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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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2
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Hamour AF, O'Connell D, Biron VL, Allegretto M, Seemann R, Harris JR, Seikaly H, Côté DWJ. Clinical diagnostic utility of ultrasound-guided fine needle aspiration biopsy in parotid masses. EAR, NOSE & THROAT JOURNAL 2024; 103:NP340-NP344. [PMID: 34818946 DOI: 10.1177/01455613211058922] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) is a common diagnostic tool used in the initial evaluation of parotid masses. In the literature, variable diagnostic accuracy of FNA is reported. Therefore, when considering clinical management of these patients, the utility of FNA is unclear. The aim of this study was to determine the capability of ultrasound-guided FNA to differentiate between benign and malignant neoplasms. Further, the way in which FNA results affect clinical decision-making was assessed. METHODS Retrospective data were collected for all patients who underwent parotidectomy at a large Canadian tertiary care center between 2011 and 2016. Patient demographics, preoperative imaging reports, preoperative FNA results, and final pathological diagnosis were analyzed. RESULTS Of the 199 patients who underwent parotidectomy, 184 had preoperative ultrasound-guided FNA. There were a total of 13 non-diagnostic FNAs. In diagnosing malignancy, FNA had a sensitivity and specificity of 71.4% and 98.7%, respectively. The positive predictive value (PPV) was 83.3%. The negative predictive value was 97.5%. Of the non-diagnostic FNAs, 2 out of 13 (15.4%) were deemed malignant neoplasms on final pathology. CONCLUSION FNA is a useful adjunct in the work-up of parotid masses, but it should be used with caution. Due to limited sensitivity, it should not be relied upon as the sole determinant of a surgeon's management plan.
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Affiliation(s)
- Amr F Hamour
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Dan O'Connell
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vincent L Biron
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Michael Allegretto
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Robert Seemann
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey R Harris
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David W J Côté
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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3
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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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4
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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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5
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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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6
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Sanchez-Avila M, Tjendra Y, Zuo Y, Ruiz-Cordero R, Garcia-Buitrago M, Jorda M, Gomez-Fernandez C, Velez Torres JM. Don't SUMP it! Utility of PLAG1 immunocytochemistry in basaloid SUMP subcategory. Cancer Cytopathol 2024; 132:60-68. [PMID: 37702124 DOI: 10.1002/cncy.22762] [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: 05/31/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Basaloid salivary gland neoplasm of uncertain malignant potential (B-SUMP) is an indeterminate diagnostic subcategory, with pleomorphic adenoma (PA) representing the most common benign neoplasm. Pleomorphic adenoma gene 1 (PLAG1) staining is frequently seen in PAs and could aid in distinguishing them from other basaloid neoplasms. The authors evaluated the utility of PLAG1 immunocytochemistry (ICC) in differentiating PAs from other basaloid neoplasms in smears and liquid-based cytology (LBC) specimens. METHODS In total, 45 B-SUMP cytology aspirates and corresponding surgical excision specimens were identified. PLAG1 immunostaining was performed in all aspirates and surgical excision specimens and was scored as positive (strong/diffuse), equivocal (focal/weak), or negative. RESULTS PLAG1 ICC was performed directly on 38 smears and seven LBC specimens. PLAG1 was positive in 29 of 45 cases (64%), whereas six of 45 (13%) were equivocal, and 10 of 45 (22%) were negative. PLAG1-positive aspirates included 26 (90%) PAs, two (7%) basal cell adenomas (BCAs), and one (3%) carcinoma ex-PA. PLAG1-equivocal aspirates included four (67%) PAs and two (33%) BCAs, whereas negative aspirates included five (50%) BCAs, four (40%) adenoid cystic carcinomas, and one (10%) metastatic adenosquamous carcinoma. The sensitivity, specificity, positive, and negative predictive values were 87%, 86%, 93%, and 75%, respectively. Diagnostic accuracy was 87%. CONCLUSIONS PLAG1 ICC is useful when positive (strong/diffuse) and can be reliably performed on smears and LBC specimens. PLAG1 was positive in most PAs and in a small subset of BCAs. Therefore, in the absence of atypical cytologic features, PLAG1-positive tumors could be diagnosed as benign, with a note favoring PA versus BCA. In contrast, PLAG1-negative/equivocal tumors should remain in the B-SUMP category.
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Affiliation(s)
- Monica Sanchez-Avila
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Pathology and Laboratory Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Youley Tjendra
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yiqin Zuo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Monica Garcia-Buitrago
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carmen Gomez-Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Vegni F, Feraco A, Policardo F, Tralongo P, De Stefano I, Ferraro G, Zhang Q, Carlino A, Navarra E, Mulè A, Rossi ED. Cystic lesions in the salivary gland. Pitfalls to be avoided on cytology. Cytopathology 2023; 34:542-550. [PMID: 37377125 DOI: 10.1111/cyt.13263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Cystic lesions of the salivary glands are very uncommon entities. However, on occasion, some neoplasms of the salivary glands show a cystic component, which may be predominant or only partially cystic. Basal cell adenoma, canalicular adenoma, oncocytoma, sebaceous adenoma, intraductal papilloma, epithelial-myoepithelial carcinoma, intraductal carcinoma, and secretory carcinoma are such cystic entities. Cystic degeneration and necrosis, which can develop within solid tumours, represent another possibility. The ability to recognise this type of lesion is a challenge in diagnostic cytology because hypocellular fluid is frequently recovered. Furthermore, evaluating all of the differential diagnoses for cystic lesions of the salivary glands is helpful in obtaining the correct diagnosis. Herein, we evaluate the various types of cystic lesions within the salivary glands.
