Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Access via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply

Select

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: February 14, 2022
Accepted: May 18, 2022
Published online: June 23, 2022

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 3

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

For additional information: https://www.karger.com/ACY

Abstract

Background: Evaluation of salivary gland lesions is routinely done preoperatively by fine-needle aspiration cytology (FNAC). The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), with diagnostic categories I–VI, has been recommended to standardize the reporting of salivary gland lesions by FNAC. We aimed to reclassify archival salivary gland FNAC samples using MSRSGC, correlate the samples with surgical resections, and calculate the risk of malignancy (ROM) for each category. Methods: A total of 354 salivary gland FNAC samples (2013–2018) were reviewed. All FNAC results were retrospectively classified according to the MSRSGC. All cases had surgical follow-up. Histology was used to calculate the ROM, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Results: The 354 aspirates were classified as: nondiagnostic (ND) 17.0% (60), non-neoplastic (NN) 1.4% (5), atypia of undetermined significance (AUS) 11.0% (39), benign neoplasm (BN) 49.4% (175), salivary gland neoplasms of unknown malignant potential (SUMP) 10.7% (38), suspicious for malignancy (SM) 3.4% (12), and malignant (M) 7.1% (25). The ROM was as follows: ND 22%, NN 20%, AUS 15%, BN 2%, SUMP 53%, SM 75%, and M 96%. The diagnostic accuracy for separating benign versus malignant neoplasms was 96%. Cytologic-histologic correlation yielded a false-negative rate of 2.7%, false-positive rate of 10.5%, PPV of 89%, NPV of 97%, sensitivity of 87%, and specificity of 98%. Conclusion: MSRSGC helps standardize cytology reports, provides useful information for appropriate clinical management, and ensures the best care of patients with salivary gland lesions.

