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Lagerstam H, Tommola E, Kares S, Kholová I. The Milan system atypia of undetermined significance: 5-year performance data. Cancer Cytopathol 2024. [PMID: 39003586 DOI: 10.1002/cncy.22883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The objective of this study was to evaluate the diagnostic performance of the category atypia of undetermined significance (AUS) at the authors' institution based on the Milan System for Reporting Salivary Gland Cytopathology. METHODS All AUS cases diagnosed at Fimlab Laboratories between January 1, 2018, and December 31, 2022, were included. Histologic verifications were checked until May 31, 2023. The upper-bound and lower-bound risk of malignancy and risk of neoplasm were calculated. The timelines between the pathology laboratory workflow and patient management were also calculated. RESULTS From 1157 fine-needle aspirations (FNAs), 162 (14.0%) AUS cases were diagnosed in 146 patients, with an average ± standard deviation age of 66.1 ± 14.9 years. There was variation in the AUS percentages, with higher values during the coronavirus disease 2019 pandemic years (15% and 17.5% in 2020 and 2021, respectively). Seventy-five cases (46.3%) had histologic follow-up: 16 were malignant neoplasms, and 36 were benign neoplasms. The upper and the lower bounds of the-risk of malignancy and risk of neoplasm were 21.3% and 69.3% and 9.9% and 32.1%, respectively. The average time from the first FNA with an AUS diagnosis to surgical resection ranged from 6 to 682 days, and the time to the first repeat FNA ranged from 10 to 691 days. CONCLUSIONS The results indicated higher percentages of AUS cases compared with the reference value, which may be attributed to the impact of the coronavirus disease 2019 pandemic. The risk of malignancy calculated in this study was closer to the reference value from the first edition of the Milan System for Reporting Salivary Gland Cytopathology compared with the second edition.
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Affiliation(s)
- Henri Lagerstam
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - Erkka Tommola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - Saara Kares
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - Ivana Kholová
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
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Arisi MF, Jin X, Ravish NA, Chand MT, Baloch Z. How important are the cytomorphologic subtypes of the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan system for reporting salivary gland cytology? An institutional experience 2018-2024. Diagn Cytopathol 2024. [PMID: 38970450 DOI: 10.1002/dc.25380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Salivary gland neoplasm of uncertain malignant potential (SUMP) is an important diagnostic category of the Milan System for reporting salivary gland cytology (MSRSGC). Further subcategorization by cytomorphologic subtypes has been recommended to risk-stratify cases. In this study, our institutional experience with the risk of neoplasm (RON) and risk of malignancy (ROM) based on cytomorphologic subcategorization of SUMP is reported. We also report the prevalence of malignancy (POM) at our institution. METHODS The pathology database was queried for cases of fine-needle aspiration (FNA) diagnosed as SUMP along with follow-up at our institution from 2018-February 2024. This study was approved by an institutional review board. RESULTS Of 1159 cases of salivary gland FNA specimens reported as per MSRSGC at our institution, 14.8% (171/1159 cases) were diagnosed as SUMP, with these reports verified by at least 16 cytopathologists. Surgical follow-up was available for 139/171 (81.3%) of these cases, for which the original cytomorphologic subgroups were as follows: 65 (46.8%) basaloid, 48 (34.5%) oncocytic/oncocytoid, 14 (10.1%) myoepithelial, 9 (6.5%) other, 2 (1.4%) clear cell, and 1 (0.7%) mucinous. The POM within SUMP at our institution is within a range of 29.8%-36.7%. When considering all cases, our institutional RON for SUMP was 97.8% (136/139), and the ROM was 36.7% (51/139). Notably, a significant portion of cases (36%, 50/139) underwent review at a daily intradepartmental consensus conference. Analysis revealed that SUMP cases that underwent consensus review had a ROM of 46% (23/50), versus 31.5% (28/89) in independently verified cases (p = .13). Of the cytomorphologic subgroups, basaloid SUMP in particular was more likely to be benign on resection when the case had been independently verified than after consensus review (p = .0082). When considering only the independently verified cases, the ROM for each subgroup was as follows: 38.7% (12/31) in oncocytic/oncocytoid, 20% (9/45) in basaloid, 33.3% (2/6) in myoepithelial, 60% (3/5) in "other", and 100% (1/1) in both mucinous and clear cell (p = .0407). CONCLUSION While the RON is high across all cytomorphologic subgroups of SUMP, the ROM does vary across the groups, with basaloid cytomorphology having the lowest ROM. This effect is seen in independently verified cases but not in cases having undergone consensus review.
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Affiliation(s)
- Maria Florencia Arisi
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xueting Jin
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nakul A Ravish
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Momal T Chand
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zubair Baloch
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Lagerstam H, Kalfert D, Maleki Z, Kholová I. How the Milan System for Reporting Salivary Gland Cytopathology works in cytopathology practice: Meta-analysis of prospective studies and comparison with retrospective studies. Cancer Cytopathol 2024; 132:447-457. [PMID: 38594082 DOI: 10.1002/cncy.22815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/11/2024] [Accepted: 03/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is widely accepted and endorsed by professional societies. Although several studies focusing on the MSRSGC have been published, few have been prospective studies. The objective of this study was to evaluate the effectiveness of the MSRSGC in cytopathology practice. METHODS A comprehensive literature search was conducted to identify all prospective studies on the MSRSGC. The risk of malignancy (ROM), risk of neoplasm, and diagnostic accuracy for each diagnostic category were calculated. Data were tabulated in Microsoft Excel, and analyses were performed with the Open Meta-Analyst program. RESULTS Seven prospective and seven retrospective studies were identified. The total number of fine-needle aspirations (FNAs) was 1587 in the prospective studies and 1764 in the retrospective studies. The ROM values for the nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant categories in prospective versus retrospective studies were 21.0% versus 26.6%, 9.4% versus 8.1%, 34.9% versus 39.6%, 2.4% versus 2.1%, 36.6% versus 31.2%, 86.0% versus 66.0%, and 97.0% versus 96.7%, respectively. Sensitivities, specificities, and diagnostic odds ratios were 83.1% (95% confidence interval [CI], 71.1%-90.8%) versus 89.1% (95% CI, 83.6%-92.9%), 98.4% (95% CI, 96.6%-99.3%) versus 94.9% (95% CI, 91.9%-96.9%), and 310.7 (95% CI, 121.2-796.6) versus 218.8 (95% CI, 107.3-438.1). CONCLUSIONS This meta-analysis indicated that the MSRSGC works well in FNA cytopathology practice and improves diagnostic accuracy in all diagnostic categories. The ROMs of prospective studies were in concordance with the MSRSGC reference values.
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Affiliation(s)
- Henri Lagerstam
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ivana Kholová
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
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Calo L, Alboni T, Bruno C, Policardo F, Feraco A, Tralongo P, Vegni F, Mulè A, Brigato F, Rossi G, Bussu F, Pantanowitz L, Galli J, Rossi ED. Metastases to the parotid glands: An institutional experience. Cytopathology 2024; 35:488-496. [PMID: 38752464 DOI: 10.1111/cyt.13387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Metastatic lesions to the salivary gland are rare and mostly affect the parotids. Metastases represent 8% of all malignant lesions of the parotid gland. Around 80% originate from squamous cell carcinomas (SCC) of the head and neck region. Fine needle aspiration (FNA) plays a crucial role in distinguishing primary salivary gland lesions from metastases. Herein we describe our series of metastases to the parotid glands. MATERIALS AND METHODS We analysed 630 parotid gland FNAs over a decade including conventional and liquid-based cytology specimens. Ancillary techniques such as immunocytochemistry (ICC) were conducted on cell blocks. RESULTS Eighty (12.4%) cases were malignant lesions, of which 53 (63.75%) were metastases including 24% melanoma, 22.6% SCC, 19% renal carcinomas, 7.5% breast carcinomas, 11.3% lung, 9% intestinal and 1.8% testicular, malignant solitary fibrous tumour and Merkel cell carcinoma. The 53 cases, classified according to the Milan system for salivary cytopathology, belonged to 5 Suspicious for malignancy (SFM) and 48 malignant (M) categories. Forty had a known history of primary malignancy (75.4%), while 13 were suspicious to be a metastatic localisation (24.5%), distributed as 5SFM (2SCC and 3Melanoma) and 8 M. A combination of clinical history, cytomorphology and ICC identified 100% of them. CONCLUSIONS Fine needle aspiration plays a central role in the diagnostic workup of patients with metastatic lesions to their parotid glands, thereby defining the correct management. Diagnostic accuracy may be enhanced by applying ICC. Although melanoma and SCC are the most common histological types, several other malignancies may also metastasize to the parotid glands and should be kept into consideration.
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Affiliation(s)
- Lea Calo
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Tiziana Alboni
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Carmine Bruno
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Policardo
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Angela Feraco
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Vegni
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Antonio Mulè
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Francesca Brigato
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Giorgia Rossi
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Francesco Bussu
- Division of Head and Neck, Policlinico di Sassari, Sassari, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacopo Galli
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
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Xu M, Deng L, Peng K, Wei X, Xie M, Liu M, Peng H. Rapid on-site evaluation improves diagnostic performance of fine-needle aspiration cytology for salivary lesions: Comparison of data from two cancer centers in southern China. Diagn Cytopathol 2024; 52:243-253. [PMID: 38263730 DOI: 10.1002/dc.25277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To evaluate the diagnostic performance of Milan system for reporting salivary gland cytopathology (MSRSGC) in two southern China tertiary cancer centers and investigate the impact of rapid on-site evaluation (ROSE) on FNAC performance. MATERIALS AND METHODS Five hundred and forty-nine patients who underwent FNAC for salivary lesions with surgical follow-up from two centers were enrolled in this retrospective cohort study. All slides were recategorized using MSRSGC after consensus on diagnostic criteria for each category. The diagnostic performance of FNAC for salivary lesions was evaluated and compared and the impact of ROSE on FNAC performance was analyzed. RESULTS The distribution of cases per category based on the MSRSGC criteria in the whole series was as followed: ND 49 (8.9%), NN 76 (14.4%), BN 262 (47.7%), AUS 20 (3.6%), SUMP 43 (7.8%), SM 21 (3.8%), M 78 (14.2%). The SUMC series had significantly more ND distributions than JXCH did (16.2% vs. 0, p = .000). Risk of malignancy for each category in the total series was as followed: 42.9% for ND, 9.2% for NN, 3.8% for BN, 30.0% for AUS, 23.3% for SUMP, 81.0% for SM, and 94.9% for M. When ND and AUS/SUMP were excluded, the sensitivity, specificity, PPV, NPV, and accuracy were 84.0%, 97.1%, 89.9%, 95.1%, and 94.0%, respectively; sensitivity, specificity, PPV, NPV, and accuracy were comparable between the two centers. CONCLUSIONS FNAC using MSRSGC provides a good tool in preoperative evaluation for salivary lesions in southern China. ROSE improves its diagnostic performance by reducing the ratio of the ND category.