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Affiliation(s)
- Federica Vegni
- 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
| | - Federica Policardo
- 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
| | - Ilenia De Stefano
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Giulia Ferraro
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Qianqian Zhang
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Angela Carlino
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Elena Navarra
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Antonino Mulè
- Division of Anatomic Pathology and Histology, 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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Huang YT, Ho CY, Ou CY, Huang CC, Lee WT, Tsai SW, Hsu HJ, Hung DSY, Tsai CS, Fang SY, Tsai ST, Hsiao JR, Chang CC, Chen CC. Evaluation of Fine Needle Aspiration Cytopathology in Salivary Gland Tumors under Milan System: Challenges, Misdiagnosis Rates, and Clinical Recommendations. Biomedicines 2023; 11:1973. [PMID: 37509612 PMCID: PMC10376957 DOI: 10.3390/biomedicines11071973] [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: 05/14/2023] [Revised: 07/01/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Salivary gland tumors are rare in the head and neck. To determine the need and extent of surgical intervention, fine needle aspiration (FNA) is a widely accepted tool to approach salivary gland lesions. However, the FNA cytology varies between entities, while the lack of uniform terminology makes diagnosis more challenging. Since establishing the Milan system for reporting salivary gland cytopathology (MSRSGC) has become an increasingly accepted reporting standard, further examination and detailed recommendations were needed. (2) Methods: Between April 2013 and October 2021, 375 cases with FNA and salivary gland resection were retrospectively collected. All FNA specimens were reclassified according to the criteria of MSRSGC. After surgical excision, the FNA data were compared with the histological diagnosis to estimate the risk of malignancy (ROM), the risk of neoplasm (RON), and the diagnostic accuracy for each diagnostic category. (3) Results: Our cohort's distribution of ROM and RON was similar to the MSRSGC's recommendation. Carcinoma ex pleomorphic adenoma (CXPA) has the highest rate (66.7%) of misdiagnosed as a nonneoplastic lesion or benign salivary gland tumor. Pleomorphic adenoma (PA) and Warthin's tumor were the most common benign salivary gland tumors, while the cytology diagnosis of Warthin's tumor seems more challenging than PAs. (4) Conclusions: Despite the convenience and effectiveness of MSRSGC, we suggest close follow-up, re-biopsy, or surgical removal for salivary lesions even in Milan IVA-Benign for possibly missing FNA of malignancy, mixed lesions, or prevention of malignant transformation.
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Affiliation(s)
- Yi-Tien Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chen-Yu Ho
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Cheng-Chih Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Heng-Jui Hsu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - David Shang-Yu Hung
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chien-Sheng Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Sheen-Yie Fang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600, Taiwan
- Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
- Ph.D. Program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan 701, Taiwan
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9
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Ratzon F, Feliciano DL, Katabi N, Xu B, Lin O, Wei XJ. Salivary gland fine-needle aspiration biopsy: quality assurance results from a tertiary cancer center. J Am Soc Cytopathol 2023; 12:206-215. [PMID: 36792408 PMCID: PMC10563449 DOI: 10.1016/j.jasc.2023.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Fine-needle aspiration biopsy (FNAB) plays a critical role in the management of patients with salivary gland lesions. A specific diagnosis can be difficult due to the wide range of lesions with overlapping morphologic features, potentially leading to interpretation errors. We analyzed the cytologic-histologic discrepancies identified in the quality assurance program of a major cancer center in cases of salivary gland FNAB and performed a root cause analysis. MATERIALS AND METHODS Salivary gland FNAB specimens performed during a 12-year period at a major tertiary cancer center were reviewed. The inclusion criteria for this study included FNAB cases of salivary glands with subsequent histologic or flow cytometry follow up. The cytologic diagnoses for these cases were recategorized according to the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) based on the original reports. The risk of neoplasm and malignancy based on the cases with subsequent resection or flow cytometry and the most common causes of discrepancy were analyzed. RESULTS The risk of neoplasm ranged from 41% to 99% and the risk of malignancy ranged from 22% to 99% among the different MSRSGC categories. Lymphoid and myoepithelial rich lesions were the most common miscategorized lesions using the MSRSGC. Reactive changes due to inflammation were associated with overcalls. The most common malignancy in the atypical category was mucoepidermoid carcinomas. CONCLUSIONS Myoepithelial and lymphoid rich lesions arising in the salivary gland are associated with a higher risk of misclassification. The use of category IVB in the MSRSGC is appropriate for lesions with abundant myoepithelial cells. Reactive atypia seen in sialadenitis was the most common feature associated with overcall.
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Affiliation(s)
- Fanni Ratzon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Xiao-Jun Wei
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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10
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Rakheja G, Singh M, Priyadarshnee B, Marimuthu B, Dhar L, Jain S, Khurana N, Rathore A. Categorisation of peritoneal serous effusions using the International System for Reporting Serous Fluid Cytopathology-A study on gynaecological samples. Cytopathology 2023; 34:138-145. [PMID: 36530023 DOI: 10.1111/cyt.13201] [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: 09/06/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cytology of serous effusions is an indispensable diagnostic tool for the diagnosis of non-neoplastic as well as neoplastic effusions, aiding in the categorisation, staging, and prognostication of the patient. This study focuses on reclassifying cases of peritoneal fluid cytology following the International System for Reporting Serous Fluid Cytopathology (TIS), highlighting various challenges encountered and adding to the body of data regarding the risk of malignancy (ROM), focussing on peritoneal effusions due to gynaecological causes. METHODS Peritoneal effusion samples were retrieved from our department's archives and reclassified according to the TIS. The ROM for each category was calculated based on available surgical follow-up. RESULTS A total of 818 peritoneal effusions were studied. Following the definitions and guidelines of the TIS, the cases were reclassified with 125 (15.2%) in the category of non-diagnostic (ND), 595 (72.7%) as negative for malignancy (NFM), 26 (3.2%) as atypia of undetermined significance (AUS), 12 (1.5%) as suspicious for malignancy (SFM), and 60 (7.3%) as malignant (MAL). The respective ROM values for each category were 16.9%, 12.1%, 50%, 80%, and 100%, respectively. By considering the MAL and SFM groups as positive, and the ND, NFM, and AUS groups as negative, the diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were determined as 85.2%, 36.7%, 99.1%, 91.7%, and 84.5%, respectively. CONCLUSIONS Peritoneal cytology categorisation following the proposed TIS offered a practical approach for categorisation of the fluids received. The ROMs reported in our study were mostly concordant with those published according to the TIS.
