Sialendoscopy in addition to Ultrasound: an Alternative Diagnostic Standard in Sialolithiasis?

Objective:

To assess the value of ultrasound, if indicated supplemented by sialendoscopy, in the diagnosis of sialolithiasis.

Subjects and Methods:

All patients who presented with a suspected diagnosis of obstructive sialopathy between January 2011 and April 2017 and had not underwent any treatment were retrospectively evaluated. A total of 2052 patients and 2277 glands were included in the study. Ultrasound examinations were carried out initially in all cases. Direct demonstration of sialothiasis by sialendoscopy or transoral ductal surgery, discharge of concrements/observation of fragments during sialendoscopy after extracorporeal shock-wave lithotripsy, were regarded as definitive evidence of sialolithiasis.

Results:

Ultrasound had an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 94.77%, 94.91%, 94.57%, 96.14, and 92.89%, respectively, for the diagnosis of sialolithiasis. All false-positive findings (2.24%) were excluded and all false-negative findings (2.99%) on ultrasound were correctly diagnosed using sialendoscopy. In 73.1% of the false-negative cases, the stones not detected on ultrasound were located in the distal part of the duct, which is easily accessible with the sialendoscope.

Conclusion:

This study shows that sialolithiasis can be diagnosed using ultrasonography with a very high degree of certainty. If supplemented by sialendoscopy, the correct diagnosis can be established in virtually all cases of sialolithiasis. Ultrasound followed by sialendoscopy could therefore serve as alternative diagnostic standard.

Publication History

Publication Date:
18 April 2018 (online)