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Affiliation(s)
- Manbin Xu
- Department of Head and Neck Surgery, Shantou University Medical College Cancer Hospital, Shantou, Guangdong, China
| | - Lifei Deng
- Department of Head and Neck Surgery, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Kunpeng Peng
- Department of Clinical Medicine, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiaolong Wei
- Department of Pathology, Shantou University Medical College Cancer Hospital, Shantou, Guangdong, China
| | - Mei Xie
- Department of Cytology, Jiangxi Province Cancer Hospital, Nanchang, Jiangxi, China
| | - Muyuan Liu
- Department of Head and Neck Surgery, Shantou University Medical College Cancer Hospital, Shantou, Guangdong, China
| | - Hanwei Peng
- Department of Head and Neck Surgery, Shantou University Medical College Cancer Hospital, Shantou, Guangdong, China
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Vidyalakshmi S, Shanmugasamy K. Preoperative cytopathological investigatory aids in the diagnosis of salivary gland lesions. J Oral Maxillofac Pathol 2024; 28:172-177. [PMID: 39157837 PMCID: PMC11329079 DOI: 10.4103/jomfp.jomfp_132_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 05/25/2024] [Accepted: 06/01/2024] [Indexed: 08/20/2024] Open
Abstract
Salivary gland lesions are a group of heterogeneous lesions inclusive of non-neoplastic and neoplastic lesions. History, clinical examination and preoperative investigations attempt to minimise the challenges faced in diagnosing these diverse lesions. Preoperative investigations include imaging and cytopathology. The advent of onsite evaluation methods to ensure sample adequacy and newer reporting systems that assign risk of malignancy has improved the sensitivity and specificity of cytopathology. The scope of this review is limited to the preoperative cytopathological investigations and the diagnostic challenges met in reporting salivary gland tumours.
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Affiliation(s)
- S Vidyalakshmi
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Pillayarkuppam, Puducherry, India
| | - K Shanmugasamy
- Department of Pathology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pillayarkuppam, Puducherry, India
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Rossi ED, Baloch Z, Barkan G, Foschini MP, Kurtycz D, Pusztaszeri M, Vielh P, Faquin WC. Second edition of the Milan System for Reporting Salivary Gland Cytopathology: Refining the role of salivary gland FNA. Cytopathology 2024; 35:188-198. [PMID: 37971186 DOI: 10.1111/cyt.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
The use of standardised reporting systems for non-gynaecologic cytopathology has made enormous gains in popularity during the past decade, including for thyroid fine-needle aspiration, urine cytology, serous effusions, pancreas, lymph nodes, lung and more. In February 2018, the first edition of the Atlas of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was published. The MSRSGC defines six diagnostic fine-needle aspiration categories encompassing the spectrum of non-neoplastic, benign and malignant lesions of the salivary glands. The goal of the MSRSGC is to combine each diagnostic category with a defined risk of malignancy and a specific clinical and/or surgical management algorithm. Since its initial publication in 2018, more than 200 studies and commentaries have been published, confirming the role of the MSRSGC. The second edition of the MSRSGC, published in July 2023, includes refined risks of malignancy based on systematic reviews and meta-analyses, a new chapter summarising the use of salivary gland imaging, new advances in ancillary testing and updates in nomenclature.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guliz Barkan
- Department of Pathology, Loyola University School of Medicine, Maywood, Illinois, USA
| | - Maria Pia Foschini
- Unit of Anatomic Pathology at Bellaria Hospital, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Daniel Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marc Pusztaszeri
- Division of Pathology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Philippe Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Rossi ED, Baloch Z, Barkan G, Foschini MP, Kurtycz D, Pusztaszeri M, Vielh P, Faquin WC. Second edition of the Milan System for Reporting Salivary Gland Cytopathology: Refining the role of salivary gland FNA. J Am Soc Cytopathol 2024; 13:67-77. [PMID: 38184365 DOI: 10.1016/j.jasc.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 01/08/2024]
Abstract
The use of standardized reporting systems for nongynecologic cytopathology has made enormous gains in popularity during the past decade, including for thyroid fine-needle aspiration, urine cytology, serous effusions, pancreas, lymph nodes, lung, and more. In February 2018, the first edition Atlas of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was published. The MSRSGC defines six diagnostic fine-needle aspiration categories encompassing the spectrum of Non-Neoplastic, benign, and malignant lesions of the salivary glands. The goal of the MSRSGC is to combine each diagnostic category with a defined risk of malignancy and a specific clinical and/or surgical management algorithm. Since its initial publication in 2018, more than 200 studies and commentaries have been published confirming the role of the MSRSGC. The second edition of the MSRSGC, published in July 2023, includes refined risks of malignancy based on systematic reviews and meta-analyses, a new chapter summarizing the use of salivary gland imaging, new advances in ancillary testing, and updates in nomenclature. CONCISE SENTENCE: The second edition of the Milan System for Reporting Salivary Gland Cytopathology, published in July 2023, includes refined risks of malignancy based on systematic reviews and meta-analyses, a new chapter summarizing the use of salivary gland imaging, new advances in ancillary testing, updates in nomenclature, and a guide to the practical application of the latest ancillary markers for the diagnosis of selected salivary gland fine-needle aspiration cases.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy.
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guliz Barkan
- Department of Pathology, Loyola University School of Medicine, Maywood, Illinois, USA
| | - Maria Pia Foschini
- Unit of Anatomic Pathology at Bellaria Hospital, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Daniel Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marc Pusztaszeri
- Division of Pathology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Philippe Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Rossi ED, Baloch Z, Barkan G, Foschini MP, Kurtycz D, Pusztaszeri M, Vielh P, Faquin WC. Second edition of the Milan System for Reporting Salivary Gland Cytopathology: Refining the role of salivary gland FNA. Cancer Cytopathol 2024; 132:10-21. [PMID: 37971077 DOI: 10.1002/cncy.22753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 11/19/2023]
Abstract
The use of standardized reporting systems for non-gynecologic cytopathology has made enormous gains in popularity during the past decade, including for thyroid fine-needle aspiration, urine cytology, serous effusions, pancreas, lymph nodes, lung, and more. In February 2018, the first edition Atlas of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was published. The MSRSGC defines six diagnostic fine-needle aspiration categories encompassing the spectrum of non-neoplastic, benign, and malignant lesions of the salivary glands. The goal of the MSRSGC is to combine each diagnostic category with a defined risk of malignancy and a specific clinical and/or surgical management algorithm. Since its initial publication in 2018, more than 200 studies and commentaries have been published confirming the role of the MSRSGC. The second edition of the MSRSGC, published in July 2023, includes refined risks of malignancy based on systematic reviews and meta-analyses, a new chapter summarizing the use of salivary gland imaging, new advances in ancillary testing, and updates in nomenclature.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guliz Barkan
- Guliz Barkan Department of Pathology, Loyola University School of Medicine, Maywood, Illinois, USA
| | - Maria Pia Foschini
- Maria Pia Foschini Unit of Anatomic Pathology at Bellaria Hospital, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Daniel Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marc Pusztaszeri
- Division of Pathology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Philippe Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Vijayakumar G, Narayanan AV, Srikiran TK, Aravind S, Sandeep Vijay P. Importance of radio-histo-cytopathological correlation, A retrospective study of cyto-histological and radiological correlation of salivary gland lesions using Milan System for Reporting Salivary Gland Cytopathology. J Cancer Res Ther 2023:01363817-990000000-00029. [PMID: 38102913 DOI: 10.4103/jcrt.jcrt_2687_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) for salivary gland tumors can be challenging to due to the diversity of lesions and cytomorphological convergence between the tumors. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was hence developed and introduced to provide enhanced communication in salivary gland cytopathology. To evaluate the diagnostic utility and validity of MSRSGC in combination with ancillary radiological investigations, we aim to find correlation between Milan system and the radiological impression comparing with final histopathological diagnosis. AIMS AND OBJECTIVE Correlate the Milan category with the radiological and final histopathological diagnosis of salivary gland lesions. Review the FNAC diagnosis of salivary gland lesions and identify cytomorphological predictors of malignancy. Correlate the FNAC and the radiological diagnosis with final diagnosis in histopathology. MATERIAL AND METHODS A five year retrospective study, comprising fifty four cases of salivary gland FNAC were included in the study. RESULTS Majority of the cases belong to Milan VI-Malignant followed by Milan IVa-Benign and rest of cases were among other categories. The sensitivity, specificity, positive predictive value, and negative predictive value of adjuvant radiological diagnosis in differentiating benign and malignant salivary gland lesions was found to be 80%, 62.5%, 72.7%, and 71.4%, respectively. We could observe that the concurrent radiological assessment along with Milan system of reporting in salivary gland FNAC especially under suspicious categories (Milan Category IVb as well as Milan Category V) is a useful and sensitive predictor of malignancy. CONCLUSION A correlation with any form of ancillary radiological assessment is a helpful adjuvant with Milan system to derive a relatable diagnosis in salivary gland neoplasm especially those in categories describing the suspicious entities.
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Affiliation(s)
| | | | - T K Srikiran
- Consultant Radiologist, MVR Cancer Centre and Research Institute, Calicut, Kerala, India
| | - Sithara Aravind
- Department of Pathology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - P Sandeep Vijay
- Department of Head and Neck Surgery, Malabar Cancer Centre, Thalassery, Kerala, India
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Abbate V, Barone S, Borriello G, Troise S, Bonavolontà P, Pacella D, Vaira LA, Turri-Zanoni M, Cuéllar CN, Califano L, Dell' Aversana Orabona G. Diagnostic performance of inflammatory biomarkers and cytological analysis in salivary gland tumors. Head Neck 2023; 45:3015-3023. [PMID: 37752706 DOI: 10.1002/hed.27528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the diagnostic performance of serum inflammatory biomarkers in salivary gland tumors with dubious results following cytological analysis. METHODS A retrospective analysis of 239 cases following surgery between January 2011 and June 2022 was performed. Receiver Operating Characteristic curves were drawn and areas under the curves were computed to evaluate the diagnostic performance of the inflammatory biomarkers (SII, SIRI, PLR, and NLR). Optimal cut-offs for each marker were determined by maximizing the Youden index. RESULTS Analysis showed that among the major biomarkers examined, SIRI performed an AUC of 0.77. The best SIRI cut-off was 0.94 with an accuracy of 79.9%. The accuracy, sensitivity, and specificity of cytological analysis were 77.8%, 59.6%, and 90.7% respectively. By combining SIRI with cytological analysis we demonstrated an increase in sensitivity to 82.8%. CONCLUSIONS Inflammatory biomarkers could be evaluated to support the diagnosis and treatment of salivary gland tumors in difficult cases.