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Affiliation(s)
- Garima Rakheja
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Meeta Singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | | | | | - Lity Dhar
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shyama Jain
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Asmita Rathore
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, India
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11
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Pusztaszeri M, Deschler D, Faquin Md PhD WC. The 2021 ASCO guideline on the management of salivary gland malignancy endorses FNA biopsy and the risk stratification scheme proposed by the Milan System for Reporting Salivary Gland Cytopathology. Cancer Cytopathol 2023; 131:83-89. [PMID: 36574228 DOI: 10.1002/cncy.22678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Daniel Deschler
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - William C Faquin Md PhD
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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12
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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: 0] [Impact Index Per Article: 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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13
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Morand GB, Alsayegh R, Mlynarek AM, Plourde M, Mach T, Mascarella MA, Hier MP, Florianova L, Pusztaszeri MP. Application of the Milan system for reporting salivary gland cytopathology using cell blocks. Virchows Arch 2022; 481:575-583. [PMID: 35750873 DOI: 10.1007/s00428-022-03364-x] [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: 04/11/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022]
Abstract
The Milan system for reporting salivary gland cytopathology (MSRSGC) is a novel standardized classification tool for salivary gland cytology specimens based on the use of direct smears. Formalin-fixed paraffin-embedded (FFPE) cell blocks facilitate the use of ancillary studies, leading to improved diagnostic accuracy. However, the application of the MSRSGC with only cell blocks has not been well established. Consecutive cohort of all parotid gland cytology specimens between 01/01/2018 and 30/06/2021 was performed. All cytology specimens were processed into cell blocks only. Cytologic diagnoses were classified prospectively according to the MSRSGC categories. The risk of malignancy (ROM) for each diagnostic category and the diagnostic performance were calculated. A total of 230 FNA samples from 221 patients were identified, including 47% and 78.4% with surgical or clinical follow-up, respectively. The ROMs based on surgical follow-up for the non-diagnostic, non-neoplastic, AUS, neoplasm: benign, SUMP, SFM and malignant categories were 21.4%,0%,50%,0%,30%,100% and 100%, respectively. The ROMs based on the clinical follow-up for these categories were 7.3%,0%,37.3%,0%,27.3%,100% and 100%, respectively. Following surgical excision, all Milan IVa category samples were confirmed as benign, and all Milan V and VI category samples were confirmed as malignant. This study validates the application of the MSRSGC with the sole use of FFPE cell blocks. The diagnostic accuracy of MSRSGC is high and compares favorably to other institutions using traditional cytology assessment methods. Furthermore, FNA results using this technique enabled to provide optimal patient management based on the ROM of the different Milan system categories.
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Affiliation(s)
- Grégoire B Morand
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Raihanah Alsayegh
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alex M Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Marianne Plourde
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Tiffany Mach
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Livia Florianova
- Department of Pathology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, Canada
| | - Marc P Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, Canada.
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14
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Pusztaszeri MP, Baloch ZW. Subcategorizing salivary gland neoplasm of uncertain malignant potential (SUMP) in the Milan System for Reporting Salivary Gland Cytopathology. Cancer Cytopathol 2022; 130:484-487. [PMID: 35637574 DOI: 10.1002/cncy.22592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
| | - Zubair W Baloch
- Department of Pathology, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, Pennsylvania
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15
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Pang J, Houlton JJ. Management of Malignant Salivary Gland Conditions. Surg Clin North Am 2022; 102:325-333. [PMID: 35344700 DOI: 10.1016/j.suc.2021.12.008] [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: 10/18/2022]
Abstract
Salivary cancers are rare tumors that arise in major and minor salivary glands. Workup almost always includes fine-needle aspiration or core needle biopsy in select cases. Imaging with ultrasound, computed tomography, or MRI is also helpful, particularly with MRI to assess facial nerve involvement or skull base involvement. Preserving function of the facial nerve is of paramount importance, and the standard of care is to not sacrifice facial nerve except in instances of gross encasement and inability to dissect tumor off of the nerve. Adjuvant radiation and chemotherapy offer survival advantages for select patients.
