33. Ahuja AT, Ying M, Yuen HY, Metreweli C. “Pseudocystic” appearance of non-Hodgkin’s lymphomatous nodes: an “infrequent” finding with high-resolution transducers. ClinRadiol 2001; 6:

34. Lin CC, Tsai MH, Huang CC, Hua CH, Tseng HC, Huang ST. Parotid tumors: a 10-year experience. Am J Otolaryngol 2008;29:94–100.

35. Takahama A, Jr, Almeida OP, Kowalski LP. Parotid neoplasms: analysis of 600 patients attended at a single institution. Braz J Otorhinolaryngol 2009; 75: 497–501.

36. Shimizu M, Ussmuller J, Hartwein J, Donath K. A comparative study of sonographic and histopathologic findings of tumorous lesions in the parotid gland. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 1999; 88:723–37.

37. Ellis GL, Auclair PL. Ductal papillomas. In: Ellis GL, Auclair PL, Gnepp DR, editors. Surgical pathology of the salivary glands. Philadelphia: W.B. Saunders; 1991; 238–52.

38. Soofer SB, Tabbara S. Intraductal papilloma of the salivary gland. A report of two cases with diagnosis by fine needle aspiration biopsy. ActaCytologica 1999; 43: 1142–6.

39.Bialek EJ, Jakubowski W, Zajkowski P , Kazimierz T. US of the Major Salivary Glands: Anatomy and Spatial Relationships, Pathologic Conditions, and Pitfalls. Radiographics2006; 26:

 40. Howlett DC, Kesse KW, Hughes DV, Sallomi DF. The role of imaging in the evaluation of parotid disease. ClinRadiol2002; 57:692–701.

41. Bradley MJ. Salivary glands. In: Ahuja AT, Evans RM, eds. Practical head and neck ultrasound. London, England: Greenwich Medical Media, 2000;19–33.

42. Miwa K, Yuasa K, Yonetsu K, Kanda S, Higuchi K, Shinohara M, Higuchi K, Kanda S, Yonetsu K, Yuasa K, Miwa K. Diagnostic accuracy of ultrasonography for salivary gland tumors.Journal of the Japanese Stomatological society 1995;44:240-244

43. Solbiati L, Osti V, Cova L. The neck. In: Meire H, Cosgrove D, Dewbury K, Farant P. Abdominal and General Ultrasound. 2nd ed. London, UK: Churchill Livingstone; 2001:719–24.