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Sadullahoğlu C, Yıldırım HT, Nergiz D, Çekiç B, Selçuk ÖT, Osma Ü, Alparslan AŞ, Sezer C. The risk of malignancy according to Milan reporting system of salivary gland fine-needle aspiration with Becton Dickinson SurePath liquid-based processing. Diagn Cytopathol 2019; 47:863-868. [PMID: 31095901 DOI: 10.1002/dc.24214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) is a noninvasive, safe, cost-effective, diagnostic procedure for the evaluation of salivary gland lesions and the selection of patients for surgery. The aim of this study was to analyze the risk of malignancy (ROM) according to the Milan reporting system of salivary gland FNA specimens using a liquid-based cytology (LBC) technique. METHODS The cytological diagnosis of 459 cases between 2014 and 2017 was revised according to the Milan reporting system. The FNAC results of 129 cases with a histological diagnosis were compared with respect to the final diagnosis. The ROM for each category calculated. RESULTS The ROM was high in the indeterminate and malignant categories, while the ROM in the benign neoplasm category was low. Sensitivity and specificity analyzed in two different ways were 95.1% and 88.8%, 81%, and 77.7%, respectively. CONCLUSIONS When salivary gland lesions are evaluated together with clinical and radiological data, the LBC technique can be applied to salivary gland specimens based on the high diagnostic sensitivity and specificity in liquid-based samples reported according to the Milan system.
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Affiliation(s)
- Canan Sadullahoğlu
- Department of Pathology, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Hülya T Yıldırım
- Department of Pathology, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Döndü Nergiz
- Department of Pathology, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Bülent Çekiç
- Department of Radiology, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ömer T Selçuk
- Department of Ear, Nose, Throat, Head and Neck Surgery, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Üstün Osma
- Department of Ear, Nose, Throat, Head and Neck Surgery, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ahmet Ş Alparslan
- Department of Radiology, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Cem Sezer
- Department of Pathology, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey
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Martini M, Capodimonti S, Cenci T, Bilotta M, Fadda G, Larocca LM, Rossi ED. To Obtain More With Less: Cytologic Samples With Ancillary Molecular Techniques-The Useful Role of Liquid-Based Cytology. Arch Pathol Lab Med 2019; 142:299-307. [PMID: 29494225 DOI: 10.5858/arpa.2017-0148-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Fine-needle aspiration cytology has been increasingly used as the first tool in the evaluation of several diseases. Although cytology has a relevant role in the discrimination between benign and malignant lesions, conventional slides cannot lead to 100% conclusive results. It was hoped that the introduction of liquid-based cytology (LBC) would improve the efficacy of cytology through standardization, quality improvement, and the possibility of carrying out ancillary techniques on the residual stored material. In recent decades, the application of genomic alterations has been studied on cytologic samples with feasible and reliable results. The molecular analysis offers a powerful aid to define the best clinical or surgical approaches and follow-up for patients. In recent years, the application of different ancillary techniques has been carried out on conventional slides even though LBC represents a useful additional and alternative method for molecular testing. OBJECTIVE - To demonstrate the relevance of LBC as a valid aid to overcoming the difficulties encountered in the application of ancillary techniques on conventional slides. DATA SOURCES - We examined and reviewed our experience with the application of ancillary techniques on LBC performed on different body sites. CONCLUSIONS - We emphasize that LBC achieves significant and accurate results. It represents a valid method for cytologic evaluation and it provides highly reproducible and informative molecular yields.