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Affiliation(s)
- John Pang
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Jeffrey J Houlton
- Otolaryngology-Head and Neck Surgery, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
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16
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Maleki Z, Saoud C, Viswanathan K, Kilic I, Tommola E, Griffin DT, Heider A, Petrone G, Jo VY, Centeno BA, Saieg M, Mikou P, Fadda G, Ali SZ, Kholová I, Wojcik EM, Barkan GA, Eisele DW, Bellevicine C, Vigliar E, Wiles AB, Al-Ibraheemi A, Allison DB, Dixon GR, Chandra A, Walsh JM, Baloch ZW, Faquin WC, Krane JF, Rossi ED, Pantanowitz L, Troncone G, Callegari FM, Klijanienko J. Application of the Milan System for Reporting Salivary Gland Cytopathology in pediatric patients: An international, multi-institutional study. Cancer Cytopathol 2022; 130:370-380. [PMID: 35081269 DOI: 10.1002/cncy.22556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pediatric salivary gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a small proportion of malignancies. This international, multi-institutional cohort evaluated the application of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and the risk of malignancy (ROM) for each diagnostic category. METHODS Pediatric (0- to 21-year-old) salivary gland FNA specimens from 22 international institutions of 7 countries, including the United States, England, Italy, Greece, Finland, Brazil, and France, were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. Cytology-histology correlation was performed where available, and the ROM was calculated for each MSRSGC diagnostic category. RESULTS The cohort of 477 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 10.3%; nonneoplastic, 34.6%; AUS, 5.2%; benign neoplasm, 27.5%; SUMP, 7.5%; SM, 2.5%; and malignant, 12.4%. Histopathologic follow-up was available for 237 cases (49.7%). The ROMs were as follows: nondiagnostic, 5.9%; nonneoplastic, 9.1%; AUS, 35.7%; benign neoplasm, 3.3%; SUMP, 31.8%; SM, 100%; and malignant, 100%. Mucoepidermoid carcinoma was the most common malignancy (18 of 237; 7.6%), and it was followed by acinic cell carcinoma (16 of 237; 6.8%). Pleomorphic adenoma was the most common benign neoplasm (95 of 237; 40.1%). CONCLUSIONS The MSRSGC can be reliably applied to pediatric salivary gland FNA. The ROM of each MSRSGC category in pediatric salivary gland FNA is relatively similar to the ROM of each category in adult salivary gland FNA, although the reported rates for the different MSRSGC categories are variable across institutions.
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Affiliation(s)
- Zahra Maleki
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Carla Saoud
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kartik Viswanathan
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Irem Kilic
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Erkka Tommola
- Fimlab Laboratories, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Daniel T Griffin
- Department of Pathology, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Amer Heider
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Gianluigi Petrone
- Department of Pathology, Catholic University of Sacred Heart University, Rome, Italy
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Mauro Saieg
- Department of Pathology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Guido Fadda
- Department of Pathology, University of Messina, Messina, Italy
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ivana Kholová
- Fimlab Laboratories, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eva M Wojcik
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - David W Eisele
- Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Austin B Wiles
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Derek B Allison
- Department of Pathology, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Glen R Dixon
- HCA Laboratories, HCA Healthcare, London, United Kingdom
| | - Ashish Chandra
- Department of Pathology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Walsh
- Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Zubair W Baloch
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey F Krane
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Esther Diana Rossi
- Department of Pathology, Catholic University of Sacred Heart University, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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17
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Bradley PJ. Parotid lymph nodes in primary malignant salivary neoplasms. Curr Opin Otolaryngol Head Neck Surg 2021; 30:99-106. [DOI: 10.1097/moo.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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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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19
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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: 8] [Impact Index Per Article: 2.7] [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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20
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Kanber Y, Pusztaszeri M, Auger M. Immunocytochemistry for diagnostic cytopathology-A practical guide. Cytopathology 2021; 32:562-587. [PMID: 34033162 DOI: 10.1111/cyt.12993] [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: 01/12/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Cytological specimens, which are obtained by minimally invasive methods, are an excellent source of diagnostic material. Sometimes they are the only material available for diagnosis as well as for prognostic/predictive markers. When cytomorphology is not straightforward, ancillary tests may be required for a definitive diagnosis to guide clinical management. Immunocytochemistry (ICC) is the most common and practical ancillary tool used to reach a diagnosis when cytomorphology is equivocal, to differentiate entities with overlapping morphological features, and to determine the cell lineage and the site of origin of a metastatic neoplasm. Numerous immunomarkers are available, and some are expressed in multiple neoplasms. To rule out entities within a differential diagnosis, the use of more than one marker, sometimes panels, is necessary. ICC panels for diagnostic purposes should be customised based on the clinical context and cytomorphology, and the markers should be used judiciously to preserve material for additional tests for targeted therapies in the appropriate setting. This review offers a practical guide for the use of ICC for diagnostic cytopathology, covering the most commonly encountered non-hematolymphoid diagnostic scenarios in various body sites.
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Affiliation(s)
- Yonca Kanber
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Manon Auger
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
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21
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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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22
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SalvGlandDx - a comprehensive salivary gland neoplasm specific next generation sequencing panel to facilitate diagnosis and identify therapeutic targets. Neoplasia 2021; 23:473-487. [PMID: 33878706 PMCID: PMC8081865 DOI: 10.1016/j.neo.2021.03.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Diagnosis of salivary gland neoplasms is often challenging due to their high morphological diversity and overlaps. Several recurrent molecular alterations have been described recently, which can serve as powerful diagnostic tools and potential therapeutic targets (e.g. NTRK or RET fusions). However, current sequential molecular testing can be expensive and time consuming. In order to facilitate the diagnosis of salivary gland neoplasms, we designed an all-in-one RNA-based next generation sequencing panel suitable for the detection of mutations, fusions and gene expression levels (including NR4A3) of 27 genes involved in salivary gland neoplasms. Here we present the validation of the "SalvGlandDx" panel on FFPE histological specimen including fine needle aspiration (FNA) cell block material, against the standard methods currently used at our institution. In a second part we describe selected unique cases in which the SalvGlandDx panel allowed proper diagnosis and new insights into special molecular characteristics of selected salivary gland tumors. We characterize a unique salivary gland adenocarcinoma harboring a ZCCHC7-NTRK2 fusion, a highly uncommon spindle cell and pseudoangiomatoid adenoid-cystic carcinoma with MYBL1-NFIB fusion, and a purely oncocytic mucoepidermoid carcinoma, whereas diagnosis could be made by detection of a CRTC3-MAML2 rearrangement on the cell block specimen of the FNA. Further, a rare case of a SS18-ZBTB7A rearranged low-grade adenocarcinoma previously described as potential spectrum of microsecretory adenocarcinoma, is reported. In addition, features of six cases within the spectrum of polymorphous adenocarcinoma / cribriform adenocarcinoma of salivary gland including PRKD1 p.E710D mutations and novel fusions involving PRKAR2A-PRKD1, SNX9-PRKD1 and ATL2-PRKD3, are described.