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Affiliation(s)
- Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Simona Barone
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Gerardo Borriello
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Stefania Troise
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Paola Bonavolontà
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mario Turri-Zanoni
- ENT Unit, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo Via Guicciardini, Varese, Italy
| | - Carlos Navarro Cuéllar
- Division of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Dell' Aversana Orabona
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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Fois P, Mureddu L, Manca A, Varrucciu S, Crescio C, Gallus R, Rizzo D, Cossu A, Bussu F. Preoperative Diagnosis of Warthin Tumors Combining Cytological, Clinical and Ultrasonographic Information within a Multidisciplinary Approach in a Lump Clinic. J Pers Med 2023; 13:1075. [PMID: 37511688 PMCID: PMC10381898 DOI: 10.3390/jpm13071075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.
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Affiliation(s)
- Paolo Fois
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Luca Mureddu
- U.O.C. Otorinolaringoiatria, Università degli Studi di Cagliari, Policlinico Universitario Duilio Casula, 09042 Monserrato, Italy
| | - Alessandra Manca
- Institute of Pathology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Simona Varrucciu
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Claudia Crescio
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Roberto Gallus
- Otolaryngology, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Davide Rizzo
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Antonio Cossu
- Institute of Pathology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Francesco Bussu
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
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13
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Tangjaturonrasme N, Samuckkeethum W, Klibngern H, Ratanaprasert N, Naruekon J, Jantharapattana K. Pediatric parotidectomy outcomes: A 14-year multicenter study. Laryngoscope Investig Otolaryngol 2022; 7:1875-1880. [PMID: 36544925 PMCID: PMC9764785 DOI: 10.1002/lio2.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives Parotidectomy increases childhood challenges. This study aimed to determine the clinical profiles, investigations, and outcomes of pediatric patients who had undergone parotidectomy. Methods A multicenter retrospective review of parotidectomy in pediatric patients between 2007 and 2020. Results In 108 parotidectomies, the final diagnoses were benign (47.22%), malignant (36.11%), and non-neoplastic (16.67%). The incidence of facial palsy was 37.03%, which was significantly lower in the superficial group than that in the total parotidectomy group (p = .021). The incidence of facial nerve palsy was significantly higher in the malignancy group than that in the benign group (p = .035). Magnetic resonance imaging (MRI) detected malignancy with 92.8% overall accuracy, 83.3% sensitivity, and 100% specificity. The sensitivity and specificity of fine-needle aspiration (FNA) were 54.2% and 92.7%, respectively. Conclusions Parotidectomy is commonly performed for benign and non-neoplastic diseases in pediatric patients. Facial nerve palsy is significantly associated with malignant tumors and total parotidectomy. MRI is the most accurate imaging modality for diagnosing malignant lesions. FNA exhibits moderate agreement with the final pathology. Level of Evidence Level IV.
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Affiliation(s)
| | - Wisarut Samuckkeethum
- Department of Otolaryngology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Hanpon Klibngern
- Department of Otolaryngology, Faculty of MedicineChiang Mai University HospitalChiang MaiThailand
| | - Narin Ratanaprasert
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Jakkree Naruekon
- Department of Otorhinolaryngology, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Kitti Jantharapattana
- Department of Otolaryngology Head and Neck Surgery, Faculty of MedicinePrince of Songkla UniversityHat YaiThailand
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Felicelli C, Reznicek J, Chornenkyy Y, Jager L, Johnson D. Validation of the Milan system for reporting salivary gland cytopathology: a single institution's 10-year experience. J Am Soc Cytopathol 2022; 11:264-273. [PMID: 35660360 DOI: 10.1016/j.jasc.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Fine needle aspiration cytology is often used for the initial diagnosis and management of patients with salivary gland tumors. Because of its global usage, a consensus classification schema was devised in 2018 to initiate universal reporting of salivary gland cytology specimens, termed the Milan system for reporting salivary gland cytopathology (MSRSGC) and composed of distinct diagnostic categories. Few retrospective studies have been undertaken to review the MSRSGC within institutions. MATERIALS AND METHODS We analyzed salivary gland fine needle aspirations during a 10-year span from 2011 to 2021, categorized each cytology case to fit the MSRSGC, and subsequently reviewed the corresponding surgical resections, if indicated, to determine the rate of malignancy (ROM) and rate of neoplasia. RESULTS Our ROM was higher (>10%) for the following MSRSGC categories: non-neoplastic, atypia of undetermined significance, and suspicious for malignancy. Also, our data correlated well with the following MSRSGC categories: nondiagnostic, neoplasm-benign, salivary gland neoplasm of uncertain malignant, and malignant. CONCLUSIONS Although the data were indicative of the ROM for surgically resected salivary gland lesions, the ROM for non-neoplastic lesions could truly be lower given that most lesions in this category will not undergo surgical resection. Additionally, determination of the rate of neoplasia could a tool that could be used to further guide our clinical colleagues.
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Affiliation(s)
- Christopher Felicelli
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Joseph Reznicek
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yevgen Chornenkyy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lucy Jager
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Johnson
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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15
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Hindi I, Simsir A, Szeto O, Hernandez O, Sun W, Zhou F, Brandler TC. The Milan System for Reporting Salivary Gland Cytopathology. Am J Clin Pathol 2022; 158:583-597. [PMID: 35849113 DOI: 10.1093/ajcp/aqac075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Our study assesses whether the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) offers any benefit over the original cytology classification, and measures interobserver agreement. METHODS Four cytopathologists retrospectively blindly classified preoperative cytology by MSRSGC from 101 resected salivary tumors. Consensus MSRSGC diagnoses were correlated with surgical pathology diagnoses and compared with the original cytology classification. Diagnostic parameters were calculated for both systems. Interobserver variability was assessed. RESULTS The original cytology classification vs MSRSGC had sensitivity, specificity, positive predictive value, and negative predictive value of 75.0% vs 78.3%, 97.1% vs 98.0%, 91.2% vs 94.7%, and 90.1% vs 90.0%, respectively. The original cytology classification risk of neoplasm (RON) was 91.7% for "negative for malignancy" and 100.0% for other categories. The MSRSGC RON was 71.4% in category II (nonneoplastic) and 100.0% in all other categories. The original cytology classification risk of malignancy (ROM) ranged from 0.0% for "atypical" to 100.0% for "positive for malignancy." The MSRSGC ROM ranged from 0.0% in categories I (nondiagnostic) and III (nonneoplastic) to 100.0% in category VI (malignant). Weighted agreement using the MSRSGC was 92% (Gwet AC1, 0.84); unweighted agreement was 69% (Gwet AC1, 0.64). MSRSGC category IVA (benign neoplasm) was most likely to show interobserver agreement, with complete agreement in 67% of cases. CONCLUSIONS The MSRSGC performs similarly to the original cytology classification and shows relatively high interobserver agreement.
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Affiliation(s)
- Issa Hindi
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Aylin Simsir
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Oliver Szeto
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Osvaldo Hernandez
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Wei Sun
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Tamar C Brandler
- Department of Pathology, New York University Langone Health, New York, NY, USA
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16
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Gubbiotti MA, Jalaly J, Baloch Z. Making a case for the success of Milan system for reporting salivary gland cytopathology. Diagn Cytopathol 2022; 50:451-455. [PMID: 35801712 DOI: 10.1002/dc.25010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Maria A Gubbiotti
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jalal Jalaly
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Trabzonlu L, Jager L, Tabibi S, Compton ML, Weiss VL, Kanber Y, Robila V, Antic T, Maleki Z, Morency E, Barkan GA. Adrenal gland cytology reporting: a multi-institutional proposal for a standardized reporting system. Cancer Cytopathol 2022; 130:423-432. [PMID: 35244974 PMCID: PMC10191772 DOI: 10.1002/cncy.22564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the development of new technologies and the changing patient profiles, cytopathology departments receive increasing numbers of adrenal gland cytology specimens. In this study, the authors analyzed archival adrenal gland cytology cases and attempted to implement a diagnostic reporting system. DESIGN Retrospective electronic medical record search was performed for adrenal gland cytology specimens in seven tertiary care centers. The cytology diagnoses were grouped in 7 categories: nondiagnostic, nonneoplastic, benign adrenal cortical elements (BACE), primary neoplasm of noncortical origin (NONC), atypia of undetermined significance (AUS), suspicious for malignancy (SM), and malignant (MAL). If available, histopathology results of concurrent and/or follow-up biopsies and/or resections were documented. RESULTS A total of 473 adrenal gland cytology cases were included. BACE cases comprised 21.8%, whereas MAL cases were 57.5% of all cases. For BACE and MAL categories, there were 100% and 98.9% correlation, respectively, in the cases with histopathology follow-up. Six of 10 NONC cases had histopathology diagnoses and there were 3 pheochromocytomas and 3 schwannomas. Twenty-one AUS cases had histology follow-up and 10 (47.6%) of them were malignant. Six cases of SM had histopathology follow-up, and all of them were malignant on the follow-up. CONCLUSIONS The authors propose a 7-tier diagnostic scheme for adrenal gland cytology. The risk of malignancy was 98.9% in MAL cases (87/88) in the cohort. The only case with discordance was reported as "adrenal cortical adenoma with marked atypia"' on resection. There was no difference between endoscopic ultrasound-guided and percutaneous methods. Further studies are needed to validate and make this approach universal.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Lucy Jager
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Seena Tabibi
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Margaret L. Compton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vivian L. Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yonca Kanber
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Valentina Robila
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Tatjana Antic
- Department of Pathology, The University of Chicago Medical Center, Chicago, Illinois
| | - Zahra Maleki
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Elizabeth Morency
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Güliz A. Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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Isgor IS, Ercetin SY, Enver N, Cinel L. Histopathological Review of Diagnostic Categories of the Milan System for Reporting Salivary Gland Cytopathology - An Institutional Experience of 6 Years. J Cytol 2022; 38:203-209. [PMID: 35002113 PMCID: PMC8670457 DOI: 10.4103/joc.joc_193_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 07/29/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Salivary gland malignancies account for 2 to 4% of head and neck cancers. Fine needle aspiration cytology (FNAC) is used in preoperative diagnosis of salivary gland lesions. Although FNAC is a highly reliable technique for preoperative diagnosis, there were no consensus on salivary gland cytopathology reporting. Recently, an international group has recommended a classification system for salivary gland FNAC reporting titled “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC). In this study, we aimed to evaluate the usability of the Milan System, its ability to determine the risk of malignancy for each category, with comparisons of inital cytologic and final histopathological diagnosis. Materials and Methods: We performed a retrospective analysis of salivary gland lesion FNAC in our department from 2013 to 2019. A total of 578 FNACs were performed in 514 patients. Of these, 85 cases had surgical follow-up (parotid gland, n = 73, submandibular gland, n = 12). The cytological samples were categorized according to the MSRSGC into six categories by two pathologists. The risk of malignancy (ROM) and diagnostic accuracy values were calculated for each diagnostic categories. Results: A total of 85 aspirates of the patients with follow-up, the MSRSGC diagnostic categories were as follows: non-diagnostic in 7 aspirates (8.2%), non-neoplastic in 3 (3.5%), atypia of undetermined significance (AUS) in 9 (10.5%), benign neoplasm in 43 (50.5%), salivary gland neoplasm of undetermined malignant potential in 7 (8.2%), suspicious for malignancy in 10 (11.7%), and malignant in 6 (7%). The ROM for each category was 28, 5%, 0%, 33%, 0%, 28.5%, 90%, and 100%, respectively. Conclusion: FNAC plays a critical role in the evaluation of patients with salivary gland lesions. The MSRSGC helps in the standardization of the process of diagnosis and clinical management of salivary gland lesions, especially of AUS and SUMP categories that are indeterminate categories in nature.