© 2022 S. Karger AG, Basel

References Kocjan G, Nayagam M, Harris M. Fine needle aspiration cytology of salivary gland lesions: advantages and pitfalls. Cytopathology. 1990;1(5):269–75. Chen YA, Wu CY, Yang CS. Application of the Milan system for reporting salivary gland cytopathology: a retrospective study in a tertiary institute. Diagn Cytopathol. 2019;47(11):1160–7. Seethala RR, LiVolsi VA, Baloch ZW. Relative accuracy of fine-needle aspiration and frozen section in the diagnosis of lesions of the parotid gland. Head Neck. 2005;27(3):217–23. Jain R, Gupta R, Kudesia M, Singh S. Fine needle aspiration cytology in diagnosis of salivary gland lesions: a study with histologic comparison. Cytojournal. 2013;10:5. Colella G, Cannavale R, Flamminio F, Foschini MP. Fine-needle aspiration cytology of salivary gland lesions: a systematic review. J Oral Maxillofac Surg. 2010;68(9):2146–53. Mairembam P, Jay A, Beale T, Morley S, Vaz F, Kalavrezos N, et al. Salivary gland FNA cytology: role as a triage tool and an approach to pitfalls in cytomorphology. Cytopathology. 2016;27(2):91–6. Daneshbod Y, Daneshbod K, Khademi B. Diagnostic difficulties in the interpretation of fine needle aspirate samples in salivary lesions: diagnostic pitfalls revisited. Acta Cytol. 2009;53(1):53–70. Rajwanshi A, Gupta K, Gupta N, Shukla R, Srinivasan R, Nijhawan R, et al. Fine-needle aspiration cytology of salivary glands: diagnostic pitfalls – revisited. Diagn Cytopathol. 2006;34(8):580–4. Rossi ED, Baloch Z, Pusztaszeri M, Faquin WC. The Milan system for reporting salivary gland cytopathology (MSRSGC): an ASC-IAC-sponsored system for reporting salivary gland fine-needle aspiration. J Am Soc Cytopathol. 2018;7(3):111–8. Rimm DL, Stastny JF, Rimm EB, Ayer S, Frable WJ. Comparison of the costs of fine-needle aspiration and open surgical biopsy as methods for obtaining a pathologic diagnosis. Cancer. 1997;81(1):51–6. Kaushik R, Bhatia K, Sarin H, Gautam D, Sarin D. Incorporation of the Milan system in reporting salivary gland fine needle aspiration cytology-An insight into its value addition to the conventional system. Diagn Cytopathol. 2020;48(1):17–29. Pusztaszeri M, Baloch Z, Vielh P, Faquin WC. Application of the Milan system for reporting risk stratification in salivary gland cytopathology. Cancer Cytopathol. 2018;126(1):69–70. Baloch ZW, Faquin WC, Layfield LJ. Is it time to develop a tiered classification scheme for salivary gland fine-needle aspiration specimens? Diagn Cytopathol. 2017;45(4):285–6. Pusztaszeri M, Rossi ED, Baloch ZW, Faquin WC. Salivary gland fine needle aspiration and introduction of the Milan reporting system. Adv Anat Pathol. 2019;26(2):84–92. Wei S, Layfield LJ, LiVolsi VA, Montone KT, Baloch ZW. Reporting of fine needle aspiration (FNA) specimens of salivary gland lesions: a comprehensive review. Diagn Cytopathol. 2017;45(9):820–7. Piccioni LO, Fabiano B, Gemma M, Sarandria D, Bussi M. Fine-needle aspiration cytology in the diagnosis of parotid lesions. Acta Otorhinolaryngol Ital. 2011;31(1):1–4. Lubin D, Buonocore D, Wei XJ, Cohen JM, Lin O. The Milan system at Memorial Sloan Kettering: utility of the categorization system for in-house salivary gland fine-needle aspiration cytology at a comprehensive cancer center. Diagn Cytopathol. 2020;48(3):183–90. Wong DS, Wong LY. “Cystic” parotid swelling on FNA: significance on clinical management. Otolaryngol Head Neck Surg. 2004;130(5):593–6. Rossi ED, Faquin WC, Baloch Z, Barkan GA, Foschini MP, Pusztaszeri M, et al. The Milan system for reporting salivary gland cytopathology: analysis and suggestions of initial survey. Cancer Cytopathol. 2017;125(10):757–66. Rossi ED, Faquin WC. The Milan system for reporting salivary gland cytopathology: the clinical impact so far. Considerations from theory to practice. Cytopathology. 2020;31(3):181–4. Viswanathan K, Sung S, Scognamiglio T, Yang GCH, Siddiqui MT, Rao RA. The role of the Milan system for reporting salivary gland cytopathology: a 5-year institutional experience. Cancer Cytopathol. 2018;126(8):541–51. Rossi ED, Wong LQ, Bizzarro T, Petrone G, Mule A, Fadda G, et al. The impact of FNAC in the management of salivary gland lesions: institutional experiences leading to a risk-based classification scheme. Cancer Cytopathol. 2016;124(6):388–96. Wu HH, Alruwaii F, Zeng BR, Cramer HM, Lai CR, Hang JF. Application of the Milan system for reporting salivary gland cytopathology: a retrospective 12-year bi-institutional study. Am J Clin Pathol. 2019;151(6):613–21. Song SJ, Shafique K, Wong LQ, LiVolsi VA, Montone KT, Baloch Z. The utility of the Milan system as a risk stratification tool for salivary gland fine needle aspiration cytology specimens. Cytopathology. 2019;30(1):91–8. Billings TL, Barr R, Dyson S. Langerhans cell histiocytosis mimicking malignant melanoma: a diagnostic pitfall. Am J Dermatopathol. 2008;30(5):497–9. Rohilla M, Singh P, Rajwanshi A, Gupta N, Srinivasan R, Dey P, et al. Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification. Cancer Cytopathol. 2017;125(10):767–75. Bhutani N, Sen R, Gupta M, Kataria S. Moving toward a systematic approach for reporting salivary gland cytopathology: cytohistological correlation with the application of the Milan system for risk stratification at a tertiary care center. Diagn Cytopathol. 2019;47(11):1125–31. Viguer JM, Vicandi B, Jimenez-Heffernan JA, Lopez-Ferrer P, Limeres MA. Fine needle aspiration cytology of pleomorphic adenoma. An analysis of 212 cases. Acta Cytol. 1997;41(3):786–94. Ogawa I, Miyauchi M, Matsuura H, Takata T. Pleomorphic adenoma with extensive adenoid cystic carcinoma-like cribriform areas of parotid gland. Pathol Int. 2003;53(1):30–4. Hernandez-Prera JC, Skalova A, Franchi A, Rinaldo A, Vander Poorten V, Zbaren P, et al. Pleomorphic adenoma: the great mimicker of malignancy. Histopathology. 2021;79(3):279–90. Stenman G. Fusion oncogenes in salivary gland tumors: molecular and clinical consequences. Head Neck Pathol. 2013;7(Suppl 1):S12–19. Matsuyama A, Hisaoka M, Nagao Y, Hashimoto H. Aberrant PLAG1 expression in pleomorphic adenomas of the salivary gland: a molecular genetic and immunohistochemical study. Virchows Arch. 2011;458(5):583–92. Rotellini M, Palomba A, Baroni G, Franchi A. Diagnostic utility of PLAG1 immunohistochemical determination in salivary gland tumors. Appl Immunohistochem Mol Morphol. 2014;22(5):390–4. Jo VY, Krane JF. Ancillary testing in salivary gland cytology: a practical guide. Cancer Cytopathol. 2018;126(Suppl 8):627–42. West RB, Kong C, Clarke N, Gilks T, Lipsick JS, Cao H, et al. MYB expression and translocation in adenoid cystic carcinomas and other salivary gland tumors with clinicopathologic correlation. Am J Surg Pathol. 2011;35(1):92–9. Brill LB 2nd, Kanner WA, Fehr A, Andren Y, Moskaluk CA, Loning T, et al. Analysis of MYB expression and MYB-NFIB gene fusions in adenoid cystic carcinoma and other salivary neoplasms. Mod Pathol. 2011;24(9):1169–76. Katabi N, Xu B, Jungbluth AA, Zhang L, Shao SY, Lane J, et al. PLAG1 immunohistochemistry is a sensitive marker for pleomorphic adenoma: a comparative study with PLAG1 genetic abnormalities. Histopathology. 2018;72(2):285–93. Tan Y, Kryvenko ON, Kerr DA, Chapman JR, Kovacs C, Arnold DJ, et al. Diagnostic pitfalls of infarcted Warthin tumor in frozen section evaluation. Ann Diagn Pathol. 2016;25:26–30. Mooney EE, Dodd LG, Layfield LJ. Squamous cells in fine-needle aspiration biopsies of salivary gland lesions: potential pitfalls in cytologic diagnosis. Diagn Cytopathol. 1996;15(5):447–52. Parwani AV, Ali SZ. Diagnostic accuracy and pitfalls in fine-needle aspiration interpretation of Warthin tumor. Cancer. 2003;99(3):166–71. Article / Publication Details

First-Page Preview

Received: February 14, 2022
Accepted: May 18, 2022
Published online: June 23, 2022

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 3

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

For additional information: https://www.karger.com/ACY