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23
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Johnson DN, Antic T, Reeves W, Mueller J, Lastra RR, Cipriani NA, Biernacka A. Histopathologic and clinical outcomes of Milan System categories "non-diagnostic" and "non-neoplastic" of salivary gland fine needle aspirations. J Am Soc Cytopathol 2021; 10:349-356. [PMID: 33867311 DOI: 10.1016/j.jasc.2021.03.001] [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: 01/07/2021] [Revised: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) specifies six categories with estimated risks of malignancy (ROM) and suggested management. The estimated ROM is 25% for Non-Diagnostic (ND) category, and 10% for Non-Neoplastic (NN). This study aimed to investigate histopathologic and clinical outcomes of MSRSGC categories ND and NN at the authors' institution. MATERIALS AND METHODS Cytopathology fine needle aspiration reports from 2008-2020 were searched for the word "salivary", "parotid", and "submandibular". Cases fitting Non-Diagnostic (ND) and Non-Neoplastic (NN) categories were identified. Follow-up cyto-/histopathologic and clinical data were extracted. RESULTS There were 43 ND and 46 NN cases. The average age was 58.3 years. Neoplastic lesions were found in 13 of 43 (30%) ND and 3 of 46 (6.5%) NN. The rate of malignancy in ND category was 14.0% (6/43) and 0% (0/46) in NN category. Four cases in ND (9.3%) and 6 (13.0%) in NN had no neoplasm and instead had an underlying reactive condition (e.g., chronic sialadenitis) or inflammatory lesion (e.g., lymphoepithelial cyst) on histologic follow-up. There was no follow-up pathology in 46.5% NDs (20/43) and 82.6% NNs (38/46); however, no lesions were apparent clinically with a mean follow-up of 3 years and 1.5 years, respectively. CONCLUSIONS MSRSGC categories ND and NN are helpful for reporting salivary gland FNA results. With proper clinical and radiologic correlation, ROM of NN is low; however, ROM of ND remains significant. Repeat FNA after correlation for ND cases seems prudent as neoplasms and malignancies may have gone undetected.
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Affiliation(s)
- Daniel N Johnson
- Department of Pathology, Northwestern University, Chicago, Illinois.
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ward Reeves
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Anna Biernacka
- Department of Pathology, The University of Chicago, Chicago, Illinois
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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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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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26
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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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Sun T, Faquin WC, Torous VF. Crystalloids in FNA specimens of salivary gland lesions: A retrospective study in a single large institute. Cancer Cytopathol 2020; 129:432-438. [PMID: 33296146 DOI: 10.1002/cncy.22395] [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: 09/27/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Identifying crystalloids, which includes amylase and tyrosine crystalloids, is relatively uncommon in salivary gland fine-needle aspiration (FNA) cytology. Although it has been suggested that the presence of crystalloids favors a benign process, the full significance has not been well established. METHODS The authors performed a review of slides from all salivary gland FNA cases received in their laboratory from January 2017 to September 2019 to identify cases with crystalloids (screened cohort). In addition, the departmental archives were searched retrospectively for all salivary gland FNA cases that had specifically reported crystalloids. Cytologic findings as well as correlation with surgical pathology and clinical follow-up were examined. RESULTS There were 664 cases in the screened cohort. Crystalloids were present in 37 cases (incidence, 5.6%). Amylase crystalloids were the most commonly identified (n = 28; 75%), followed by tyrosine crystalloids (n = 4; 11%), and collagenous crystalloids (n = 1; 3%). Four cases with crystalloids could not be further classified because of low quantity (n = 4; 11%). An additional 54 cases were identified in the 10-year retrospective review. Diagnostic categorization for the total cohort (N = 91) was as follows: nondiagnostic, 30 cases (33%); nonneoplastic/benign, 42 cases (46%); neoplasm: benign, 10 cases (11%); and atypia of undetermined significance, 9 cases (10%). Twenty-six cases had subsequent resection findings, including oncocytic cyst/cystadenoma in 8 cases (31%), chronic sialadenitis/ductal obstructive change in 7 cases (27%), pleomorphic adenoma in 5 cases (27%), developmental cyst in 3 cases (12%), lymphoepithelial cyst in 2 cases (8%), and Warthin tumor in 1 case (4%). CONCLUSIONS This cohort represents the largest FNA series of salivary gland crystalloids. All cases were associated with nonneoplastic or benign neoplastic lesions.
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Affiliation(s)
- Tong Sun
- Yale School of Medicine, New Haven, Connecticut
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vanda F Torous
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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28
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Taniuchi M, Kawata R, Omura S, Haginomori SI, Terada T, Higashino M, Kurisu Y, Hirose Y. A novel clinically-oriented classification of fine-needle aspiration cytology for salivary gland tumors: a 20-year retrospective analysis of 1175 patients. Int J Clin Oncol 2020; 26:326-334. [PMID: 33219459 PMCID: PMC7819905 DOI: 10.1007/s10147-020-01816-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/15/2020] [Indexed: 01/23/2023]
Abstract
Background When determining treatment strategy for a salivary gland tumor, assessing histology and malignancy grade before surgery is essential. Several new diagnostic classification systems for salivary gland cytology have recently been proposed. However, none incorporate histology and grade of malignancy. Methods We developed a new cytology classification system that incorporates histology and grade of malignancy of salivary gland tumors (OMC classification), consisting of 11 categories. Our OMC classification was applied to 1175 patients who had preoperative cytology and confirmed final pathological diagnosis available from the past 20 years at our hospital (benign tumor: 981 patients, malignant tumor: 194 patients). Results Based on the cytology, 729 patients (62.0%) had benign histology (Category 4–1), and 87 patients (7.4%) were diagnosed with grade of malignancy (Category 6–3 + 6–4). Based on the final pathological diagnosis, the accuracy rate of Category 4–1 and Category 6–3 + 6–4 of our classification system was 93.4% and 88.5%, respectively. Conclusion Based on the correct diagnosis rate, the inclusion of histology and grade of malignancy in the salivary gland cytology classification was considered feasible. Thus, the OMC classification system is considered a useful tool when determining the treatment strategy for a salivary gland tumor.