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Affiliation(s)
| | | | | | | | | | | | - Esther Diana Rossi
- From the Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
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Farahani SJ, Baloch Z. Retrospective assessment of the effectiveness of the Milan system for reporting salivary gland cytology: A systematic review and meta-analysis of published literature. Diagn Cytopathol 2018; 47:67-87. [DOI: 10.1002/dc.24097] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Sahar J Farahani
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania; University of Pennsylvania; Philadelphia Pennsylvania
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania; University of Pennsylvania; Philadelphia Pennsylvania
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Kumar M, Katiyar S, Sagar M, Kumari M, Goel MM. Liquid-based cytology versus conventional cytology in fine-needle aspirates of salivary gland neoplasms. INDIAN J PATHOL MICR 2018; 61:45-49. [PMID: 29567883 DOI: 10.4103/ijpm.ijpm_729_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Liquid-based cytology (LBC) is a method of retrieving and processing of cytological material for the assessment of both gynecological and nongynecological cases introduced in 1996. Mostly conventional smears (CS) are prepared in Indian scenario; however, due to increasing popularity of LBC in nongynecology specimens, LBC is also used in few centers for diagnosing salivary gland neoplasm. Aim The aim of this study is to compare CS and LBC in fine-needle aspiration cytology (FNAC) of the salivary gland neoplasms in terms of cytomorphological details, adequacy, ease of interpretation, pitfalls, and diagnostic efficiency. Materials and Methods We conducted a prospective, observational, comparative study which included 64 salivary gland neoplasms. Both CS and LBC (SurePath) were prepared as per standard protocols and examined. Results and Conclusion In our study, specificity and positive predictive value of both the techniques (conventional and LBC) were found to be 100%. Sensitivity of both the techniques was found to be similar (66.7%). Negative predictive value and diagnostic accuracy of conventional technique were found to be almost similar to that of LBC technique (97.6% vs. 97.2% and 97.7% vs. 97.4%). In terms of adequacy and cellularity, CSs were better than LBC. Ease of interpretation was better with CSs due to abundant chondromyxoid stroma, an important clue in the diagnosis of pleomorphic adenoma. Nuclear details and background were better in LBC as compared to CS. Hence, we conclude that in salivary gland FNAC, both CS and LBC have similar diagnostic efficiency. however, interpretation of conventional smears is easier than Liquid Based Cytology especially in cases of pleomorphic adenoma. However, some advantages of LBC in respect to conventional cytology, with better-preserved morphology obtained from LBC becomes furthermore obligatory.
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Affiliation(s)
- Madhu Kumar
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shweta Katiyar
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mala Sagar
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Malti Kumari
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Madhu Mati Goel
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Wang H, Malik A, Maleki Z, Rossi ED, Ping B, Chandra A, Ali SZ, Fadda G, Wang J, Arab SE, Zhao H, Jhala N. “Atypical” salivary gland fine needle aspiration: Risk of malignancy and interinstitutional variability. Diagn Cytopathol 2017; 45:1088-1094. [DOI: 10.1002/dc.23826] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/09/2017] [Accepted: 09/18/2017] [Indexed: 01/19/2023]
Affiliation(s)
- He Wang
- Department of Laboratory Medicine and Pathology; Temple University Hospital; Pennsylvania
| | - Aatika Malik
- Department of Laboratory Medicine and Pathology; Temple University Hospital; Pennsylvania
| | - Zahra Maleki
- Department of Pathology; The Johns Hopkins Hospital; Maryland
| | - Esther Diana Rossi
- The Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | - Bo Ping
- Department of Pathology; Fudan University Cancer Hospital; Shanghai People's Republic of China
| | - Ashish Chandra
- Department of Cellular Pathology; Guy's & St Thomas's Hospital NHSfT; London United Kingdom
| | - Syed Z. Ali
- Department of Pathology; The Johns Hopkins Hospital; Maryland
| | - Guido Fadda
- The Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | - Jindong Wang
- Department of Laboratory Medicine and Pathology; Temple University Hospital; Pennsylvania
| | - Seyedeh Elham Arab
- Department of Laboratory Medicine and Pathology; Temple University Hospital; Pennsylvania
| | - Huaqing Zhao
- Department of Laboratory Medicine and Pathology; Temple University Hospital; Pennsylvania
| | - Nirag Jhala
- Department of Laboratory Medicine and Pathology; Temple University Hospital; Pennsylvania
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Rohilla M, Singh P, Rajwanshi A, Gupta N, Srinivasan R, Dey P, Vashishta RK. Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification. Cancer Cytopathol 2017; 125:767-775. [PMID: 28786207 DOI: 10.1002/cncy.21900] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/08/2017] [Accepted: 06/28/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) cytology of salivary glands is a well-established technique that plays a critical role in the preoperative diagnosis of lesions. A risk stratification of FNA diagnostic categories has been recently proposed to be useful in reporting. The aims of this study were to evaluate the diagnostic accuracy of salivary gland FNA and to apply the proposed Milan system for reporting salivary gland lesions. METHODS A retrospective audit of FNA specimens of salivary gland lesions reported from 2014 to 2016 was performed. A correlation with the follow-up histopathology, wherever it was available, was performed. The aspirates were then categorized according to the Milan system as follows: nondiagnostic, nonneoplastic, atypical, benign neoplasm, neoplasm of uncertain malignant potential (NUMP), suspicious for malignancy, or positive for malignancy. Furthermore, the risk of malignancy and the risk of high-grade malignancy were calculated for all diagnostic categories. RESULTS A total of 631 salivary gland aspirates were evaluated: 2.2% were nondiagnostic, 55.8% indicated nonneoplastic lesions, and 40.4% indicated neoplastic lesions. Histopathology was available for 94 cases (14.9%). FNA had a sensitivity of 79.4% and a specificity of 98.3% with an overall diagnostic accuracy of 91.4% for differentiating malignant tumors from benign tumors. The overall risk of malignancy was 17.4% for the nonneoplastic category, 100% for the atypical category, 7.3% for the benign neoplasm category, 50% for the NUMP category, and 96% for the positive-for-malignancy category. CONCLUSIONS Salivary gland FNA continues to have high diagnostic accuracy and is thus helpful for guiding management. Neoplasms with classic cytomorphology are easily diagnosed; however, in difficult cases showing overlapping features, the use of the Milan system could be beneficial. Cancer Cytopathol 2017;125:767-75. © 2017 American Cancer Society.
