Zahra Maleki1, Zubair Baloch2, Ryan Lu1, Khurram Shafique2, Sharon J Song2, Kartik Viswanathan3, Rema A Rao3, Holly Lefler4, Aisha Fatima5, Austin Wiles6, Vickie Y Jo7, He Wang5, Guido Fadda8, Celeste N Powers6, Syed Z Ali1, Liron Pantanowitz9, Momin T Siddiqui3, Ritu Nayar4, Jerzy Klijanienko10, Guliz A Barkan11, Jeffrey F Krane7, Esther D Rossi8, Fabiano Callegari12, Ivana Kholová13,14, Massimo Bongiovanni15, William C Faquin16, Marc P Pusztaszeri17. 1. Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland. 2. Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Pathology, Weill Cornell Medicine, New York, New York. 4. Department of Pathology, Northwestern University, Chicago, Illinois. 5. Department of Pathology, Rutgers Robert Wood Johnson University, New Brunswick, New Jersey. 6. Department of Pathology, Virginia Commonwealth University, Richmond, Virginia. 7. Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts. 8. Department of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy. 9. Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania. 10. Department of Pathology, Curie Institute, Paris, France. 11. Department of Pathology, Loyola University, Chicago, Illinois. 12. Department of Pathology, Sao Paulo Federal University, Sao Paulo, Brazil. 13. Department of Pathology, Fimlab Laboratories, Tampere, Finland. 14. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. 15. Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland. 16. Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts. 17. Department of Pathology, McGill University, Montreal, Quebec, Canada.
Abstract
BACKGROUND: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6-tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs. METHODS: Submandibular gland FNA cytology specimens from 15 international institutions (2013-2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow-up was performed, and the ROM was calculated for each MSRSGC diagnostic category. RESULTS: The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%-50%); nonneoplastic, 24.2% (9.1%-53.6%); AUS, 6.7% (0%-14.3%); benign neoplasm, 18.3% (0%-52.5%); SUMP, 12% (0%-37.7%); SM, 3.5% (0%-12.5%); and malignant, 13.9% (2%-31.3%). The histopathologic follow-up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. CONCLUSIONS: This multi-institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA.
BACKGROUND: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6-tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs. METHODS: Submandibular gland FNA cytology specimens from 15 international institutions (2013-2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow-up was performed, and the ROM was calculated for each MSRSGC diagnostic category. RESULTS: The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%-50%); nonneoplastic, 24.2% (9.1%-53.6%); AUS, 6.7% (0%-14.3%); benign neoplasm, 18.3% (0%-52.5%); SUMP, 12% (0%-37.7%); SM, 3.5% (0%-12.5%); and malignant, 13.9% (2%-31.3%). The histopathologic follow-up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. CONCLUSIONS: This multi-institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA.
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Authors: Austin B Wiles; Matthew Gabrielson; Zubair W Baloch; William C Faquin; Vickie Y Jo; Fabiano Callegari; Ivana Kholova; Sharon Song; Barbara A Centeno; Syed Z Ali; Satu Tommola; Guido Fadda; Gianluigi Petrone; He Wang; Esther D Rossi; Liron Pantanowitz; Zahra Maleki Journal: Cancer Cytopathol Date: 2022-04-06 Impact factor: 4.264