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Affiliation(s)
- Masataka Taniuchi
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Shuji Omura
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shin- Ichi Haginomori
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Tetsuya Terada
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masaaki Higashino
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshitaka Kurisu
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
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Val-Bernal JF, Martino M, Marcos S, Yllera E, García-Montesinos B. Fine-needle aspiration cytology in the diagnosis of salivary gland lesions. The role of the Milan system for reporting cytopathology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hirata Y, Higuchi K, Tamashiro K, Koja K, Yasutomi Y, Matsuzaki A, Yoshimi N. Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution. Acta Cytol 2020; 65:123-131. [PMID: 33113539 DOI: 10.1159/000510990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a recently published evidence-based categorization system for salivary gland fine-needle aspiration (FNA). We applied MSRSGC to Japanese cases and evaluated its utility. STUDY DESIGN A total of 480 FNA cases were reviewed. We recategorized each case into one of the MSRSGC categories. The risk of neoplasm (RON) and the risk of malignancy (ROM) for each diagnostic category in MSRSGC, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for malignancy and for neoplasms were calculated for cases with histological follow-up. In addition, the overall ROM (O-ROM) was calculated for all FNA cases. RESULTS RON, ROM, and O-ROM rates were as follows - non-diagnostic: 51.3, 5.1, and 1.0%; non-neoplastic: 0, 0, and 0%; atypia of undetermined significance: 83.9, 12.9, and 7.3%; neoplasm, benign: 100, 0, and 0%; salivary gland neoplasm of uncertain malignant potential: 100, 32.1, and 23.7%; suspicious for malignancy: 100, 85.7, and 60%; and malignant: 100, 100, 81.8%. The sensitivity, specificity, and accuracy with (without) indeterminate cases for malignancy were 65 (100), 99 (99), 92% (99%) and PPV and NPV were 96 and 100%, respectively, and those for neoplasms were 84 (100), 100 (100), 85% (100%), and PPV and NPV were 100 and 100%, respectively. CONCLUSIONS The MSRSGC is useful for stratification of ROM and for promoting the performance of salivary gland FNA. The MSRSGC could be easily introduced in Japan and may improve the Japanese salivary gland FNA status.
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Affiliation(s)
- Yukiya Hirata
- Department of Pathology, University of the Ryukyus Hospital, Okinawa, Japan,
| | - Kayoko Higuchi
- Department of Surgical Pathology, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Koichi Tamashiro
- Department of Diagnostic Pathology, Okinawa Chubu Hospital, Okinawa, Japan
| | - Keisuke Koja
- Department of Diagnostic Pathology, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yuiko Yasutomi
- Department of Diagnostic Pathology, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Akiko Matsuzaki
- Department of Diagnostic Pathology, Urasoe General Hospital, Okinawa, Japan
| | - Naoki Yoshimi
- Department of Diagnostic Pathology, Okinawa Red Cross Hospital, Okinawa, Japan
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31
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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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32
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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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33
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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: 24] [Impact Index Per Article: 6.0] [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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34
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Fine-needle aspiration cytology in the diagnosis of salivary gland lesions. The role of the Milan system for reporting cytopathology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:343-348. [PMID: 32317098 DOI: 10.1016/j.otorri.2019.11.007] [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: 05/28/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is an established technique in the management of salivary gland lesions. The Milan System for reporting salivary gland cytopathology (MSRSGC) intents to standardize diagnostic categories. Current studies are trying to evaluate the diagnostic approach of this system. METHODS FNAC of salivary gland lesions were retrieved over an 11-year period. 185 FNAC specimens from 182 patients were reviewed blindly and classified according to the criteria established by the MSRSGC. 136 (74.7%) patients had follow-up of their processes. RESULTS The total number of diagnostic categories and risk of malignancy (ROM) in 185 specimens were the following: non-diagnostic 39 (21.1%; ROM 12%), non-neoplastic 35 (18.9%; ROM 0%), atypia of undetermined significance (AUS) 17 (9.2%; ROM 46.1%), benign neoplasm 75 (40.5%; ROM 4.9%), salivary gland neoplasm of uncertain malignant potential 4 (2.2%; ROM 100%), suspicious for malignancy 7 (3.8%; ROM 100%), malignant 8 (4.3%; ROM 100%). No false positives were observed in groups IVb, V, and VI in this series. The overall sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy were 88%, 91.8%, 96.3%, 76.7%, and 91% respectively. CONCLUSION The ROM reported in our study was in keeping with ROM published by the MSRSGC. This system provides standardized information for risk stratification. The category AUS encompassed cases causing uncertainty representing a challenge in management. Defining criteria for AUS category need to be refined. The system facilitates communication between pathologists and clinicians favoring improvement in patient care.