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Affiliation(s)
- Manish Rohilla
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Priya Singh
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh K Vashishta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hang JF, Shum CH, Ali SZ, Bishop JA. Cytological features of the Warthin-like variant of salivary mucoepidermoid carcinoma. Diagn Cytopathol 2017; 45:1132-1136. [PMID: 28755513 DOI: 10.1002/dc.23785] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/05/2022]
Abstract
Warthin-like mucoepidermoid carcinoma is a recently proposed variant of musoepidermoid carcinoma. Histologically, it is characterized by its close resemblance to Warthin tumor, including dense lymphocytic infiltration, flattened intermediate epithelium resembling squamous metaplasia, and cystic change. Given its histologic similarity to Warthin tumor, confirmatory testing for MAML2 rearrangement is often required for this diagnosis. Here we present the first cytologic reports of two 53-year-old female patients with parotid masses. In both cases, the fine needle aspirations showed fragments of bland epithelium with a squamous appearance, mucinous cyst content, and focal lymphocytic background. Neither frank keratinization nor mucinous cells were identified in the smears. Fluorescence in situ hybridization (FISH) study confirmed MAML2 rearrangement on the resection specimens in both. Other cytologic differential diagnoses, including Warthin tumor with metaplasia, lymphadenoma, and lymphoepithelial cyst, were briefly discussed.
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Affiliation(s)
- Jen-Fan Hang
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Justin A Bishop
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
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Evrard SM, Meilleroux J, Daniel G, Basset C, Lacoste-Collin L, Vergez S, Uro-Coste E, Courtade-Saidi M. Use of fluorescent in-situ hybridisation in salivary gland cytology: A powerful diagnostic tool. Cytopathology 2017; 28:312-320. [PMID: 28503786 DOI: 10.1111/cyt.12427] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Salivary gland cytology is challenging because it includes a diversity of lesions and a wide spectra of tumours. Recently, it has been reported that many types of salivary gland tumours have specific molecular diagnostic signatures that could be identified by fluorescent in-situ hybridisation (FISH). The aim of the present study was to demonstrate the feasibility and efficiency of FISH on routine cytological salivary gland smears. METHODS FISH was conducted on 37 cytological salivary gland smears from 34 patients. According to the cytological diagnosis suspected, MECT1/MAML2 gene fusion and rearrangements of PLAG1, MYB, or ETV6 were analysed. The presence and percentages of cells that had gene rearrangements were evaluated. Results were compared with the histological surgical samples, available from 26 patients. RESULTS The PLAG1 rearrangement was observed in 12/20 (60%) cases of pleomorphic adenoma. MECT1/MAML2 gene fusion was observed in 1:2 mucoepidermoid carcinomas but was not observed in five other tumours (two pleomorphic adenomas, one Warthin's tumour, one mammary analogue secretory carcinoma [MASC] and one cystic tumour). MYB rearrangement was observed in 4/4 adenoid cystic carcinomas. ETV6-gene splitting identified one MASC. CONCLUSION Overall, FISH had a specificity of 100% and a sensitivity of 66.7%. When FISH and cytological analyses were combined, the overall sensitivity was increased to 93.3%. It can thus be concluded that when the FISH analysis is positive, the extent of surgery could be determined with confidence pre-operatively without needing a diagnosis from a frozen section.