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Affiliation(s)
- Irem S Isgor
- Department of Pathology, Sinop Ataturk State Hospital, Sinop, Turkey
| | - Selim Yigit Ercetin
- Department of Pathology, Marmara University School of Medicine, Pendik Research and Training Hospital, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology, Marmara University School of Medicine, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Leyla Cinel
- Department of Pathology, Marmara University School of Medicine, Pendik Research and Training Hospital, Istanbul, Turkey
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Gnanapriya V, Pahwa S, Panjwani P. Reclassification of salivary gland aspirates based on “The Milan system for reporting salivary gland cytology”: A five-year retrospective study. J Cytol 2022; 39:98-104. [PMID: 36277807 PMCID: PMC9585809 DOI: 10.4103/joc.joc_106_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: The Milan System for reporting salivary gland cytopathology helps standardize reporting systems across institutions, improve communication between clinicians and pathologists and guide the clinical management of patients. Aims: This study was undertaken to evaluate the utility of the Milan system classification in cytology reporting. Settings and Design: The present study is a retrospective study conducted over a period of five years in tertiary care centre. Methods and Materials: All the cases of salivary gland aspirates were reviewed and reclassified into six diagnostic categories according to the Milan system of reporting salivary gland cytology (MSRSGC). Cytological diagnosis was correlated with the histopathological diagnosis wherever available. Results: A total of 258 cases were classified using the Milan system as non-diagnostic (20.9%), non-neoplastic (26.3%), atypia of undetermined significance (4.7%), neoplasm benign (37.5%), neoplasm of uncertain malignant potential (3.5%), suspicious for malignancy (0.4%), and malignancy (6.6%). Cytohistological discordance was noted among 8/76 cases (10.5%). The sensitivity and specificity of FNAC were 75% and 98.5%, respectively. The risk of malignancy was 14.2% for Category I, 9% for II, 50% for III, zero for IVA and IVB, and 83.3% for category VI. Conclusions: The new classification system helps pathologists to standardize reporting leading to better clinical and surgical management.
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20
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Yildiz S, Seneldir L, Tepe Karaca C, Zer Toros S. Fine-Needle Aspiration Cytology of Salivary Gland Tumors Before the Milan System: Ten Years of Experience at a Tertiary Care Center in Turkey. Medeni Med J 2021; 36:233-240. [PMID: 34915682 PMCID: PMC8565579 DOI: 10.5222/mmj.2021.90912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/31/2021] [Indexed: 11/05/2022] Open
Abstract
Objective The role of fine-needle aspiration cytology (FNAC) is well established for preoperative evaluation of patients with salivary gland lesions. However, the lack of a uniform system for salivary gland FNAC has limited its effectiveness. In recent years, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been in use around the world to report the cytology results. We aimed to investigate the efficacy and accuracy of FNAC examined according to pre-MSRSGC era dichotomous benign/malignant classification in salivary gland tumors. Methods Patients who underwent surgery between January 2011 and December 2020 due to major salivary gland tumors were retrospectively analyzed. Two hundred and four patients were included in the analysis. Preoperative FNAC results and final histopatological diagnoses were grouped as benign or malignant. Final histopatological diagnoses were compared with the preoperative FNAC results. Also, sensitivity, specificity, and accuracy of the preoperative FNAC results, as well as the agreement between both tests were investigated. Results The sensitivity, specificity, accuracy, positive and negative predictive values of the preoperative FNAC for the diagnosis of malignancy were 59.09%, 97.85%, 93.75%, 76.47%, and 95.29%, respectively. There was a moderate agreement between the preoperative FNAC results and final histopatological diagnoses. Conclusion The accuracy of the preoperative FNAC and the information given about malignancy risk are the most important criteria for patient management and decision-making. The MSRSGC, which consists of a six-tiered classification rather than a dichotomous "yes/no" system, may contribute to patient management and decision-making by increasing the efficacy and accuracy of FNAC.
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Affiliation(s)
- Selcuk Yildiz
- Haydarpaşa Numune Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, İstanbul, Turkey
| | - Lutfu Seneldir
- Haydarpaşa Numune Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, İstanbul, Turkey
| | - Cigdem Tepe Karaca
- Haydarpaşa Numune Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, İstanbul, Turkey
| | - Sema Zer Toros
- Haydarpaşa Numune Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, İstanbul, Turkey
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21
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Tommola E, Kalfert D, Hakso-Mäkinen H, Kholová I. The Contributory Role of Cell Blocks in Salivary Gland Neoplasms Fine Needle Aspirations Classified by the Milan System for Reporting Salivary Gland Cytology. Diagnostics (Basel) 2021; 11:diagnostics11101778. [PMID: 34679476 PMCID: PMC8534546 DOI: 10.3390/diagnostics11101778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022] Open
Abstract
(1) Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018, bringing an organ-specific classification system for salivary gland cytopathology. The aim of present study is to evaluate the MSRSGC prospectively, based on a two-year experience in the tertiary care center pathology department, and evaluate the role of routine cell block (CB) preparation in salivary gland cytopathological diagnostics. (2) Methods: In our institution, the Department of Pathology, Fimlab Laboratories, Tampere, Finland, the MSRSGC has been implemented in salivary gland cytopathology since January 2018 and, over a two-year period (January 2018–December 2019), there were 365 fine-needle aspirations, of which 164 had a surgical follow-up. The CB methods used were Plasma-thrombin, the collection of visible fragments, and the Shandon and in-house methods. (3) Results: The MSRSGC diagnostic figures were as follows: accuracy 87.5%, sensitivity 45.8% and specificity 98.9%. For diagnostic categories of MSRSGC (non-neoplastic, benign neoplasm and malignant neoplasm) (n = 63) diagnostic accuracy was 98.4%, and for undetermined categories (atypia of undetermined significance, salivary gland neoplasm of uncertain malignant potential and suspicious for malignancy) (n = 49) diagnostic accuracy was 73.5%. Non-contributory cell blocks resulted more often in a false negative diagnosis (25%, 3/12) than a true negative diagnosis (10%, 7/73, p < 0.001), and is, most likely, an insufficient cytological diagnosis (86%, 18/21, p < 0.001). (4) Conclusion: The application of MSRSGC and CBs are beneficial in salivary gland cytological diagnosis, increasing diagnostic accuracy and, thus, patients’ management and treatment.
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Affiliation(s)
- Erkka Tommola
- Fimlab Laboratories, Department of Pathology, Tampere University Hospital, 33520 Tampere, Finland; (E.T.); (H.H.-M.)
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic;
| | - Heli Hakso-Mäkinen
- Fimlab Laboratories, Department of Pathology, Tampere University Hospital, 33520 Tampere, Finland; (E.T.); (H.H.-M.)
| | - Ivana Kholová
- Fimlab Laboratories, Department of Pathology, Tampere University Hospital, 33520 Tampere, Finland; (E.T.); (H.H.-M.)
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Correspondence: ; Tel.: +358-3-311-74851
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22
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Gupta S, Dey P. Diagnostic challenges in the gray-zone lesions of fine-needle aspiration cytology. Cytojournal 2021; 18:23. [PMID: 34754322 PMCID: PMC8571265 DOI: 10.25259/cytojournal_66_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
Fine-needle aspiration cytology (FNAC) is an excellent technique for rapid diagnosis due to its speed, accuracy, and cost-effectiveness. However, there are many gray-zone areas in cytology that needs attention. These lesions in the aspiration cytology can be overcome by applying the selective use of the series of tests. This review discusses the diagnostic challenges in the gray-zone areas in FNAC. It emphasizes the use of selective ancillary techniques to solve the problems in this area.
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Affiliation(s)
- Shruti Gupta
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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23
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Mydlarz WK. Clinician's commentary: Atypia in salivary gland fine needle aspiration. Diagn Cytopathol 2021; 50:162-163. [PMID: 34432382 DOI: 10.1002/dc.24858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/12/2022]
Abstract
Due to the heterogenicity and morphological overlap among the broad spectrum of benign and malignant salivary gland lesions, cytopathology result interpretations can be challenging and variable even among the most experienced head and neck pathologist. There was no standardization of cytopathology result reporting until the recently proposed "Milan system for reporting salivary gland cytopathology" (MSRSGC). MSRSGC may offer more clarity and help minimize ambiguity, but surgeons, as part of multidisciplinary teams, do not only rely on the tiered stratification and risk of malignancy assessment. With only the MSRSGC reported, there may be critical information missing from the overall diagnostic evaluation of salivary gland masses. Cytopathologist evaluation, description of findings, and expert interpretation of the fine-needle aspiration cytology along with differential diagnosis can be critical pieces of information, that is, utilized in management discussions with patients and their families. This information needs to be included in every cytopathology interpretation in addition to the MSRSGC classification. In clinical practice, decisions concerning salivary gland tumor management are not based on single examinations but incorporate information from multiple sources including patient histories, clinical symptoms and signs, physical examinations, imaging studies, and when available, cytopathology. Additional cytopathology information will likely help to improve the utility and predictive power of MSRSGC, similar to Bethesda Classification and the predictive importance of nuclear atypia in indeterminate thyroid biopsy material for thyroid neoplasms.
