Abstract
This study aimed at performing a meta-analysis on the prevalence and risk of malignancy of focal parotid incidental uptake (FPIU) detected by hybrid fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) or 18F-FDG PET alone. A comprehensive literature search of studies published up to July 2014 was performed. Records reporting at least 5 FPIUs were selected. Pooled prevalence and malignancy risk of FPIU were calculated including 95 % confidence intervals (95 % CI). Twelve records were selected for our meta-analysis. Pooled prevalence of FPIU detected by 18F-FDG PET or PET/CT was 0.6 % (95 % CI 0.4–0.7 %), collecting data of 220 patients with FPIU. Overall, 181 FPIUs underwent further evaluation and 165 FPIUs were pathologically proven. Pooled risk of malignancy was 9.6 % (95 % CI 5.4–14.8 %), 10.9 % (95 % CI 5.8–17.3 %) and 20.4 % (95 % CI 12.3–30 %), considering all FPIUs detected, only those which underwent further evaluation and only those pathologically proven, respectively. Selection bias in the included studies, the heterogeneity among studies and the publication bias are limitations of our meta-analysis. Overall FPIUs are observed in about 1 % of 18F-FDG PET or PET/CT scans and they are benign in most of the cases. Nevertheless, further evaluation is needed whenever FPIUs are detected by 18F-FDG-PET or PET/CT to exclude malignant lesions or with possible malignant degeneration. Prospective studies are needed to confirm the findings reported by our meta-analysis.
Similar content being viewed by others
References
Lee YYP, Wong KT, King AD, Ahuja AT (2008) Imaging of salivary gland tumours. Eur J Radiol 66:419–436
Burke CJ, Thomas RH, Howlett D (2011) Imaging the major salivary glands. Br J Oral Maxillofac Surg 49:261–269
Friedman ER, Saindane AM (2013) Pitfalls in the staging of cancer of the major salivary gland neoplasms. Neuroimaging Clin N Am 23:107–122
Lee SK, Rho BH, Won KS (2009) 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
Wang HC, Zuo CT, Hua FC et al (2010) Efficacy of conventional whole-body 18F-FDG PET/CT in the incidental findings of parotid masses. Ann Nucl Med 24:571–577
Treglia G, Cason E, Fagioli G (2010) Recent applications of nuclear medicine in diagnostics (first part). Ital J Med 4:84–91
Park HL, IeR Yoo, Lee N et al (2013) The value of F-18 FDG PET for planning treatment and detecting recurrence in malignant salivary gland tumors: comparison with conventional imaging studies. Nucl Med Mol Imaging 47:242–248
Sharma P, Jain TK, Singh H et al (2013) Utility of (18)F-FDG PET-CT in staging and restaging of patients with malignant salivary gland tumours: a single-institutional experience. Nucl Med Commun 34:211–219
Kim MJ, Kim JS, Roh JL et al (2013) Utility of 18F-FDG PET/CT for detecting neck metastasis in patients with salivary gland carcinomas: preoperative planning for necessity and extent of neck dissection. Ann Surg Oncol 20:899–905
Kim JY, Lee SW, Kim JS et al (2012) Diagnostic value of neck node status using 18F-FDG PET for salivary duct carcinoma of the major salivary glands. J Nucl Med 53:881–886
Kawabe J, Higashiyama S, Yoshida A, Kotani K, Shiomi S (2012) The role of FDG PET-CT in the therapeutic evaluation for HNSCC patients. Jpn J Radiol 30:463–470
Razfar A, Heron DE, Branstetter BF 4th, Seethala RR, Ferris RL (2010) Positron emission tomography-computed tomography adds to the management of salivary gland malignancies. Laryngoscope 120:734–738
Jeong HS, Chung MK, Son YI et al (2007) Role of 18F-FDG PET/CT in management of high-grade salivary gland malignancies. J Nucl Med 48:1237–1244
Cermik TF, Mavi A, Acikgoz G, Houseni M, Dadparvar S, Alavi A (2007) FDG PET in detecting primary and recurrent malignant salivary gland tumors. Clin Nucl Med 32:286–291
Basu S, Mahne A, Iruvuri S, Alavi A (2007) Potential clinical role of fluorodeoxyglucose-positron emission tomography in assessing primary or secondary lymphomas of the parotid gland. Clin Lymphoma Myeloma 7:309–314
Roh JL, Ryu CH, Choi SH et al (2007) Clinical utility of 18F-FDG PET for patients with salivary gland malignancies. J Nucl Med 48:240–246
Otsuka H, Graham MM, Kogame M, Nishitani H (2005) The impact of FDG-PET in the management of patients with salivary gland malignancy. Ann Nucl Med 19:691–694
Liu Y, Ghesani NV, Zuckier LS (2010) Physiology and pathophysiology of incidental findings detected on FDG-PET scintigraphy. Semin Nucl Med 40:294–315
Nakamoto Y, Tatsumi M, Hammoud D, Cohade C, Osman MM, Wahl RL (2005) Normal FDG distribution patterns in the head and neck: PET/CT evaluation. Radiology 234:879–885
Nakamura S, Okochi K, Murata Y, Shibuya H, Kurabayashi T (2009) [18F]Fluorodeoxyglucose-PET/CT differentiation between physiological and pathological accumulations in head and neck. Nucl Med Commun 30:498–503
Stahl A, Dzewas B, Schwaiger M, Weber WA (2002) Excretion of FDG into saliva and its significance for PET imaging. Nuklearmedizin 41:214–216