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35
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Johnson DN, Onenerk M, Krane JF, Rossi ED, Baloch Z, Barkan G, Bongiovanni M, Callegari F, Canberk S, Dixon G, Field A, Griffith CC, Jhala N, Jiang S, Kurtycz D, Layfield L, Lin O, Maleki Z, Perez-Machado M, Pusztaszeri M, Vielh P, Wang H, Zarka MA, Faquin WC. Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel. Cancer Cytopathol 2020; 128:392-402. [PMID: 32267606 DOI: 10.1002/cncy.22271] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Fine needle aspiration (FNA) is commonly used for the preoperative evaluation of salivary gland tumors. Tumor grade is a key factor influencing clinical management of salivary gland carcinomas (SGCs). To assess the ability to grade nonbasaloid SGCs in FNA specimens, an international panel of cytopathologists convened to review and score SGC cases. METHODS The study cohort included 61 cases of primary SGC from the pathology archives of 3 tertiary medical centers. Cases from 2005 to 2016 were selected, scanned, and digitized. Nineteen cytopathologists blinded to the histologic diagnosis reviewed the digitized cytology slides and graded them as low, high, or indeterminate. The panelists' results were then compared to the tumor grades based on histopathologic examination of the corresponding resection specimens. RESULTS All but 2 of the 19 (89.5%) expert panelists review more than 20 salivary gland FNAs per year; 16 (84.2%) of the panelists work at academic medical centers, and 13 (68.4%) have more than 10 years' experience. Participants had an overall accuracy of 89.4% in the grading of SGC cases, with 90.2% and 88.3% for low- and high-grade SGC, respectively. Acinic cell carcinoma and mucoepidermoid carcinoma had the highest degree of accuracy, while epithelial-myoepithelial carcinoma and salivary duct carcinoma had the lowest degree of accuracy. As expected, the intermediate-grade SGC cases showed the greatest variability (high-grade, 42.1%; low-grade, 37.5%, indeterminate, 20.4%). CONCLUSION This study confirms the high accuracy of cytomorphologic grading of primary SGC by FNA as low- or high-grade. However, caution should be exercised when a grade cannot be confidently assigned.
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Affiliation(s)
- Daniel N Johnson
- Department of Pathology, Cytopathology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mine Onenerk
- Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Jeffrey F Krane
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Esther Diana Rossi
- Department of Pathology, Fondazione Policlinico Universitario "Agostino Gemelli," IRCCS, Universita' Cattolica, Rome, Italy
| | - Zubair Baloch
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Güliz Barkan
- Loyola University Healthcare System, Maywood, Illinois
| | | | | | - Sule Canberk
- Cancer Signaling and Metabolism, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Division of Cytopathology, Department of Pathology, Acibadem University, Istanbul, Turkey
| | - Glen Dixon
- HCA Laboratories, HCA Healthcare UK, London, United Kingdom
| | - Andrew Field
- Department of Pathology, St. Vincent Hospital, Sydney, Australia
| | | | - Nirag Jhala
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Sara Jiang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Daniel Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, State Laboratory of Hygiene, Madison, Wisconsin
| | - Lester Layfield
- Department of Pathology and Anatomical Services, University of Missouri, Columbia, Missouri
| | - Oscar Lin
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Marc Pusztaszeri
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Philippe Vielh
- Department of Pathology, Laboratoire National de Santé, Dudelange, Luxembourg
| | - He Wang
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew A Zarka
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Scottsdale, Arizona
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts
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Dostalova L, Kalfert D, Jechova A, Koucky V, Novak S, Kuchar M, Zabrodsky M, Novakova Kodetova D, Ludvikova M, Kholova I, Plzak J. The role of fine-needle aspiration biopsy (FNAB) in the diagnostic management of parotid gland masses with emphasis on potential pitfalls. Eur Arch Otorhinolaryngol 2020; 277:1763-1769. [PMID: 32107613 DOI: 10.1007/s00405-020-05868-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The treatment strategy of parotid gland tumours depends mainly on the histopathological type of the lesion. Fine-needle aspiration biopsy (FNAB) is recommended in preoperative diagnostics. The aim of the study was to evaluate the FNAB standing in the diagnostic algorithm of parotid gland lesions and to correlate FNAB results in relation to the definitive histopathological diagnosis. MATERIAL AND METHODS The retrospective analyses of 651 examined and consequently surgically treated parotid gland lesions at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague between 2006 and 2016 were used. Preoperative cytological results were consequently evaluated in relation to the definitive histopathological diagnosis. RESULTS The cohort consisted of 367 women and 284 men (average age 58 years). FNAB was diagnostic in 604 (92.8%) patients and non-diagnostic in 47 (7.2%) patients. The result of FNAB was positive (suspicious for malignant tumour) in 89 (14.7%) patients and negative (benign) in 515 (85.3%) patients. Sensitivity of the examination was 80.00%, specificity was 93.82%, PPV 62.92%, NPV 97.28%, and LR + and LR- were 12.95 and 0.21, respectively, with an accuracy of 92.22%. CONCLUSION Our results confirm the significant role of FNAB in the diagnostic algorithm of parotid gland lesions.
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Affiliation(s)
- Lucie Dostalova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic.