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Affiliation(s)
- Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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24
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Collins GL, Hubbard EW, Clark CT, Duncan LD, Nodit L. Cytologic analysis of vitreous fluids: A retrospective review of our 24 years of experience. Diagn Cytopathol 2021; 49:1122-1128. [PMID: 34342943 DOI: 10.1002/dc.24831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/04/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cytologic analysis of vitreous fluid is an important component in diagnosis of vitreitis. No standard reporting guidelines exist for these specimens. This study chronicles our 24 years experience and proposes a tentative diagnostic model. METHODS Retrospective cytology reports review and database study. Clinical indications, cytologic patterns, ancillary studies performed, and diagnoses were recorded. RESULTS 176 samples from 160 patients were included and main cytologic patterns are reflected in Table 1. Most fluids were negative for malignancy (88%) and patterns IIB (53%) and IIA (19%) were dominant. The non-diagnostic rate was 7%; atypical and suspicious categories represented <0.5% of fluids tested and only 2% were positive for malignancy (3 intraocular lymphoma and one melanoma). Clinical indications for fluid examination were infection/inflammation (59%), to rule out lymphoma (11%), amyloidosis (3%), melanoma (2%), or to investigate intraocular hemorrhage. Fungal elements were demonstrated in 7 cases. No viral inclusions were appreciated; however, one case was positive for HSV 2 by IHC and 2 were negative by PCR. One case had Gram + cocci. Flow cytometry studies were suboptimal in 6 fluids, negative for an aberrant lymphocyte population in 11, and positive for high grade lymphoma in 3 cases. Atypical, suspicious and positive for melanoma were reported in 3 samples. Amyloid was identified in 1 aspirate. CONCLUSIONS Cytologic analysis of vitreous fluid is a useful tool. Modern techniques like flow cytometry and PCR testing further expand the diagnostic possibilities. Standardization of diagnostic terminology will aid clinicians caring for patients suffering from ocular disease.
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Affiliation(s)
- Gabriel L Collins
- Department of Pathology, University of Tennessee Medical Center Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Elizabeth W Hubbard
- Department of Pathology, University of Tennessee Medical Center Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Christopher T Clark
- Department of Pathology, University of Tennessee Medical Center Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Lisa D Duncan
- Department of Pathology, University of Tennessee Medical Center Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Laurentia Nodit
- Department of Pathology, University of Tennessee Medical Center Graduate School of Medicine, Knoxville, Tennessee, USA
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25
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Bharti JN, Elhence P, Rao M, Nalwa A, Khera S. Risk stratification by application of Milan system for reporting salivary gland cytopathology: A tertiary care experience. Cytojournal 2021; 18:19. [PMID: 34512790 PMCID: PMC8422464 DOI: 10.25259/cytojournal_26_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/30/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The Milan system for reporting salivary gland cytopathology (MSRSGC) classification has been proposed to improve reproducibility in the management of salivary gland lesions. Fine-needle aspiration cytology (FNAC) is a widely accepted, well-tolerated, cost-effective, minimally invasive diagnostic method for pre-operative evaluation of salivary gland lesion that aids management decisions. The present study aims to reclassify the salivary gland FNAC aspirates by applying MSRSGC and calculating the risk of neoplasm and malignancy for each diagnostic category. MATERIAL AND METHODS The present study is a retrospective observational study done for 54 months. A total of 168 cases of salivary gland FNA, 54 cases were excised in our institute for histopathology. Retrospective reviews were performed, and the FNAC cases were reclassified according to the Milan system, and the results of FNAC and final histology were correlated, wherever available. Furthermore, the risk of malignancy was calculated for all the diagnostic categories. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of FNAC were determined. RESULTS In the present study, the age of patients ranged from 3 to 86 years, with a mean age of 39 years. Among all the patients, 61.3% were male, and 38.6% were female. However, only 54 salivary gland FNA samples for which histopathology was available were categorized into six categories. Among them, category IV (neoplastic) had a maximum number of cases of 66.6%. The rate of malignancy was calculated for all diagnostic categories as follows: (1) Non-diagnostic: 0.0%, (2) non-neoplastic 0.0%, (3) atypia of undermined significance 100%, (4a) benign 5.5%, (4b) uncertain malignant potential 33.33%, (5) suspicious for malignancy 00%, and (6) malignancy 80%. The sensitivity, specificity, PPV, NPV, and DA for differentiating between benign and malignant neoplasm were 36.3%, 94.4%, 66.6%, 82.9%, and 80%. Two false-positive and seven false-negative neoplastic cases were noted. CONCLUSION FNAC is a reliable, minimally invasive diagnostic method with high DA for diagnosing salivary gland lesions. Most salivary gland lesions can be accurately diagnosed on FNAC with adequate sampling and cytopathologists experience.
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Affiliation(s)
- Jyotsna Naresh Bharti
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Meenakshi Rao
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Aasma Nalwa
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sudeep Khera
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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26
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Modifying phrases in surgical pathology reports: introduction of Standardized Scheme of Reporting Certainty in Pathology Reports (SSRC-Path). Virchows Arch 2021; 479:1021-1029. [PMID: 34272982 DOI: 10.1007/s00428-021-03155-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Pathologists often incorporate modifying phrases in their diagnosis to imply varying levels of diagnostic certainty; however, what is implied by the pathologists is not equivalent with what is perceived by the referring physicians and patients. This discordance can have significant implications in management, safety, and cost. We intend to identify lack of consistency in interpretation of modifying phrases by comparing perceived level of certainty by pathologists and non-pathologists, and introduce a standard scheme for reporting uncertainty in pathology reports using the experience with imaging reporting and data systems. In this study, a list of 18 most commonly used modifying phrases in pathology reports was distributed among separate cohorts of pathologists (N = 17) and non-pathology clinicians (N = 225) as a questionnaire survey, and the participants were asked to assign a certainty level to each phrase. All the participants had practice privileges in Brown University-affiliated teaching hospitals. The survey was completed by 207 participants (17 pathologists, 190 non-pathologists). It reveals a significant discordance between the interpretations of the modifying phrases between the two cohorts, with significant variations in subgroups of non-pathology clinicians. Also there is disagreement between pathologists and other clinicians regarding the causes of miscommunication triggered by pathology reports. Pathologists and non-pathology clinicians should be mindful of the potential sources of misunderstanding of pathology reports and take necessary actions to prevent and clarify the uncertainties. Using a standard scheme for reporting uncertainty in pathology reports is recommended.
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27
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Wang H, Weiss VL, Ely K, Johnson J, Coogan A, Borinstein SC, Mannion K, Virgin F, Liang J. Application of the Milan System for Reporting Pediatric Salivary Gland Cytopathology: Analysis of histologic follow-up, risk of malignancy, and diagnostic accuracy. Cancer Cytopathol 2021; 129:555-565. [PMID: 33595882 PMCID: PMC10030063 DOI: 10.1002/cncy.22415] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The diagnosis and management of salivary gland tumors in pediatric patients can be challenging. The utility of fine-needle aspiration (FNA) cytopathology and the performance of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in this age group have not been systematically assessed. The paucity of data has contributed to the controversial role of FNA cytopathology in the presurgical management of these patients. METHODS The authors retrospectively analyzed 104 pediatric salivary gland FNAs (2000-2020). A correlation with the available histopathologic follow-up (n = 54) was performed. The distribution percentages, the risk of neoplasm (RON), and the risk of malignancy (ROM) were assessed for each category of the MSRSGC. RESULTS The overall sensitivity, specificity, negative predictive value, and positive predictive value of pediatric salivary gland FNAs were 80%, 97%, and 92%, respectively. The RON values for the nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant categories were 60%, 11%, 100%, 100%, 100%, 100%, and 100%, respectively, whereas the ROM values were 0%, 11%, 100%, 6%, 67%, 100%, and 100%, respectively. The percentage of nonneoplastic FNAs was greater in comparison with the adult population (52% vs 8%). All neoplasms in patients aged 0 to 10 years were malignant, whereas benign neoplasms occurred only in patients aged ≥11 years; this supported an inverse correlation between age and malignancy rate in salivary gland neoplasms. CONCLUSIONS FNA cytopathology demonstrates excellent diagnostic performance in differentiating malignant and benign pediatric salivary gland lesions. The MSRSGC is a valuable tool for standardization of the reporting and preoperative risk stratification of these lesions.
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Affiliation(s)
- Huiying Wang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center
| | - Vivian Lee Weiss
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center
| | - Kim Ely
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center
| | - Joyce Johnson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center
| | - Alice Coogan
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center
| | - Scott C. Borinstein
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center
| | - Kyle Mannion
- Department of Otolaryngology, Vanderbilt University Medical Center
| | - Frank Virgin
- Department of Otolaryngology, Vanderbilt University Medical Center
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center
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28
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Mireles MG, Julián A, Salgado-Chavarría F, González GM. Benign myoepithelioma of the soft palate: an unusual clinical entity. BMJ Case Rep 2021; 14:e240384. [PMID: 34187791 PMCID: PMC10577746 DOI: 10.1136/bcr-2020-240384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/06/2022] Open
Abstract
Myoepitheliomas are rare benign tumours that affect the exocrine glands and are sporadically located in the salivary glands. The most common location of myoepithelioma in the oral cavity is the parotid gland and it is seldom encountered in the palate. The diagnosis of this entity is challenging since its clinical presentation may resemble those of more common neoplasms, rendering a complex histopathological diagnosis. The aim of the present case report is to describe an unusual case of myoepithelioma of the soft palate in a male patient, which developed as an asymptomatic, slowly growing mass. The tumour was assessed with histopathological examination and the diagnosis was verified via immunohistochemistry. Finally, the treatment included surgical resection of the tumour and no signs of recurrence were noted 2.5 years after the surgical procedure. Early diagnosis and treatment plays an important role in the prognosis of this pathological entity.