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
Egger M, Smith GD, Phillips AN (1997) Meta-analysis: principles and procedures. BMJ 315:1533–1537
Lim I, Lee WW, Chung JH et al (2007) Incidental benign parotid lesions on FDG-PET: prevalence and clinico-pathologic findings. Nucl Med Mol Imaging 47:359–363
Kiendys U, Ham H, Bauters W, Van den Broecke C, Deron P, Goethals I (2009) F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)-positive parotid incidentaloma: prevalence and clinical significance. Rep Med Imaging 2:1–6
Park SB, Choi JY, Lee EJ et al (2012) Diagnostic criteria on (18)F-FDG PET/CT for differentiating benign from malignant focal hypermetabolic lesions of parotid gland. Nucl Med Mol Imaging 46:95–101
Sebro R, Aparici CM, Pampaloni MH (2013) Frequency and clinical implications of incidental new primary cancers detected on true whole-body 18F-FDG PET/CT studies. Nucl Med Commun 34:333–339
Adams HL, Jaunoo SS (2014) Clinical significance of incidental findings on staging positron emission tomography for oesophagogastric malignancies. Ann R Coll Surg Engl 96:207–210
Gobel Y, Valette G, Abgral R et al (2014) Interpretation of suspect head and neck fixations seen on PET/CT in lung cancer. Eur Ann Otorhinolaryngol Head Neck Dis 131:217–221
Seo JH, Song BI, Lee KJ et al (2010) Significance of focal hypermetabolic lesions of the parotid gland on F-18 FDG PET/CT. J Nucl Med 51(Suppl 2):1236
Ciarallo A, Makis W, Gotra A, Hickeson M (2012) Significance of incidental parotid gland 18F-FDG uptake on PET/CT and its impact on patient management. J Nucl Med 53(Suppl 1):448
Soubeyran V, Duc C, Giger R, Kishore S, Constantin C, Kamel ME (2012) Prevalence and clinical significance of focal incidentally detected parotid lesions on FDG-PET/CT. Eur J Nucl Med Mol Imaging 39(Suppl 2):S202
Treglia G, Taralli S, Salsano M, Muoio B, Sadeghi R, Giovanella L (2014) Prevalence and malignancy risk of focal colorectal incidental uptake detected by (18)F-FDG-PET or PET/CT: a meta-analysis. Radiol Oncol 48:99–104
Bertagna F, Treglia G, Orlando E et al (2014) Prevalence and clinical significance of incidental F18-FDG breast uptake: a systematic review and meta-analysis. Jpn J Radiol 32:59–68
Treglia G, Bertagna F, Sadeghi R, Verburg FA, Ceriani L, Giovanella L (2013) Focal thyroid incidental uptake detected by 18F-fluorodeoxyglucose positron emission tomography. Meta-analysis on prevalence and malignancy risk. Nuklearmedizin 52:130–136
Bertagna F, Sadeghi R, Giovanella L, Treglia G (2014) Incidental uptake of 18F-fluorodeoxyglucose in the prostate gland. Systematic review and meta-analysis on prevalence and risk of malignancy. Nuklearmedizin. doi:10.3413/Nukmed-0668-14-05
Treglia G, Sadeghi R (2013) Meta-analyses and systematic reviews on PET and PET/CT in oncology: the state of the art. Clin Transl Imaging 1:73–75
Sreeja C, Shahela T, Aesha S, Satish MK (2014) Taxonomy of salivary gland neoplasm. J Clin Diagn Res 8:291–293
Carlson ER, Webb DE (2013) The diagnosis and management of parotid disease. Oral Maxillofac Surg Clin North Am 25:31–48
Keyes JW Jr, Harkness BA, Greven KM, Williams DW III, Watson NE Jr, McGuirt WF (1994) Salivary gland tumors: pretherapy evaluation with PET. Radiology 192:99–102
Mcguirt WF, Keyes JW Jr, Greven KM, Wiliams DW III, Watson NE Jr, Cappellari JO (1995) Preoperative identification of benign versus malignant parotid masses: a comparative study including positron emission tomography. Laryngoscope 105:579–584
Okamura T, Kawabe J, Koyama K et al (1998) Fluorine-18 fluorodeoxyglucose positron emission tomography imaging of parotid mass lesions. Acta Otolaryngol Suppl 538:209–213
Rubello D, Nanni C, Castellucci P et al (2005) Does 18F-FDG PET/CT play a role in the differential diagnosis of parotid masses. Panminerva Med 47:187–189
Uchida Y, Minoshima S, Kawata T et al (2005) Diagnostic value of FDG PET and salivary gland scintigraphy for parotid tumors. Clin Nucl Med 30:170–176
Ozawa N, Okamura T, Koyama K et al (2006) Retrospective review: usefulness of a number of imaging modalities including CT, MRI, technetium-99m pertechnetate scintigraphy, gallium-67 scintigraphy and F-18-FDG PET in the differentiation of benign from malignant parotid masses. Radiat Med 24:41–49
Toriihara A, Nakamura S, Kubota K, Makino T, Okochi K, Shibuya H (2013) Can dual-time-point 18F-FDG PET/CT differentiate malignant salivary gland tumors from benign tumors? AJR Am J Roentgenol 201:639–644
Hadiprodjo D, Ryan T, Truong MT, Mercier G, Subramaniam RM (2012) Parotid gland tumors: preliminary data for the value of FDG PET/CT diagnostic parameters. AJR Am J Roentgenol 198:W185–W190
Acknowledgments
No funding.
Conflict of interest
The authors declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Treglia, G., Bertagna, F., Sadeghi, R. et al. 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 272, 3617–3626 (2015). https://doi.org/10.1007/s00405-014-3308-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-014-3308-8