Daniel N Johnson1, Mine Onenerk2, Jeffrey F Krane3, Esther Diana Rossi4, Zubair Baloch5, Güliz Barkan6, Massimo Bongiovanni7, Fabiano Callegari8, Sule Canberk9,10, Glen Dixon11, Andrew Field12, Christopher C Griffith13, Nirag Jhala14, Sara Jiang15, Daniel Kurtycz16, Lester Layfield17, Oscar Lin18, Zahra Maleki19, Miguel Perez-Machado20, Marc Pusztaszeri7, Philippe Vielh21, He Wang22, Matthew A Zarka23, William C Faquin24. 1. Department of Pathology, Cytopathology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 2. Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey. 3. Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California. 4. Department of Pathology, Fondazione Policlinico Universitario "Agostino Gemelli," IRCCS, Universita' Cattolica, Rome, Italy. 5. Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania. 6. Loyola University Healthcare System, Maywood, Illinois. 7. Department of Pathology, McGill University, Montreal, Quebec, Canada. 8. Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. 9. Cancer Signaling and Metabolism, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. 10. Division of Cytopathology, Department of Pathology, Acibadem University, Istanbul, Turkey. 11. HCA Laboratories, HCA Healthcare UK, London, United Kingdom. 12. Department of Pathology, St. Vincent Hospital, Sydney, Australia. 13. Cleveland Clinic Foundation, Cleveland, Ohio. 14. Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pennsylvania. 15. Department of Pathology, Duke University Medical Center, Durham, North Carolina. 16. Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, State Laboratory of Hygiene, Madison, Wisconsin. 17. Department of Pathology and Anatomical Services, University of Missouri, Columbia, Missouri. 18. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York. 19. Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland. 20. Department of Cellular Pathology, Royal Free Hospital, London, United Kingdom. 21. Department of Pathology, Laboratoire National de Santé, Dudelange, Luxembourg. 22. Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey. 23. Department of Pathology and Laboratory Medicine, Mayo Clinic, Scottsdale, Arizona. 24. Department of Pathology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts.
Abstract
BACKGROUND: Fine needle aspiration (FNA) is commonly used for the preoperative evaluation of salivary gland tumors. Tumor grade is a key factor influencing clinical management of salivary gland carcinomas (SGCs). To assess the ability to grade nonbasaloid SGCs in FNA specimens, an international panel of cytopathologists convened to review and score SGC cases. METHODS: The study cohort included 61 cases of primary SGC from the pathology archives of 3 tertiary medical centers. Cases from 2005 to 2016 were selected, scanned, and digitized. Nineteen cytopathologists blinded to the histologic diagnosis reviewed the digitized cytology slides and graded them as low, high, or indeterminate. The panelists' results were then compared to the tumor grades based on histopathologic examination of the corresponding resection specimens. RESULTS: All but 2 of the 19 (89.5%) expert panelists review more than 20 salivary gland FNAs per year; 16 (84.2%) of the panelists work at academic medical centers, and 13 (68.4%) have more than 10 years' experience. Participants had an overall accuracy of 89.4% in the grading of SGC cases, with 90.2% and 88.3% for low- and high-grade SGC, respectively. Acinic cell carcinoma and mucoepidermoid carcinoma had the highest degree of accuracy, while epithelial-myoepithelial carcinoma and salivary duct carcinoma had the lowest degree of accuracy. As expected, the intermediate-grade SGC cases showed the greatest variability (high-grade, 42.1%; low-grade, 37.5%, indeterminate, 20.4%). CONCLUSION: This study confirms the high accuracy of cytomorphologic grading of primary SGC by FNA as low- or high-grade. However, caution should be exercised when a grade cannot be confidently assigned.
BACKGROUND: Fine needle aspiration (FNA) is commonly used for the preoperative evaluation of salivary gland tumors. Tumor grade is a key factor influencing clinical management of salivary gland carcinomas (SGCs). To assess the ability to grade nonbasaloid SGCs in FNA specimens, an international panel of cytopathologists convened to review and score SGC cases. METHODS: The study cohort included 61 cases of primary SGC from the pathology archives of 3 tertiary medical centers. Cases from 2005 to 2016 were selected, scanned, and digitized. Nineteen cytopathologists blinded to the histologic diagnosis reviewed the digitized cytology slides and graded them as low, high, or indeterminate. The panelists' results were then compared to the tumor grades based on histopathologic examination of the corresponding resection specimens. RESULTS: All but 2 of the 19 (89.5%) expert panelists review more than 20 salivary gland FNAs per year; 16 (84.2%) of the panelists work at academic medical centers, and 13 (68.4%) have more than 10 years' experience. Participants had an overall accuracy of 89.4% in the grading of SGC cases, with 90.2% and 88.3% for low- and high-grade SGC, respectively. Acinic cell carcinoma and mucoepidermoid carcinoma had the highest degree of accuracy, while epithelial-myoepithelial carcinoma and salivary duct carcinoma had the lowest degree of accuracy. As expected, the intermediate-grade SGC cases showed the greatest variability (high-grade, 42.1%; low-grade, 37.5%, indeterminate, 20.4%). CONCLUSION: This study confirms the high accuracy of cytomorphologic grading of primary SGC by FNA as low- or high-grade. However, caution should be exercised when a grade cannot be confidently assigned.
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