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Affiliation(s)
| | - Angelica Julián
- Cirugia Maxilofacial, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de México, México
| | - Fabiola Salgado-Chavarría
- Especialidad de Cirugía Oral y Maxilofacial, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Guillermo Manuel González
- Anatomía Patológica, Hospital Regional De Alta Especialidad de Ixtapaluca, Estado de México, Estado de México, México
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29
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Sučić M, Ljubić N, Perković L, Ivanović D, Pažanin L, Sučić Radovanović T, Župnić-Krmek D, Knežević F. Cytopathology and diagnostics of Warthin's tumour. Cytopathology 2021; 31:193-207. [PMID: 32259367 DOI: 10.1111/cyt.12830] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
Warthin's tumour (WT) is a benign epithelial salivary tumour, one type of salivary adenoma. Histologically, WT is structured of two components, epithelial tissue that often lines cystic formations and lymphoid tissue in the tumour stroma. FNA is a reliable diagnostic approach in the diagnosis of salivary gland lesions allowing a highly accurate categorization of benign tumour-like lesions, benign tumours and malignant tumours. In the proposed Milan reporting system of salivary gland lesions, WT is categorized in the IVA group of benign neoplasms. Accurate cytological diagnosis is straightforward when three characteristic components are present: oncocytes, either isolated or associated in clusters, lymphocytes and lymphoid cells and often an inflammatory/necrotic-like substance. Also, specific features of scintigraphy and radiological imaging contribute to the diagnosis of WT. WT is categorized according to Seifert G. et al in 4 types, depending on the proportions of the epithelial component and lymphoid stroma. Differential cytopathological and pathohistological diagnosis include other salivary gland lesions with lymphoid, oncocytic epithelial and cystic components. In some cases, such as the metaplastic WT variant, there are additional cytopathological and histological diagnostic difficulties. Moreover, bilateral, multicentric or multiple and infrequently seen extra-salivary localizations of WT are associated with further cytopathological diagnostic difficulties. Also, a rare possibility of malignant transformation of the epithelial or lymphoid component of WT as well as possible association with other primary tumours remains a challenge in accurate cytopathological and histological diagnosis of WT.
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Affiliation(s)
- Mirna Sučić
- Division of Cytology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia.,Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, Zagreb University, Zagreb, Croatia.,Zagreb Medical School, Zagreb University, Zagreb, Croatia
| | - Nives Ljubić
- Division of Cytology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Leila Perković
- Division of Cytology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Dunja Ivanović
- Division of Cytology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Leo Pažanin
- Ljudevit Jurak Department of Pathology and Cytology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - Dubravka Župnić-Krmek
- Division of Haematology, Clinical Department of Internal Medicine, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Fabijan Knežević
- Division of Pathology, Department of Pathology and Cytology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
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30
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Rossi ED, Faquin WC. The Milan system for reporting salivary gland cytopathology: The clinical impact so far. Considerations from theory to practice. Cytopathology 2021; 31:181-184. [PMID: 32463557 DOI: 10.1111/cyt.12819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Agostino gemelli-IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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31
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Boldes T, Hilly O, Alkan U, Shkedy Y, Morgenstern S, Shpitzer T, Bachar G, Mizrachi A. Accuracy, predictability and prognostic implications of fine-needle aspiration biopsy for parotid gland tumours: A retrospective case series. Clin Otolaryngol 2021; 46:1065-1072. [PMID: 33942516 DOI: 10.1111/coa.13795] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 03/06/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the precision and utility of fine-needle aspiration (FNA) in differentiating between benign and malignant parotid tumours, and the implications of FNA results on management and outcomes. DESIGN Retrospective case series. SETTING Tertiary medical centre. PARTICIPANTS All adults who underwent preoperative FNA, followed by postoperative histological examination, between 1986 and 2014. MAIN OUTCOME MEASURES Differences in clinical management and outcomes of patients with parotid masses in light of FNA results. RESULTS We analysed 505 samples from 485 patients. According to histopathological results, preoperative FNA successfully identified benign tumours in 89% of the cases (362/405) and only 59% of malignant tumours (59/100). Overall sensitivity and specificity of FNA in distinguishing between different subtypes of benign lesions were 80% and 99%, respectively, whereas positive predictive value (PPV) and negative predictive value (NPV) were 85% and 98%. Moreover, malignant lesions subtyping had high false-positive and false-negative rates with sensitivity, specificity, PPV and NPV of 44%, 100%, 75% and 99%, respectively. Additionally, when FNA falsely classified malignant tumours as benign, surgeries were inappropriately delayed and the durations of surgeries and hospitalisations were shorter, compared to true malignant FNA results. Interestingly, survival was not affected in falsely benign lesions that were mostly low-grade, conversely non-diagnostic FNA for malignant tumours resulted in decreased survival. CONCLUSIONS Our findings highlight the limitations of FNA as a decision-making tool in preoperative evaluation of parotid masses. Clinicians should take into account that FNA is inaccurate for identifying specific subtypes of malignant lesions, which may eventually delay treatment and influence outcome.
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Affiliation(s)
- Tomer Boldes
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Alkan
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Morgenstern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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32
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The Milan System, from Its Introduction to Its Current Adoption in the Diagnosis of Salivary Gland Cytology. JOURNAL OF MOLECULAR PATHOLOGY 2021. [DOI: 10.3390/jmp2020012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Salivary gland masses are often encountered in the everyday practice of cytopathology. It is commonly known that the cytologic interpretation of these lesions can pose diagnostic problems due to overlapping cytomorphologic features. Fine needle aspiration (FNA) of salivary lesions shows good to excellent sensitivity and specificity in differentiating a neoplastic from a non-neoplastic process and in diagnosing common tumors such as pleomorphic adenoma. However, its value is limited in diagnosing specific neoplastic entities especially those with well-differentiated morphology. In light of this gap, an international group of pathologists has proposed a management-oriented, tiered classification for reporting salivary gland FNA specimens, “The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)”. Similar to other classification systems, the MSRSGC scheme comprises six diagnostic categories, which were linked with a specific risk of malignancy (ROM) and management. In this review article, the author evaluated the published literature on FNA in diagnosing salivary gland lesions with the adoption of the Milan system since its introduction in the daily practice of salivary cytopathology.
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33
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Rossi ED, Faquin WC. Experience from the world: The accuracy of salivary gland FNA and reliability of the Milan System for Reporting Salivary Gland Cytopathology in a large study from the Netherlands. Cancer Cytopathol 2021; 129:675-676. [PMID: 33900675 DOI: 10.1002/cncy.22437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, Rome, Italy
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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34
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Hosseini SM, Resta IT, Baloch ZW. Diagnostic performance of Milan system for reporting salivary gland cytopathology: A prospective study. Diagn Cytopathol 2021; 49:822-831. [PMID: 33823076 DOI: 10.1002/dc.24748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is a well-established modality for diagnosing salivary gland pathologies. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized uniform framework leading to an evidence-based risk of malignancy (ROM). Based on the current literature, ROM in the 6-tier MSRSGC ranges from <5% for neoplasm-benign to >90% for the malignant category. Here, we report our institutional experience adopting MSRSGC. METHODS The cytopathology group at our institution implemented MSRSGC at the end of 2018. Through a query of our laboratory information system, we identified all salivary gland FNA cases from 27 November 2018 to 26 October 2020. The pertinent surgical pathology follow-up was also extracted. After manual curation, data was analyzed in Rv4.0.2. RESULTS Our cohort comprised of 315 patients undergoing 343 salivary gland FNA biopsies, predominantly on the parotid (90%), 162 with a surgical pathology follow-up. The risk of malignancy ranged from 3.2% in neoplasm-benign (IVA) to 100% in suspicious for malignancy (V) and malignant (VI) categories. ROM in the other categories was: 12.5% for non-diagnostic, 0 for non-neoplastic, 33.3% for atypia of undetermined significance, and 41.9% for salivary gland neoplasm of uncertain malignant potential (SUMP). Most SUMP cases had a basaloid or oncocytoid cytomorphology with similar ROM. In distinguishing benign and malignant salivary gland lesions, FNA had adequacy of 93.6%, a diagnostic yield of 62.2%, a sensitivity of 93.1% and a specificity of 100%. CONCLUSIONS MSRSGC was successfully adopted by our cytology group and clinicians, with overall diagnostic performance similar to previous studies.
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Affiliation(s)
- S Mohsen Hosseini
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isabella Tondi Resta
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Remote cytological diagnosis of salivary gland lesions by means of precaptured videos. J Am Soc Cytopathol 2021; 10:435-443. [PMID: 33707150 DOI: 10.1016/j.jasc.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/24/2021] [Accepted: 02/15/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of implementing videos captured by static telecytological applications for remote cytological diagnosis of fine needle aspiration (FNA) specimens from salivary gland lesions. METHODS The current study was performed on 102 specimens from patients referred to the Alpha Prolipsis Cytopathology Department for preoperative evaluation of salivary gland lesions. In all cases, surgical excision followed the initial cytological diagnosis. (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23). Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. RESULTS Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of precaptured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71-0.89. CONCLUSIONS Videos production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary glands FNAs. Videos of salivary glands FNAs can be used for accurate diagnosis, educational and second opinion purposes,. They can also be used for archiving, teleconsultation and educational purposes, improving the performance of the already existing static telecytology stations and small cytology departments' quality indices.
