Close relationship with the glandular capsule: a highly sensitive diagnostic indicator of major salivary gland metastatic malignancies in ultrasound

Abstract Objectives To investigate the ultrasound (US) characteristics of metastatic malignancies (MM) in the major salivary glands and to assess the diagnostic value of the close relationship with the glandular capsule in identifying MM. Methods From January 2016 and April 2022, 122 patients with major salivary gland malignancies, including 20 patients with MM and 102 patients with primary malignancies (PM) confirmed by histopathological examination, were enrolled in this study. Their clinicopathologic and US data were recorded and analysed. The diagnostic performance of the close relationship with the glandular capsule for differentiating MM from PM was analysed. Results The mean age of MM were older than that of PM (59.50 ± 14.57 vs. 49.96 ± 15.73, P = .013). Compared with PM patients, MM were associated with a higher prevalence of local pain symptoms (P = .007) and abnormal facial nerve function (P < .001). MM were also more frequently characterized by unclear borders, rough margins, irregular shapes, heterogeneous internal echos, absence of cystic areas, presence of calcifications, close relationship with the glandular capsule, and US-reported positive cervical lymph nodes (all P < .05). The close relationship with the glandular capsule showed to be a good indicator in distinguishing between MM and PM, with an area under the receiver operating characteristic curve of 0.863, a sensitivity of 100%, a specificity of 72.5%, and an accuracy of 92.2%. Positive and negative predictive were calculated at 41.7% and 100%, respectively. Conclusions The US finding of a close relationship with the glandular capsule is a highly sensitive diagnostic indicator for MM. Following this finding, US-guided needle biopsy should be recommended to further confirm the diagnosis.