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Affiliation(s)
- S M Evrard
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - J Meilleroux
- Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - G Daniel
- Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - C Basset
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - L Lacoste-Collin
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
| | - S Vergez
- Otolaryngology Department, Head and Neck Surgery, CHU Toulouse, Larrey Hospital, Toulouse Cedex 9, France.,Otolaryngology Department, Head and Neck Surgery, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France.,Rangueil Medical School, Toulouse III Paul Sabatier University, Toulouse Cedex, France
| | - E Uro-Coste
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Rangueil Medical School, Toulouse III Paul Sabatier University, Toulouse Cedex, France
| | - M Courtade-Saidi
- Rangueil Medical School, Histology and Embryology, Toulouse III Paul Sabatier University, Toulouse Cedex, France.,Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France
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Wei S, Layfield LJ, LiVolsi VA, Montone KT, Baloch ZW. Reporting of fine needle aspiration (FNA) specimens of salivary gland lesions: A comprehensive review. Diagn Cytopathol 2017; 45:820-827. [DOI: 10.1002/dc.23716] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/03/2017] [Accepted: 03/15/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Shuanzeng Wei
- Department of Pathology; Fox Chase Cancer Center; Philadelphia Pennsylvania 19111
| | - Lester J. Layfield
- Department of Pathology & Anatomical Sciences; M263 Medical Science Building, One Hospital Drive, University of Missouri; Columbia Missouri 65212
| | - Virginia A. LiVolsi
- Department of Pathology and Laboratory Medicine; University of Pennsylvania, Perelman School of Medicine; 3400 Spruce Street, 6th Floor Founders Building Philadelphia Pennsylvania 19104
| | - Kathleen T. Montone
- Department of Pathology and Laboratory Medicine; University of Pennsylvania, Perelman School of Medicine; 3400 Spruce Street, 6th Floor Founders Building Philadelphia Pennsylvania 19104
| | - Zubair W. Baloch
- Department of Pathology and Laboratory Medicine; University of Pennsylvania, Perelman School of Medicine; 3400 Spruce Street, 6th Floor Founders Building Philadelphia Pennsylvania 19104
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Rossi ED, Wong LQ, Bizzarro T, Petrone G, Mule A, Fadda G, Baloch ZM. The impact of FNAC in the management of salivary gland lesions: Institutional experiences leading to a risk-based classification scheme. Cancer Cytopathol 2016; 124:388-96. [DOI: 10.1002/cncy.21710] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/03/2016] [Accepted: 02/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Lawrence Q. Wong
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Gianluigi Petrone
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Antonio Mule
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Rome Italy
| | - Zubair M. Baloch
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
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Rarick JM, Wasman J, Michael CW. The utility of liquid-based cytology in salivary gland fine-needle aspirates: experience of an academic institution. Acta Cytol 2014; 58:552-62. [PMID: 25171320 DOI: 10.1159/000364854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 05/23/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review the morphological features of salivary gland fine-needle aspirates (FNA) on ThinPrep® (TP) preparations. Emphasis is placed on the commonalities and specific differences between TP and conventional smear (CS) preparations. STUDY DESIGN The cytology and surgical pathology archives were searched for 'salivary' or 'parotid' at our institution from 2003 to 2013 for cases processed by TP and with a range of specified diagnoses and surgical follow-up. These cases were reviewed by the authors. A review of the known literature was also performed. RESULTS Morphological features and artifacts were noted for the most common salivary gland lesions. General features noted in the literature were identified, along with novel features identified on our review of cases. Emphasis was placed on cellular alterations, extracellular differences and architectural changes. CONCLUSIONS The multitude of both benign and malignant lesions coupled with the unique artifacts encountered on TP makes salivary gland FNAs difficult for most practicing pathologists and cytopathologists. For this reason, many laboratories have been reluctant to implement TP preparations for these lesions. With knowledge of the specific artifacts and differences on TP compared to CS, TP can be used with confidence without a compromise in diagnostic accuracy for adequately cellular samples.
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Affiliation(s)
- Jason M Rarick
- Department of Pathology, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
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