Characteristics of ultrasound-based calcifications in primary salivary gland tumors

Abstract Objectives This study aimed to characterize ultrasonographic features of calcifications in salivary gland tumors (SGTs) and evaluate their diagnostic significance. Materials and methods We retrospectively analyzed 104 pathologically confirmed primary SGTs with preoperative ultrasound-detected calcifications. Clinical characteristics, lesion size, and calcification patterns were systematically evaluated. Results Calcifications were classified into four distinct ultrasonographic patterns: scattered microcalcifications, clustered microcalcifications, macrocalcifications and irregular calcifications. Significant differences in calcification patterns were observed between benign (B-SGTs) and malignant SGTs (M-SGTs). Scattered microcalcifications predominated in B-SGTs ( P = 0.04), Irregular calcifications (Type IV) strongly associated with M-SGTs ( P < 0.001). Multivariate analysis identified Type IV calcifications as the strongest independent malignancy predictor (OR = 29.4, 95% CI 4.751-181.626; P < 0.001). A diagnostic model combining ill-defined borders and Type IV calcifications achieved high accuracy for malignancy (AUC = 0.909, sensitivity 90.3%, specificity 82.2%). Conclusions Irregular calcifications on US are a strong predictor of malignancy in SGTs. Characterization of calcification patterns, particularly combined with tumor border features, significantly enhances preoperative differential diagnosis.