Pleomorphic adenoma diagnostic study of choice: Difference between revisions

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=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
*The best way to arrive at a diagnosis is always do a thorough physical examination on the mass, which will guide the physician in a right direction.
 
*Next comes ultrasonography which has good sensitivity in detecting superficial lobe masses of the parotid gland.
OR
*CT and MRI both are very useful diagnostic tools, and MRI being the diagnostic study of choice for pleomorphic adenoma.
 
*FNAB is also indicated by some clinicians.
The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]
 
OR
 
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
 
OR
 
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
==== The comparison of various diagnostic studies for [disease name] ====
{|
{|
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===== Diagnostic results =====
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
======Ultrasound======
* [Finding 1]
On Ultrasound, characteristic findings of pleomorphic adenomas include:
* [Finding 2]
*Pleomorphic adenomas are hypoechoic, well-defined, lobulated tumors with posterior acoustic enhancement and may contain calcifications.
*Ultrasound is frequently used to guide FNA or core needle biopsy<ref name="BialekJakubowski2003">{{cite journal|last1=Bialek|first1=Ewa J.|last2=Jakubowski|first2=Wieslaw|last3=Karpinska|first3=Grazyna|title=Role of Ultrasonography in Diagnosis and Differentiation of Pleomorphic Adenomas|journal=Archives of Otolaryngology–Head & Neck Surgery|volume=129|issue=9|year=2003|pages=929|issn=0886-4470|doi=10.1001/archotol.129.9.929}}</ref>
 
======CT scan======
*When the tumor is small they show homogeneous attenuation and prominent enhancement.
*When the tumor is large they can be heterogeneous with less enhancement, foci of necrosis, haemorrhage and possible delayed enhancement.<ref name="pmid9874532">{{cite journal |vauthors=Lev MH, Khanduja K, Morris PP, Curtin HD |title=Parotid pleomorphic adenomas: delayed CT enhancement |journal=AJNR Am J Neuroradiol |volume=19 |issue=10 |pages=1835–9 |date=1998 |pmid=9874532 |doi= |url=}}</ref>
*Small regions of calcification are also common.
======MRI======
*MRI is the imaging modality of choice for pleomorphic adenoma.<ref name="pmid8881252">{{cite journal |vauthors=Ikeda K, Katoh T, Ha-Kawa SK, Iwai H, Yamashita T, Tanaka Y |title=The usefulness of MR in establishing the diagnosis of parotid pleomorphic adenoma |journal=AJNR Am J Neuroradiol |volume=17 |issue=3 |pages=555–9 |date=March 1996 |pmid=8881252 |doi= |url=}}</ref>
*On T1-weighted images:
** Pleomorphic adenoma's show homogeneous intensity. <ref name="HisatomiAsaumi2003">{{cite journal|last1=Hisatomi|first1=Miki|last2=Asaumi|first2=Jun-ichi|last3=Yanagi|first3=Yoshinobu|last4=Konouchi|first4=Hironobu|last5=Matsuzaki|first5=Hidenobu|last6=Honda|first6=Yasutoshi|last7=Kishi|first7=Kanji|title=Assessment of pleomorphic adenomas using MRI and dynamic contrast enhanced MRI|journal=Oral Oncology|volume=39|issue=6|year=2003|pages=574–579|issn=13688375|doi=10.1016/S1368-8375(03)00040-X}}</ref>
*On T2-weighted images:
**Marked hyperintensity reflects abundant myxochondroid stroma.<ref name="pmid29845358">{{cite journal |vauthors=Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M |title=Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features |journal=Jpn J Radiol |volume=36 |issue=8 |pages=463–471 |date=August 2018 |pmid=29845358 |doi=10.1007/s11604-018-0747-y |url=}}</ref>
**Hypointensity reflects the fibrous capsule of the tumor.<ref name="pmid29845358">{{cite journal |vauthors=Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M |title=Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features |journal=Jpn J Radiol |volume=36 |issue=8 |pages=463–471 |date=August 2018 |pmid=29845358 |doi=10.1007/s11604-018-0747-y |url=}}</ref>
*On Gd-T1weighted images:
**It shows heterogeneous enhancement.<ref name="HisatomiAsaumi2003">{{cite journal|last1=Hisatomi|first1=Miki|last2=Asaumi|first2=Jun-ichi|last3=Yanagi|first3=Yoshinobu|last4=Konouchi|first4=Hironobu|last5=Matsuzaki|first5=Hidenobu|last6=Honda|first6=Yasutoshi|last7=Kishi|first7=Kanji|title=Assessment of pleomorphic adenomas using MRI and dynamic contrast enhanced MRI|journal=Oral Oncology|volume=39|issue=6|year=2003|pages=574–579|issn=13688375|doi=10.1016/S1368-8375(03)00040-X}}</ref>
 


