Parotid incidentalomas detected by 18F-FDG PET/TC. Review and Meta-analysis
Abstract Introduction and objective: Parotid incidentalomas detected by whole body 18F-FDG PET/CT are defined as an incidental and unforeseen hypermetabolic focus present in the parotid gland, performed for any other reason, in the absence of known parotid lesion. The main objective was to determine the prevalence of parotid incidentalomas in whole body 18F-FDG PET/CT scans performed for any other reason, excluding primary parotid tumors. Method: A systematic review in the databases Pubmed, WOS, EMBASE, as well as other data sources, of retrospective studies that included series of patients in whom 18F-FDG PET/CT had been performed by any other reason and presented incidental parotid uptake. A descriptive study of the variables collected from the sample was carried out. Meta-analysis was performed to assess the prevalence of parotid uptake in the entire sample. Results: 20 articles met inclusion criteria and were selected for qualitative study; of which 19 were quantitatively studied. Studies add up to a total of 151603 patients, who underwent 154441 18F-FDG PET/CT scans. 859 patients (0,57% of the patients, CI 95% 0.53, 0.61%) showed at least one incidental parotid uptake. Among these 859 initial patients, 537 were studied, in who 560 18F-FDG parotid uptakes were detected (0,36% of the imaging techniques, CI 95% 0.34, 0.39%); the remaining patients were not studied due to different reasons. Regarding the distribution of the uptakes, unique focal uptakes (82,.7%, CI 95% 79.3, 85.6%) and unilateral uptakes (93,6%, CI 95% 91.2, 95.3%) were more frequent. Most of pathological studies turned out to be benign (50,4%, CI 95% 46.2, 54.5%). According to this study, mean SUVmax value is useless to distinguish between malignant and benign or non-tumor uptakes. According to the meta-analysis, prevalence of patients with at least one incidental uptake with respect to the total of 18F-FDG PET/CT scans performed is 0,96% (CI 95%, 0.005, 0.014%). Conclusions: Prevalence of parotid incidentalomas in whole body 18F-FDG PET/CT scans performed for any other reason, excluding primary parotid tumors, is 0.96%.
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Ladrón de Guevara D, Munizaga C, Garcia N, Letelier C, Wash AF. Frecuencia de malignidad en incidentalomas tiroideos detectados con tomografía por emisión de positrones/ tomografía computada (PET/CT) con F18-FDG de cuerpo entero. Rev Med Chile. 2020;148:10–6.
Nakamoto Y, Tatsumi M, Hammoud D, Cohade C, Osman MM, Wahl RL. Normal FDG Distribution Patterns in the Head and Neck: PET/CT Evaluation. Radiology. 2005;234(3):879.
Hernández Muñiz S, Mitjavila Casanovas M. Introducción a la tomografía computarizada. Rev Esp Med Nucl. 2006;25:206–14.
Ishimori T, Patel PV, Wahl RL. Detection of Unexpected Additional Primary Malignancies with PET/CT. Nucl Med. 2001;46(5):752–7.
Gorospe Sarasúa L, Echeveste Aizpurúa J, Raman S. Tomografía por emisión de positrones/ tomografía computarizada: artefactos y pitfalls en pacientes con cáncer. Radiologia (Panama). 2006;48(4):189–204.
Britt CJ, Maas AM, Kennedy TA, Hartig GK. Incidental Findings on FDG PET/CT in Head and Neck Cancer. Otolaryngol Head Neck Surg. 2018;158(3):484–8.
García Garzón JR, Rodriguez A, Cabrera A. Tomografía por emisión de positrones de cuerpo completo (PET/TAC) con 18F-fluorodesoxiglucosa. Rev Esp Med Nucl. 2009;28(2):85–9.
Tamayo P, Martin A, Diaz L, Cabrero M, Garcia R, García-Talavera P. 18F- FDG PET/CT in the clinical management of patients with lymphoma. Rev Esp Med Nucl Imagen Mol. 2017;36:312–21.
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Pencharz D, Nathan M, Wagner T. Evidence-based management of incidental focal uptake of fluorodeoxyglucose on PET/CT. Br J Radiol. 2018;91(1084):20170774.
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 Sep 28;272(12):3617–26.
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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 Nov;39(6):1073–9.
Roland A, Drouet C, Boulahdour H, Cochet A, de Bari B. Unusual uptakes on 18F-fluorocholine positron emission tomography/computed tomography (PET/CT): a retrospective study of 368 prostate cancer patients referred for a biochemical recurrence or an initial staging. Quant imaging Med Surg. 2021 Jan 1;11(1):172–82.
