James A Miller1, Daniel An1, Khurram Shafique2, Sharon Song2, Rema A Rao3, Kartik Viswanathan3, Elizabeth Eykman4, Austin Wiles5, Syed Z Ali1, Andrew Field4, Guido Fadda6, Guliz A Barkan7, Lester J Layfield8, Esther D Rossi6, Celeste N Powers5, Momin T Siddiqui3, Ivana Kholova9, Zubair Baloch2, Zahra Maleki10. 1. Division of Cytopathology, 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, New York Presbyterian, Weill Cornell Medicine, Pathology and Laboratory Medicine, New York, New York. 4. Department of Pathology, St. Vincent Hospital, Sydney, Australia. 5. Department of Pathology, Virginia Commonwealth University, Richmond, Virginia. 6. Department of Pathology, Catholic University of Sacred Heart, Fondazione Policlinico Univeristario A, Rome, Italy. 7. Department of Pathology, Loyola University Medical Center, Maywood, Illinois. 8. Department of Pathology, University of Missouri School of Medicine, Columbia, Missouri. 9. Department of Pathology, Fimlab Laboratories and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland. 10. Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: zmaleki1@jhmi.edu.
Abstract
BACKGROUND: We evaluated the diagnostic accuracy (DA), risk of neoplasm (RON), and risk of malignancy (ROM) for the commonly encountered malignant salivary gland tumors mucoepidermoid carcinoma (MECa), acinic cell carcinoma (ACCa), and adenoid cystic carcinoma (ADCa) applying The Milan System for Reporting Salivary Gland Cytology (MSRSGC). MATERIALS AND METHODS: The cytology archives from 2007 to 2017 of 9 academic institutions were searched for salivary gland FNAs for the following key words mentioned either in the principal and/or differential diagnosis: MEC, ACCa, and ADCa. The original cytology diagnosis was retrospectively classified according to the MSRSGC. Patient demographics, biopsy site, and available surgical follow-up were recorded. The final analysis included only cases with surgical follow-up. RESULTS: A total of 212 salivary gland FNAs were included. Based on retrospective reclassification according to MSRSGC, 97 of 212 (46%) FNA cases carried a diagnosis of malignancy specific for either MECa, ACCa, or ADCa. In the remaining 115 cases, 24 of 212 (11%) were reclassified as suspicious for malignancy (SM) and 91 of 212 (43%) as salivary gland neoplasm of uncertain malignant potential (SUMP). The DA for MECa, ACCa, and ADCa was 78.7%, 75% and 89%, respectively. The RON was 100% for all 3 tumors and the ROM was 93.6% for MECa, 96.8% for ACCa, and 94.4% for ADCa. CONCLUSIONS: The DA of 78.7% for MECa, 75% for ACCa, and 89% for ADCa is reasonable in FNA specimens. Although the management of definitive cases of malignancy remains unchanged, the MSRSGC provides a ROM for SM and SUMP categories, which can improve patient management.
BACKGROUND: We evaluated the diagnostic accuracy (DA), risk of neoplasm (RON), and risk of malignancy (ROM) for the commonly encountered malignant salivary gland tumors mucoepidermoid carcinoma (MECa), acinic cell carcinoma (ACCa), and adenoid cystic carcinoma (ADCa) applying The Milan System for Reporting Salivary Gland Cytology (MSRSGC). MATERIALS AND METHODS: The cytology archives from 2007 to 2017 of 9 academic institutions were searched for salivary gland FNAs for the following key words mentioned either in the principal and/or differential diagnosis: MEC, ACCa, and ADCa. The original cytology diagnosis was retrospectively classified according to the MSRSGC. Patient demographics, biopsy site, and available surgical follow-up were recorded. The final analysis included only cases with surgical follow-up. RESULTS: A total of 212 salivary gland FNAs were included. Based on retrospective reclassification according to MSRSGC, 97 of 212 (46%) FNA cases carried a diagnosis of malignancy specific for either MECa, ACCa, or ADCa. In the remaining 115 cases, 24 of 212 (11%) were reclassified as suspicious for malignancy (SM) and 91 of 212 (43%) as salivary gland neoplasm of uncertain malignant potential (SUMP). The DA for MECa, ACCa, and ADCa was 78.7%, 75% and 89%, respectively. The RON was 100% for all 3 tumors and the ROM was 93.6% for MECa, 96.8% for ACCa, and 94.4% for ADCa. CONCLUSIONS: The DA of 78.7% for MECa, 75% for ACCa, and 89% for ADCa is reasonable in FNA specimens. Although the management of definitive cases of malignancy remains unchanged, the MSRSGC provides a ROM for SM and SUMP categories, which can improve patient management.
Keywords:
Acinic cell carcinoma; Adenoid cystic carcinoma; Fine-needle aspiration; Mucoepidermoid carcinoma; Risk of malignancy; Risk of neoplasm; Salivary gland; The Milan System for Reporting Salivary Gland Cytology
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