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36
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Archondakis S, Roma M, Evropi K. Implementation of pre-captured videos for remote cytological evaluation of salivary gland lesions. J Telemed Telecare 2021:1357633X21995061. [PMID: 33596713 DOI: 10.1177/1357633x21995061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to examine the feasibility of implementing videos captured by static telecytological applications for remote cytological evaluation of fine needle aspiration specimens from salivary gland lesions. METHODS The current study was carried out on 102 fine needle aspiration specimens from salivary gland lesions with histological confirmation (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23), retrospectively selected from the department's registry. Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. RESULTS Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of pre-captured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71-0.89. CONCLUSIONS Video production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary gland fine needle aspirations. Videos of salivary gland fine needle aspirations can be used for rapid and accurate diagnosis, by diminishing turn-around times and improving the quality indices of small cytology departments. They can also be used for archiving, teleconsultation, educational and second opinion purposes, improving the performance of the already existing static telecytology stations.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Kaladelfou Evropi
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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37
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Marginean FE, Lesnik M, Gauthier A, Klijanienko J. The accurate cytological diagnosis of salivary carcinoma ex pleomorphic adenoma may be hampered by myoepithelial differentiation. Cytopathology 2021; 32:527-530. [PMID: 33528074 DOI: 10.1111/cyt.12950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/21/2020] [Accepted: 12/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Maria Lesnik
- Head and Neck Oncological Surgery, Institut Curie, Paris, France
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38
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Archondakis S, Roma M, Kaladelfou E. Two-Year Experience of the Implementation of the Milan for Reporting Salivary Gland Cytopathology at a Private Medical Laboratory. Head Neck Pathol 2021; 15:780-786. [PMID: 33459992 PMCID: PMC8384965 DOI: 10.1007/s12105-020-01278-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
This study aimed to present the 2-year experience of the implementation of the Milan System for Reporting Salivary Gland Cytopathology at Alpha Prolipsis Medical Laboratories, a private medical laboratory located in Athens, Greece. A totaI of 102 Fine Needle Aspirations (FNAs) performed since 2018 were included in the study. Reports were issued according to the Milan System for Reporting Salivary Gland Cytopathology. Aspirates were prepared with both conventional and liquid-based cytological methods and were evaluated by two or three Board-certified cytopathologists. Diagnostic reproducibility and accuracy were evaluated. All cases included in this study had histologic follow-up. The diagnostic accuracy of FNA for differentiating between benign and malignant disease according to MSRSGC classification was 93.3%, the specificity was 97.5% and the sensitivity was 82.2%. The positive and negative predictive values were 93.2 and 87.2%, respectively. Our results show that FNA is a valuable examination technique in the preoperative evaluation of salivary gland lesions. The integration of the 2018 Milan System for Reporting Salivary Gland Cytopathology is effective, with an overall accuracy around 95%.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, 163 Mesogion Street, 11526 Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, 163 Mesogion Street, 11526 Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, 163 Mesogion Street, 11526 Athens, Greece
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39
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Mlees MA, Elbarbary AH. Superficial or partial superficial parotidectomy for the treatment of primary benign parotid tumors. J Surg Oncol 2020; 122:1315-1322. [DOI: 10.1002/jso.25970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Mohamed Ali Mlees
- Surgical Oncology Unit, General Surgery Department Tanta University Hospitals Tanta Egypt
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40
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Castrodad-Rodríguez CA, Lajara S, Khader SN, Colanta AB, Guerrero DR, El Hussein S, Hakima L. Application of the Milan System for Reporting Salivary Gland Cytopathology: Experience of an academic institution in a tertiary academic medical center. Cancer Cytopathol 2020; 129:204-213. [PMID: 33030811 DOI: 10.1002/cncy.22361] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/01/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) represents a standardized reporting system for salivary gland lesions. The recent literature has demonstrated a wide range of data regarding range of malignancy (ROM) and interobserver variability. The objective of the current study was to evaluate the reproducibility and interobserver agreement of MSRSGC, and establish the ROM in a unique patient population residing within a designated Health Professional Shortage Area. METHODS A total of 380 salivary gland fine-needle aspiration cases were obtained over a 3-year period. Corresponding cytology reports and slides were reviewed in a blinded fashion by a panel of cytopathologists and recategorized using MSRSGC. ROM was calculated by cytohistologic correlation in 176 cases. Agreement between review of reports and slides and interobserver reliability were determined using kappa statistics. RESULTS The ROMs per MSRSGC category based on review of reports and slides were as follows: 4% and 0%, respectively, for nonneoplastic; 22% and 0%, respectively, for nondiagnostic; 42.9% and 48%, respectively, for atypia of undetermined significance; 1.6% and 1.9%, respectively, for benign-neoplastic; 17.9% and 15.6%, respectively, for salivary gland neoplasm of uncertain malignant potential; 81.8% and 71.4%, respectively, for suspicious for malignancy; and 100% and 90.5%, respectively, for malignant. There was a 59.2% overall agreement between review of reports and slides with regard to recategorizing salivary gland lesions (kappa, 0.51). The interobserver reliability demonstrated a 64.6% agreement (weighted kappa, 0.59). CONCLUSIONS The ROMs at the study institution appeared comparable to those in the published literature. There was moderate overall agreement among cytopathologists and low interobserver agreement with regard to the indeterminate categories. Image-guided fine-needle aspiration specimens; rapid onsite adequacy; and integration of clinical, imaging, and ancillary studies can improve diagnostic accuracy among indeterminate lesions.
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Affiliation(s)
| | - Sigfred Lajara
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samer N Khader
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Agnes B Colanta
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Dominick R Guerrero
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, New York
| | - Siba El Hussein
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laleh Hakima
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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41
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Horáková M, Porre S, Tommola S, Baněčková M, Skálová A, Kholová I. FNA diagnostics of secondary malignancies in the salivary gland: Bi-institutional experience of 36 cases. Diagn Cytopathol 2020; 49:241-251. [PMID: 33017519 DOI: 10.1002/dc.24629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/27/2020] [Accepted: 09/22/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Fine-needle aspiration (FNA) is a key diagnostic method in the evaluation of salivary gland lesions. Secondary tumors of salivary glands represent only 5% of all malignancies of major salivary glands. The goal of our study was to examine the cytological and clinical features of secondary tumors sampled by FNA. MATERIALS AND METHODS A series of 36 secondary tumors from the pathology departments of two university hospitals are presented. Clinical referrals to FNA, cytological features, immunohistochemical results, and histopathological diagnoses were reviewed in all cases. RESULTS The study population consisted of 36 cases (19 males and 17 females) with mean age 70.9 ± 13.0 years (range 41-96 years). The most common site of the metastasis was parotid gland (n = 26). The primary malignancy was known in 17 cases at the time of FNA diagnosis. The most common primary site was skin of head and neck area (11 cases) followed by lungs (n = 5) and tonsils (n = 5), kidney (n = 2) and breast (n = 2) and thyroid gland, gastrointestinal tract and soft tissue, 1 case of each. In 8 cases, the primary site remained unknown. The diagnostic or confirmatory immunocytochemistry was performed on cell blocks in 21 cases. CONCLUSIONS FNA is a reliable technique in the diagnosis of salivary gland secondary malignancies. The knowledge of the personal history of malignancy is essential for the successful immunocytochemical targeted diagnosis without any delay.
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Affiliation(s)
- Markéta Horáková
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd, Pilsen, Czech Republic
| | | | - Satu Tommola
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - Martina Baněčková
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd, Pilsen, Czech Republic
| | - Alena Skálová
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd, Pilsen, Czech Republic
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Tampere, Finland.,Pathology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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42
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Nakaguro M, Tada Y, Faquin WC, Sadow PM, Wirth LJ, Nagao T. Salivary duct carcinoma: Updates in histology, cytology, molecular biology, and treatment. Cancer Cytopathol 2020; 128:693-703. [PMID: 32421944 PMCID: PMC7541685 DOI: 10.1002/cncy.22288] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Abstract
Salivary duct carcinoma (SDC) is an aggressive subtype of primary salivary gland carcinoma, often with an advanced stage at presentation and high rates of metastasis and recurrence. It most commonly arises in the parotid gland of older men and microscopically resembles high-grade breast ductal carcinoma. While 50 years have lapsed since the first report of this entity, recent intensive studies have shed light on its biologic, genetic, and clinical characteristics. The diagnosis of SDC is aided by the immunohistochemical expression of androgen receptor (AR) coupled with its characteristic histomorphology. Fine-needle aspiration typically reveals cytologic features of high-grade carcinoma, and ancillary studies using cell block material can facilitate the specific diagnosis of SDC. In surgical specimens, certain histologic features are important prognostic factors, including nuclear pleomorphism, mitotic counts, vascular invasion, and the morphology at the invasion front. Several clinical studies have shown promising results using targeted therapy for AR and human epidermal growth factor receptor 2 (HER2), and the latest version of the National Comprehensive Cancer Network guidelines recommends the evaluation of AR and HER2 status before treatment. Recent molecular analyses have revealed multiple heterogeneous alterations in well-known oncogenes and tumor suppressor genes, including TP53, HRAS, PIK3CA, PTEN, and BRAF. Clinical trials of drugs targeting these genes may broaden the treatment options for SDC in the near future.
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Affiliation(s)
- Masato Nakaguro
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - William C. Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lori J. Wirth
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
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43
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Viswanathan K, Maleki Z, Pantanowitz L, Cantley R, Faquin WC. Cytomorphology and diagnostic pitfalls of sebaceous and nonsebaceous salivary gland lymphadenoma: A multi-institutional study. Diagn Cytopathol 2020; 49:83-95. [PMID: 32926569 DOI: 10.1002/dc.24602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Salivary gland lymphadenoma (LAD) is a rare benign neoplasm comprising sebaceous (SLAD) and nonsebaceous (NSLAD) types. Despite established histologic criteria, limited data on cytomorphology, tumor heterogeneity, and overlap with other entities make the diagnosis of LAD by fine needle aspiration (FNA) challenging. We describe a multi-institutional cohort of 14 LADs with cytology, clinical, radiologic, and histopathologic data. METHODS Our cohort included nine SLAD and five NSLAD with corresponding histopathology. Mean patient age and M:F ratio were 60.4 years (range 45-86 years) and 1:2 for SLADs and 57.4 years (range 42-80 years) and 1:1.5 for NSLADs, respectively. One NSLAD patient had a germline predisposition for Cowden syndrome. Glass slides and whole slide images of air-dried Diff-Quik (DQ), alcohol-stained Papanicolaou smears (Pap) and cellblocks were reviewed for key cytomorphologic findings. RESULTS FNAs from SLAD and NSLADs demonstrated vacuolated and basaloid epithelial clusters within a lymphoid background. Vacuolated cells from SLAD showed sebaceous cells with microvesicular cytoplasm indenting a central nucleus. Vacuolated cells from NSLAD were columnar with eccentric nuclei, corresponding to abluminal glandular cells. SLADs were classified using the Milan System for Reporting Salivary Gland Cytopathology as nondiagnostic (11.1%), nonneoplastic (44.4%), atypia of uncertain significance (AUS) (22.2%), and salivary gland neoplasm of uncertain malignant potential (SUMP) (22.2%). NSLADs were classified as AUS (40%), SUMP (40%) and Benign Neoplasm (20%). CONCLUSION Although rare, knowing the cytologic features of salivary LAD is important to avoid diagnostic pitfalls. Vacuolated cells can be prominent in both SLAD and NSLAD aspirates. Diagnostic issues arise from insufficient sampling of all tumor components leading to marked variation in diagnostic classification of LAD.