Wang HC, Zuo CT, Hua FC, Huang ZM, Tan HB, Zhao J, et al. Efficacy of conventional whole-body 18F-FDG PET/CT in the incidental findings of parotid masses. Ann Nucl Med. 2010 Oct;24(8):571–7.
Lee S, Rho B, Won K. 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 Radiolog. 2009 Apr 25;19(9):2268–74.
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. 2014;131(4):217–21.
Makis W, Ciarallo A, Gotra A. Clinical significance of parotid gland incidentalomas on 18F-FDG PET/CT. Clinic Imaging. 2015 Jul 1;39(4):667–71.
Barbara RR, Pawaroo D, Beadsmoore C, Hujairi N, Newman D. Parotid incidentalomas on positron emission tomography: What is their clinical significance? Nucl Med Comm. 2019 Mar 1;40(3):264–9.
Basu S, Houseni M, Alavi A. Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Comm. 2008;29(4):367–73.
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. JDDG. 2016 Aug 1;14(8):807–16.
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 Jul;85(1015):229–37.
Davidson T, Komissar O, Goshen E, Shalmon B, Chikman B, Ben-Nun A, et al. Focal fluorine-18 fluorodeoxyglucose-avid parotid findings in patients with lung cancer: Prevalence and characteristics. Nucl Med Comm. 2016 Jul 26;37(9):969–74.
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 Jun 18;19(2):112–5.
Kim BS, Kim SJ, Pak K. Diagnostic value of metabolic heterogeneity as a reliable parameter for differentiating malignant parotid gland tumors. Ann Nucl Med. 2016 Jun 1;30(5):346–54.
Homo-Seban M, Sliman H, Harache B, Boucheneb S, Ghazzar-Pierquet N, Weinmann P, et al. Focal incidental uptake detected by 18F-FDG-PET- TDM in the parotid gland: Prevalence, diagnostic and impact on patient management. Fr Med Nucl. 2018;42:432–8.
Goethals I, Kiendys U, Ham, Bauters W, van den Broecke C, Deron P. F- 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)-positive parotid incidentaloma: Prevalence and clinical significance. Rep Medical Imaging. 2009 Jan;2:1–6.
Park S bin, Choi JY, Lee EJ, Yoo J, Cheon M, Cho SK, et al. Diagnostic Criteria on 18F-FDG PET/CT for Differentiating Benign from Malignant Focal Hypermetabolic Lesions of Parotid Gland. Nucl Med Mol Imaging. 2012 Jun;46(2):95–101.
Sebro R, Aparici CM, Pampaloni MH. Frequency and clinical implications of incidental new primary cancers detected on true whole-body 18F-FDG PET/CT studies. Nucl Med Commun. 2013 Apr;34(4):333–9.
Moon PK, Tusty M, Megwalu UC. Parotid gland incidentalomas: A single- institution experience. Am J Otolaryngol. 2022 Mar 1;43(2):103296.
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? Fr J Otolaryngol. 2011 Oct 1;40(5):384–90.
Ladrón de Guevara D, Munizaga C, Garcia N, Letelier C, Wash AF. Frecuencia de malignidad en incidentalomas tiroideos detectados con tomografía por emisión de positrones/ tomografía computada (PET/CT) con F18-FDG de cuerpo entero. Rev Med Chile. 2020;148:10–6.
Nakamoto Y, Tatsumi M, Hammoud D, Cohade C, Osman MM, Wahl RL. Normal FDG Distribution Patterns in the Head and Neck: PET/CT Evaluation. Radiology. 2005;234(3):879.
Hernández Muñiz S, Mitjavila Casanovas M. Introducción a la tomografía computarizada. Rev Esp Med Nucl. 2006;25:206–14.
Ishimori T, Patel PV, Wahl RL. Detection of Unexpected Additional Primary Malignancies with PET/CT. Nucl Med. 2001;46(5):752–7.
Gorospe Sarasúa L, Echeveste Aizpurúa J, Raman S. Tomografía por emisión de positrones/ tomografía computarizada: artefactos y pitfalls en pacientes con cáncer. Radiologia (Panama). 2006;48(4):189–204.
Britt CJ, Maas AM, Kennedy TA, Hartig GK. Incidental Findings on FDG PET/CT in Head and Neck Cancer. Otolaryngol Head Neck Surg. 2018;158(3):484–8.
García Garzón JR, Rodriguez A, Cabrera A. Tomografía por emisión de positrones de cuerpo completo (PET/TAC) con 18F-fluorodesoxiglucosa. Rev Esp Med Nucl. 2009;28(2):85–9.
Tamayo P, Martin A, Diaz L, Cabrero M, Garcia R, García-Talavera P. 18F- FDG PET/CT in the clinical management of patients with lymphoma. Rev Esp Med Nucl Imagen Mol. 2017;36:312–21.