| | - Alzbeta Jechova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Vladimir Koucky
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Stepan Novak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Martin Kuchar
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Michal Zabrodsky
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Daniela Novakova Kodetova
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, University Hospital Motol, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Marie Ludvikova
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Ivana Kholova
- Department of Pathology, Faculty of Medicine and Health Technology, Fimlab Laboratories and Tampere University, Tampere, Finland
| | - Jan Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
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Faquin WC. Diagnosis and grading of basaloid salivary gland tumors using the Milan System for reporting salivary gland cytopathology. Cancer Cytopathol 2019; 128:87-88. [PMID: 31742900 DOI: 10.1002/cncy.22207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 12/18/2022]
Affiliation(s)
- William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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38
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Gargano SM, Sebastiano C, Solomides CC, Griffith CC, HooKim K. Cytohistologic correlation of basaloid salivary gland neoplasms: Can cytomorphologic classification be used to diagnose and grade these tumors? Cancer Cytopathol 2019; 128:92-99. [DOI: 10.1002/cncy.22208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Stacey M. Gargano
- Department of Pathology, Anatomy, and Cell Biology Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Christopher Sebastiano
- Department of Pathology, Anatomy, and Cell Biology Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Charalambos C. Solomides
- Department of Pathology, Anatomy, and Cell Biology Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | | | - Kim HooKim
- Department of Pathology, Anatomy, and Cell Biology Thomas Jefferson University Hospital Philadelphia Pennsylvania
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Salivary Gland FNA Diagnostics in a Real-Life Setting: One-Year-Experiences of the Implementation of the Milan System in a Tertiary Care Center. Cancers (Basel) 2019; 11:cancers11101589. [PMID: 31635317 PMCID: PMC6826610 DOI: 10.3390/cancers11101589] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/16/2022] Open
Abstract
The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018 following other organ specific cytopathological reporting systems and it aimed at bringing a practical, evidence-based, user-friendly classification system with characterization and management algorithms. At the Department of Pathology, Fimlab Laboratories, Tampere, Finland all salivary fine needle aspirations (FNAs) have been given cytopathological diagnoses according to the MSRSGC since January 2018. Analyses of a one-year-period (January 2018–December 2018) consisted of 183 salivary FNA samples from 138 patients with correlation to histopathology in 90 cases with surgical follow-up. The MSRSGC performance in patient based analysis was as follows: accuracy was 90.9%, sensitivity was 61.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89.4%, respectively. Risks of malignancy (ROMs) in MSRSGC categories were: 0.0% (0/15) in non-diagnostic category, 100.0% (1/1) in non-neoplastic category biased by only one falsely-negative lymphoma case, 14.3% (1/7) in atypia of undetermined significance category, 0.0% (0/28) in benign neoplasm category, 27.3% (3/11) in neoplasm of uncertain malignant potential category, and 100% for both suspicious for malignancy (4/4) and malignancy (4/4) categories, respectively. The MSRSGC has been proven as a reliable classification system in salivary gland FNA routine diagnostics in a tertiary care center.
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40
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Saieg M. Implementing the Papanicolaou Society of Cytopathology terminology system for reporting pancreaticobiliary cytology refines risk of malignancy in pancreatic specimens. J Am Soc Cytopathol 2019; 8:117-119. [PMID: 31097286 DOI: 10.1016/j.jasc.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Mauro Saieg
- Department of Pathology, Santa Casa Medical School, São Paulo, Brazil; Department of Pathology, A. C. Camargo Cancer Center, São Paulo, Brazil.
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41
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Layfield LJ, Esebua M, Yang Z, Vatzmitsel M, Giorgadze T, Schmidt R. The Milan system for reporting salivary gland cytopathology: A study of inter‐observer reproducibility. Diagn Cytopathol 2019; 47:765-768. [DOI: 10.1002/dc.24187] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Lester J. Layfield
- Department of Pathology and Anatomical SciencesUniversity of Missouri Columbia Missouri
| | - Magda Esebua
- Department of Pathology and Anatomical SciencesUniversity of Missouri Columbia Missouri
| | - Zhongbo Yang
- Department of Pathology and Anatomical SciencesUniversity of Missouri Columbia Missouri
| | - Maryna Vatzmitsel
- Department of Pathology and Anatomical SciencesUniversity of Missouri Columbia Missouri
| | - Tamara Giorgadze
- Department of Pathology and Laboratory MedicineMedical College of Wisconsin Milwaukee Wisconsin
| | - Robert Schmidt
- Department of Pathology and Laboratory MedicineMedical College of Wisconsin Milwaukee Wisconsin
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Maleki Z, Baloch Z, Lu R, Shafique K, Song SJ, Viswanathan K, Rao RA, Lefler H, Fatima A, Wiles A, Jo VY, Wang H, Fadda G, Powers CN, Ali SZ, Pantanowitz L, Siddiqui MT, Nayar R, Klijanienko J, Barkan GA, Krane JF, Rossi ED, Callegari F, Kholová I, Bongiovanni M, Faquin WC, Pusztaszeri MP. Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi-institutional study. Cancer Cytopathol 2019; 127:306-315. [PMID: 31050186 DOI: 10.1002/cncy.22135] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6-tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs. METHODS Submandibular gland FNA cytology specimens from 15 international institutions (2013-2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow-up was performed, and the ROM was calculated for each MSRSGC diagnostic category. RESULTS The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%-50%); nonneoplastic, 24.2% (9.1%-53.6%); AUS, 6.7% (0%-14.3%); benign neoplasm, 18.3% (0%-52.5%); SUMP, 12% (0%-37.7%); SM, 3.5% (0%-12.5%); and malignant, 13.9% (2%-31.3%). The histopathologic follow-up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. CONCLUSIONS This multi-institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA.
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Affiliation(s)
- Zahra Maleki
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Zubair Baloch
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan Lu
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Khurram Shafique
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sharon J Song
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Rema A Rao
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Holly Lefler
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Aisha Fatima
- Department of Pathology, Rutgers Robert Wood Johnson University, New Brunswick, New Jersey
| | - Austin Wiles
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - He Wang
- Department of Pathology, Rutgers Robert Wood Johnson University, New Brunswick, New Jersey
| | - 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
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Momin T Siddiqui
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Ritu Nayar
- Department of Pathology, Northwestern University, Chicago, Illinois
| | | | - Guliz A Barkan
- Department of Pathology, Loyola University, Chicago, Illinois
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Esther D Rossi
- Department of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Fabiano Callegari
- Department of Pathology, Sao Paulo Federal University, Sao Paulo, Brazil
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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