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Affiliation(s)
- Kartik Viswanathan
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zahra Maleki
- Department of Pathology, John Hopkins Hospital, Baltimore, Maryland, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburg, Pennsylvania, USA.,Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Cantley
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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44
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Faquin WC. Refining the Milan System for Reporting Salivary Gland Cytopathology. Cancer Cytopathol 2020; 129:22-23. [PMID: 32767831 DOI: 10.1002/cncy.22340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 12/15/2022]
Affiliation(s)
- William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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45
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Allison DB, Smith AP, An D, Miller JA, Shafique K, Song S, Viswanathan K, Eykman E, Rao RA, Wiles A, Barkan GA, Nayar R, Fadda G, Powers CN, Rossi ED, Siddiqui MT, Ali SZ, Kholová I, Layfield LJ, Field A, Baloch Z, Maleki Z. Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi-institutional study. Cancer Cytopathol 2020; 129:43-52. [PMID: 32767837 DOI: 10.1002/cncy.22339] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has established distinct diagnostic categories for reporting cytopathological findings, and each is associated with a defined risk of malignancy (ROM). However, the ROM is applied at the overall category level and is not specific for particular morphological entities within a category. Here, the diagnostic performance of the MSRSGC for pleomorphic adenoma (PA) and Warthin tumor (WT) is reported. METHODS The pathology archives of 11 institutions from 4 countries were retrospectively searched to identify all salivary gland fine-needle aspiration (FNA) biopsies with a differential or definitive diagnosis of PA or WT and all resection specimens with a diagnosis of PA or WT; only paired cases were included. All FNA diagnoses were retrospectively classified according to the MSRSGC. RESULTS A total of 1250 cases met the inclusion criteria, and they included 898 PA cases and 352 WT cases. The ROM in the benign neoplasm category was 3.0% and 1.3% for cases with a differential or definitive diagnosis of PA and WT, respectively. The ROM in the salivary gland neoplasm with uncertain malignant potential (SUMP) category was 2.7% and 18.8% for PA and WT, respectively (P = .0277). The diagnostic accuracy for PA and WT was 95.1% and 96.1%, respectively. CONCLUSIONS The diagnostic accuracy for PA and WT on FNA is high. Furthermore, these findings highlight the difference in the ROMs associated with 2 specific differential diagnoses in the SUMP category: basaloid neoplasms and oncocytoid neoplasms.
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Affiliation(s)
- Derek B Allison
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Alexander P Smith
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Daniel An
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - James Adam Miller
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Khurram Shafique
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sharon Song
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kartik Viswanathan
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, New York
| | - Elizabeth Eykman
- Department of Pathology, St. Vincent Hospital, Sydney, New South Wales, Australia
| | - Rema A Rao
- Department of Pathology, Montefiore Medical Center, Bronx, New York
| | - Austin Wiles
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Ritu Nayar
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Guido Fadda
- Department of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Celeste N Powers
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, New York
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lester J Layfield
- Department of Pathology, University of Missouri School of Medicine, Columbia, Missouri
| | - Andrew Field
- Department of Pathology, St. Vincent Hospital, Sydney, New South Wales, Australia
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
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Jalaly JB, Farahani SJ, Baloch ZW. The Milan system for reporting salivary gland cytopathology: A comprehensive review of the literature. Diagn Cytopathol 2020; 48:880-889. [PMID: 32640095 DOI: 10.1002/dc.24536] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Milan system for Reporting Salivary Gland Cytopathology (MSRSGC) was published in 2018. Since then, many authors have published their institutional experience by retrospectively assigning salivary gland fine-needle aspiration cases to each of the MSRSGC categories and calculated their risk of malignancy (ROM) accordingly. METHODS We reviewed all published articles available online in English that used the MSRSGC since or near its publication. We calculated the risk of neoplasm and ROM for each diagnostic category. In addition, the false-negative and false-positive rates from all studies were examined. RESULTS Thirty-seven articles were identified in the English literature; 2 were published in 2017, 14 in 2018, 18 in 2019, and 3 in 2020. The total number of cases was 16 394, and 8 468 had surgical follow-up. The mean ROM was 16.9% for category I, 10.5% for category II, 39.3% for category III, 2.9% for category IVa, 39.4% for category IVb, 84.2% for category V, and 97.5% for category VI. The mean false-negative rate for MSRSGC categories II and IVa was 4.5%. Similarly, the mean false-positive rate for MSRSGC categories V and VI was 5.1%. CONCLUSION A tiered classification scheme of MSRSGC is helpful in effectively guiding clinical management of patients with salivary gland lesions. The reported mean ROM for each category in most studies is within the recommended range published by the MSRSGC.
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Affiliation(s)
- Jalal B Jalaly
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sahar J Farahani
- Department of Pathology, Renaissance School of Medicine, Stony Brook University, University Hospital, New York, New York, USA
| | - Zubair W Baloch
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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47
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Viswanathan K, Patel A, Abdelsayed M, Rosado L, Soong L, Margolskee E, Heymann JJ, Goyal A, Rao RA. Interobserver variability between cytopathologists and cytotechnologists upon application and characterization of the indeterminate category in the Milan System for Reporting Salivary Gland Cytopathology. Cancer Cytopathol 2020; 128:828-839. [PMID: 32573971 DOI: 10.1002/cncy.22312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The indeterminate categories in the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) are diagnostically challenging because of inherent heterogeneity and complexity, with wide interobserver variability (IOV). Herein, the authors explore the concordance rate (CR) between cytopathologists (CPs) and cytotechnologists (CTs) in interpreting indeterminate salivary gland lesions using the MSRSGC. METHODS Between 2011 and 2016, 86 indeterminate fine-needle aspirations had slides available for review, of which 48 had follow-up. Four CPs and 2 CTs performed an independent, blinded review of these slides and categorized them according to the MSRSGC. The CRs between CTs and CPs with the final sign-out cytopathologist (FCP) were assessed, and interobserver agreement was categorized into uniform, majority, divided, minimal, or no agreement. RESULTS The overall CR with the FCP ranged from 48.8% to 60.5% for CPs and from 22.1% to 36% for CTs. IOV κ scores for the entire group were 0.314 and, with the FCP as the reference, ranged from 0.403 to 0.539 for CPs and from 0.091 to 0.254 for CTs. Uniform, majority, divided, minimal, and no agreement was noted in 12.8%, 31.4%, 38.4%, 10.5%, and 6.9%, respectively, of all cases and in 16.7%, 35.4%, 31.3%, 8.3%, and 6.3%, respectively, of the cases with follow-up. Diagnostic challenges included distinguishing lymphoma from a reactive process and distinguishing mucin from mucin-like material. CONCLUSIONS CPs had modestly higher CRs compared with CTs; and, although the variable CRs highlight indeterminate IOV, the MSRSGC enables reproducibility. Characterizing larger cohorts in the indeterminate categories will further improve MSRSGC criteria. Moreover, education on the MSRSGC should include CTs and CPs to improve overall diagnostic accuracy.
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Affiliation(s)
- Kartik Viswanathan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Ami Patel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Mary Abdelsayed
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Lucelina Rosado
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Lauren Soong
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Elizabeth Margolskee
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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48
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Jiménez-Heffernan JA, Rodríguez-García AM, González-Peramato P, López-Ferrer P, Muñoz-Hernández P, Gordillo CH, Viguer JM, Vicandi B. Fine needle aspiration cytology of polymorphous adenocarcinoma of the salivary glands: A report of 11 patients and review of the literature. Diagn Cytopathol 2020; 48:1013-1020. [PMID: 32421929 DOI: 10.1002/dc.24473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Polymorphous adenocarcinoma (PAC) is a rare malignant tumor of the minor salivary glands. It has an infiltrative growth, variable architectural patterns, neurotropism and cellular monomorphism. Approximately 75% of the cases show a specific mutation in the protein kinase D1 (PRKD1) gene. Reflecting the rarity of the tumor and intraoral location, the cytologic experience is limited with few reported series. In this study we analyze our cytologic experience to determine if a preoperative diagnosis is possible. METHODS A retrospective study of 11 patients with PAC in which a cytologic study was available. A review of the literature was also performed. RESULTS Our study shows that PAC has relatively constant cytological features. The analysis of the cytological literature although it shows some heterogeneity, also reveals repetitive cytological findings. Smears are cellular with irregular groups some showing pseudopapillary branching morphology. Monolayered clusters and small acinar structures are also present. Most cases have small metachromatic globules embedded within the groups determining a cylindromatous pattern. Tumoral cells are small and uniform with scarce to moderate cytoplasm. Nuclei are round and oval with occasional grooves and small nucleoli. CONCLUSION PAC has characteristic cytological features that together with its location in minor salivary gland must make us consider it preoperatively. It may resemble basal cell adenoma and epithelial-rich pleomorphic adenoma so we should be cautious in the final diagnosis. Whenever possible, the characteristic cytomorphology of PCA should make us evaluate the mutational status of PRKD1 gene since it may permit a more accurate diagnosis.
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Affiliation(s)
| | | | | | | | | | - Carlos H Gordillo
- Department of Pathology, University Hospital La Princesa, Madrid, Spain
| | - José M Viguer
- Department of Pathology, University Hospital La Paz, Madrid, Spain
| | - Blanca Vicandi
- Department of Pathology, University Hospital La Paz, Madrid, Spain
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49
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Printz C. First person profile: William C. Faquin, MD, PhD: This Harvard pathologist has helped to standardize how certain tumors are tested and diagnosed. Cancer 2020; 125:2145-2146. [PMID: 32162685 DOI: 10.1002/cncr.32298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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50
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Mullen D, Gibbons D. A retrospective comparison of salivary gland fine needle aspiration reporting with the Milan system for reporting salivary gland cytology. Cytopathology 2020; 31:208-214. [PMID: 32061105 DOI: 10.1111/cyt.12811] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fine needle aspiration (FNA) is a routine sampling method in the diagnostic work up of salivary gland lesions. Despite universal use, no standardised classification existed for the cytopathological reporting of such entities until recently. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) aims to standardise the reporting of these lesions, offering risk of malignancy rates and clinical management recommendations. METHODS We retrospectively applied MSRSGC to cases reported over a 5-year period. Salivary FNA specimens were reclassified according to the MSRSGC as (I) non-diagnostic, (II) non-neoplastic, (III) atypia of undetermined significance (AUS), (IV) benign neoplasm and salivary gland neoplasm of uncertain malignant potential, (V) suspicious for malignancy, and (VI) malignant. Cases with surgical resections were documented and risk of malignancy calculated for each group, where possible. We compared our outcomes with similar studies performed since publication of the Milan criteria. RESULTS In total, 192 specimens were reassigned as non-diagnostic (n = 30), non-neoplastic (n = 31), AUS (n = 1), benign neoplasm (n = 97) and salivary gland neoplasm of uncertain malignant potential (n = 4), suspicious for malignancy (n = 3), and malignant (n = 26). There were 73 surgical resections. Our calculated risk of malignancy was within the proposed MSRSGC rates for the non-diagnostic, benign neoplasm and malignant groups. One AUS case did not undergo surgery. Benign and malignant sensitivities and specificities for the original reporting categories were 88.24% and 95.72%, and 100% and 95.45% for the MSRSGC, respectively. CONCLUSION Salivary gland FNA has high diagnostic accuracy and the MSRSGC offers standardised reporting and assistance in the stratification of cases. This may improve communication between pathologists and clinicians with improved outcomes for patients.
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Affiliation(s)
| | - David Gibbons
- St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
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