O’Sullivan J, Muntinga T, Grigg S, Ioannidis J. Prevalence and outcomes of incidental imaging findings: umbrella review. BMJ. 2018;361.
Bialek E, Lim A, Dong Y, Fodor D, Gritzmann N, Dietrich C, et al. WFUMB position paper. Incidental findings of the salivary glands. Med Ultrason. 2021;23(3):329–38.
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(3):170–6.
Zheng D, Niu L, Liu W, Zheng C, Yan R, Gong L, et al. Correlation analysis between the SUVmax of FDG-PET/CT and clinicopathological characteristics in oral squamous cell carcinoma. Dentomaxillofac Radiol. 2019;48(5):20180416.
Pencharz D, Nathan M, Wagner T. Evidence-based management of incidental focal uptake of fluorodeoxyglucose on PET/CT. Br J Radiol. 2018;91(1084):20170774.
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 Sep 28;272(12):3617–26.
Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Plos Med. 2021;18(3):1–15.
Seo YL, Y oon DY , Baek S, Lim KJ, Y un 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 Jan 1;25(1):171–7.
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 Nov;39(6):1073–9.
Roland A, Drouet C, Boulahdour H, Cochet A, de Bari B. Unusual uptakes on 18F-fluorocholine positron emission tomography/computed tomography (PET/CT): a retrospective study of 368 prostate cancer patients referred for a biochemical recurrence or an initial staging. Quant imaging Med Surg. 2021 Jan 1;11(1):172–82.
Wang HC, Zuo CT, Hua FC, Huang ZM, Tan HB, Zhao J, et al. Efficacy of conventional whole-body 18F-FDG PET/CT in the incidental findings of parotid masses. Ann Nucl Med. 2010 Oct;24(8):571–7.
Lee S, Rho B, Won K. 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 Radiolog. 2009 Apr 25;19(9):2268–74.
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. 2014;131(4):217–21.
Makis W, Ciarallo A, Gotra A. Clinical significance of parotid gland incidentalomas on 18F-FDG PET/CT. Clinic Imaging. 2015 Jul 1;39(4):667–71.
Barbara RR, Pawaroo D, Beadsmoore C, Hujairi N, Newman D. Parotid incidentalomas on positron emission tomography: What is their clinical significance? Nucl Med Comm. 2019 Mar 1;40(3):264–9.
Basu S, Houseni M, Alavi A. Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Comm. 2008;29(4):367–73.
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. JDDG. 2016 Aug 1;14(8):807–16.
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 Jul;85(1015):229–37.
Davidson T, Komissar O, Goshen E, Shalmon B, Chikman B, Ben-Nun A, et al. Focal fluorine-18 fluorodeoxyglucose-avid parotid findings in patients with lung cancer: Prevalence and characteristics. Nucl Med Comm. 2016 Jul 26;37(9):969–74.
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 Jun 18;19(2):112–5.
Kim BS, Kim SJ, Pak K. Diagnostic value of metabolic heterogeneity as a reliable parameter for differentiating malignant parotid gland tumors. Ann Nucl Med. 2016 Jun 1;30(5):346–54.
Homo-Seban M, Sliman H, Harache B, Boucheneb S, Ghazzar-Pierquet N, Weinmann P, et al. Focal incidental uptake detected by 18F-FDG-PET- TDM in the parotid gland: Prevalence, diagnostic and impact on patient management. Fr Med Nucl. 2018;42:432–8.
Goethals I, Kiendys U, Ham, Bauters W, van den Broecke C, Deron P. F- 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)-positive parotid incidentaloma: Prevalence and clinical significance. Rep Medical Imaging. 2009 Jan;2:1–6.
Park S bin, Choi JY, Lee EJ, Yoo J, Cheon M, Cho SK, et al. Diagnostic Criteria on 18F-FDG PET/CT for Differentiating Benign from Malignant Focal Hypermetabolic Lesions of Parotid Gland. Nucl Med Mol Imaging. 2012 Jun;46(2):95–101.
Sebro R, Aparici CM, Pampaloni MH. Frequency and clinical implications of incidental new primary cancers detected on true whole-body 18F-FDG PET/CT studies. Nucl Med Commun. 2013 Apr;34(4):333–9.
Moon PK, Tusty M, Megwalu UC. Parotid gland incidentalomas: A single- institution experience. Am J Otolaryngol. 2022 Mar 1;43(2):103296.
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? Fr J Otolaryngol. 2011 Oct 1;40(5):384–90.
Melgar-Martín, S., José Luis, & María Pilar. (2023). Parotid incidentalomas detected by 18F-FDG PET/TC. Review and Meta-analysis. Revista ORL, 14(3), e29558. https://doi.org/10.14201/orl.29558
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