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====

Revision as of 15:13, 17 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Diagnostic Study of Choice

Study of choice

  • The best way to arrive at a diagnosis is always do a thorough physical examination on the mass, which will guide the physician in a right direction.
  • Next comes ultrasonography which has good sensitivity in detecting superficial lobe masses of the parotid gland.
  • CT and MRI both are very useful diagnostic tools, and MRI being the diagnostic study of choice for pleomorphic adenoma.
  • FNAB is also indicated by some clinicians.

The comparison of various diagnostic studies for [disease name]

Test Sensitivity Specificity
Test 1 ...% ...%
Test 2 ...% ...%

[Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity

Diagnostic results
Ultrasound

On Ultrasound, characteristic findings of pleomorphic adenomas include:

  • Pleomorphic adenomas are hypoechoic, well-defined, lobulated tumors with posterior acoustic enhancement and may contain calcifications.
  • Ultrasound is frequently used to guide FNA or core needle biopsy[1]
CT scan
  • When the tumor is small they show homogeneous attenuation and prominent enhancement.
  • When the tumor is large they can be heterogeneous with less enhancement, foci of necrosis, haemorrhage and possible delayed enhancement.[2]
  • Small regions of calcification are also common.
MRI
  • MRI is the imaging modality of choice for pleomorphic adenoma.[3]
  • On T1-weighted images:
    • Pleomorphic adenoma's show homogeneous intensity. [4]
  • On T2-weighted images:
    • Marked hyperintensity reflects abundant myxochondroid stroma.[5]
    • Hypointensity reflects the fibrous capsule of the tumor.[5]
  • On Gd-T1weighted images:
    • It shows heterogeneous enhancement.[4]


Sequence of Diagnostic Studies

The [name of investigation] must be performed when:

  • The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
  • A positive [test] is detected in the patient, to confirm the diagnosis.

OR

The various investigations must be performed in the following order:

  • [Initial investigation]
  • [2nd investigation]

Name of Diagnostic Criteria

It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.

[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].

OR

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

[Disease name] may be diagnosed at any time if one or more of the following criteria are met:

  • Criteria 1
  • Criteria 2
  • Criteria 3

OR

IF there are clear, established diagnostic criteria

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

IF there are no established diagnostic criteria

There are no established criteria for the diagnosis of [disease name].

References

  1. ↑ Bialek, Ewa J.; Jakubowski, Wieslaw; Karpinska, Grazyna (2003). "Role of Ultrasonography in Diagnosis and Differentiation of Pleomorphic Adenomas". Archives of Otolaryngology–Head & Neck Surgery. 129 (9): 929. doi:10.1001/archotol.129.9.929. ISSN 0886-4470.
  2. ↑ Lev MH, Khanduja K, Morris PP, Curtin HD (1998). "Parotid pleomorphic adenomas: delayed CT enhancement". AJNR Am J Neuroradiol. 19 (10): 1835–9. PMID 9874532.
  3. ↑ Ikeda K, Katoh T, Ha-Kawa SK, Iwai H, Yamashita T, Tanaka Y (March 1996). "The usefulness of MR in establishing the diagnosis of parotid pleomorphic adenoma". AJNR Am J Neuroradiol. 17 (3): 555–9. PMID 8881252.
  4. ↑ 4.0 4.1 Hisatomi, Miki; Asaumi, Jun-ichi; Yanagi, Yoshinobu; Konouchi, Hironobu; Matsuzaki, Hidenobu; Honda, Yasutoshi; Kishi, Kanji (2003). "Assessment of pleomorphic adenomas using MRI and dynamic contrast enhanced MRI". Oral Oncology. 39 (6): 574–579. doi:10.1016/S1368-8375(03)00040-X. ISSN 1368-8375.
  5. ↑ 5.0 5.1 Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M (August 2018). "Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features". Jpn J Radiol. 36 (8): 463–471. doi:10.1007/s11604-018-0747-y. PMID 29845358.

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