Abstract：Objective This study aims to investigate the value of conventional ultrasonography combined with shear wave elastography (SWE) in the diagnosis and differentiation of benign and malignant major salivary gland tumors. Methods This is a retrospective study. The clinical data of 69 (48 males and 21 females, 12-78 [54.3±9.6] years old) patients with major salivary gland tumors who underwent surgery in the First Affiliated Hospital of Bengbu Medical College from December 2019 to February 2022 were included. All patients received conventional ultrasonography and SWE examinations without any treatment before tumor surgery. Patients were divided into groups based on the results of surgical and pathological diagnosis as the gold standard: 41 and 28 cases in the benign and malignant groups, respectively, and 23 and 11 cases in the pleomorphic adenoma and Worthing's tumor groups, respectively. The elastic parameters of SWE between the benign and the malignant groups, and between the Worthing's tumor and the pleomorphic adenoma groups, i.e., the mean elasticity value (Emean), the maximum elasticity value (Emax), and the elastic data dispersion value in the sampling frame were compared (Esd). To analyze the coincidence rate between the results of conventional ultrasound and conventional ultrasound combined with SWE image diagnosis and the results of pathological diagnosis. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the efficacy of the two methods in diagnosing benign and malignant major salivary gland tumors. The ROC curve of each elastic SWE parameter was drawn, the AUC calculated, and its diagnostic performance was compared. Results The Emean, Emax, and Esd values of the benign group ([89.45±49.59] kPa, [120.58±57.59] kPa, and [15.91±11.57] kPa, respectively) were lower than those of the malignant group ([216.33±53.28] kPa, [252.68±56.42] kPa, and [30.49±13.31] kPa, respectively), and the differences were statistically significant (t=10.13, 9.43, and 4.83; all P values <0.001). The Emean, Emax, and Esd values of Worthing's tumor group ([37.46±21.57] kPa, [62.35±24.64] kPa, and [8.55±5.46] kPa, respectively), were also lower than those of the pleomorphic adenoma group ([108.51±28.46] kPa, [156.44±37.51] kPa, and [18.26±11.27] kPa, respectively), and the differences were statistically significant (t=7.31, 7.55, and 3.38; all P values <0.01). Forty-five (65.2%, 45/69) cases were consistent with the results of the conventional ultrasound diagnosis and pathology, including 18 and 27 malignant and benign cases, respectively. The diagnostic results of the conventional ultrasonography combined with SWE were consistent with the pathological results in 58 (84.1%, 58/69) cases, including 23 and 35 malignant and benign cases, respectively. The specificity, sensitivity, and accuracy of the two methods in diagnosing benign and malignant major salivary gland tumors were 65.9% and 64.3%, 65.2% and 85.4%, 82.1% and 84.1%, respectively, and the AUC was 0.651 and 0.838, respectively, and the differences were statistically significant (Z=2.67, P<0.05). The AUC of Emean, Emax, and Esd in distinguishing benign and malignant major salivary gland tumors were 0.941, 0.929, and 0.762, respectively. Emean and Emax were better than Esd. When Emean=169.5 kPa, Emax=196.4 kPa, and Esd=22.4 kPa were the optimal critical values, the corresponding specificities were 92.7%, 90.2%, and 80.5%, and the sensitivities were 92.9%, 89.3%, and 64.3%, respectively. The negative predictive values were 95.0%, 92.5%, and 76.8%, respectively, and the positive predictive values were 89.7%, 86.2%, and 69.2%, respectively. Conclusion SWE can further quantitatively measure major salivary gland tumor stiffness bases on the conventional ultrasonography, and the combination of both can significantly improve the accuracy of diagnosing benign and malignant major salivary gland tumors. Among the elastic parameters of SWE, Emean, and Emax have better diagnostic performance, and both are better than Esd.
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Yang Panpan, Li Yang, Sun Yixue. The value of conventional ultrasound combined with shear wave elastography in the diagnosis of benign and malignant major salivary gland tumors. Chinese Journal of Anatomy and Clinics, 2022, 27(9): 614-619.
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2022, Vol. 27 
