Background: Fine needle aspiration (FNA) cytology has been widely used in the preoperative evaluation of salivary gland lesions. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a tiered risk-stratification scheme designed to standardize reporting and facilitate decision making. We aimed to clarify the validity and diagnostic utility of the MSRSGC-based classification of salivary gland lesions.Methods: A total of 1020 salivary gland FNA specimens were retrieved between 2008 and 2017, with histologic follow-up data available for 349 specimens. Within the present retrospective study, each specimen with follow-up data was reclassified according to the MSRSGC diagnostic categories: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), and malignant.The risk of malignancy (ROM) was calculated based on the histologic follow-up data. Results: The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the MSRSGC-based classification of the malignant potential of salivary gland lesions were 80.1%, 70.4%, 99.2%, 90.5%, and 96.7%, respectively. The ROM calculated for specimens assigned to the nondiagnostic, nonneoplastic, AUS, benign neoplasm, SUMP, SM, and malignant categories were 8.6%, 15.4%, 36.8%, 2.6%, 32.3%, 71.4%, and 100%, respectively. Conclusion: The present results confirm the validity and diagnostic utility of MSRSGC, supporting its use in clinical practice to help devise adequate management strategies for salivary gland lesions. K E Y W O R D S cytopathology, Milan System, MSRSGC, salivary gland 1 | INTRODUCTION In the management of salivary gland lesions, fine needle aspiration (FNA) cytology represents a cost-effective and minimally invasive procedure. It has been widely applied to differentiate nonneoplastic from neoplastic lesions, which is useful in the development of management strategies, ranging from conservative observation to complete surgical excision, and it can also provide prognostic information. 1 However, interpretation of the FNA of salivary gland lesions still poses a great challenge for pathologists and cytopathologists because of the relatively low cellularity in the cystic lesion, morphological heterogeneity within the tumor, and obvious overlapping morphologic features between benign and low-grade malignant tumors. For example, the lack of specific cytologic architecture to evaluate tumor invasion makes it difficult to distinguish between basal cell adenoma and basal cell adenocarcinoma, as the cytomorphology of the two neoplasms are similar. 2-5 The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standardized reporting system designed to
Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Between December 2005 and January 2010, 200 consecutive patients with prostate cancer received RALP performed by a single surgeon. Only one case with Clavien grade II complication due to gouty arthritis. The complication rate was 1%. We suggested that patient with history of gouty arthritis need to prescribe preventive colchicine. OBJECTIVE To analyse the learning curve for reducing complications of robotic‐assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon in Taiwan. PATIENTS AND METHODS Complication rates were prospectively assessed in 200 consecutive patients undergoing RALP (Group I: cases 1–50; Group II: cases 51–100; Group III: cases 101–150 and Group IV: cases 151–200). Complications were classified using the Clavien system: grade I: deviation normal postoperative course without treatment; grade II: drug or bedside treatment; grade III: endoscopic or surgical intervention; grade IV: life‐threatening problem; and grade V: death. Operative parameters and peri‐operative complications were evaluated, including operative and console time, blood loss and transfusion rate, Gleason scores, positive surgical margin (PSM) rate, specimen volume, tumour size, tumour percentage, node positive rate and intra‐ and postoperative complications. RESULTS RALP console time was gradually lowered from Group I to Group IV (P < 0.05). Significantly less blood loss occurred after every 50 cases of RALP (Group I 275 mL, Group II 179 mL, Group III 145 mL, Group IV 102 mL, P < 0.001). Blood transfusion incidence was 8%, 4%, 2% and 0% in Groups I, II, III and IV, respectively. Complication rates were 18%, 12%, 18% and 0% in Groups I, II, III and IV, respectively. Major complications (grade III–IV) were 6%, 2%, 4% and 0% in Groups I, II, III and IV, respectively. Bowel injury occurred in three cases (Group II: 1; Group III: 2); one received intra‐operative repair without sequelae and two received a transient colostomy and later colostomy closure. CONCLUSIONS The learning curve for every 50 cases of RALP showed significantly less blood loss and blood transfusion rate. The learning curve for significantly decreasing complications is 150 cases.
BACKGROUND: In recent years, there have been increasing indications for percutaneous renal biopsy. Fine-needle aspiration (FNA), with or without core needle biopsy (CB), has been used increasingly in the management of renal tumors at the study institution. METHODS: A computerized search of laboratory records was conducted to retrieve FNA cases of renal masses as well as the correlating CB and/or nephrectomy specimens. The cases spanned a period of 10 years (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). The diagnoses were classified into 5 categories: malignant, suspicious for malignancy, neoplastic, atypical, and negative/nondiagnostic. Based on the results of the nephrectomy specimens, the diagnostic rate, sensitivity, and diagnostic accuracy were calculated among 3 groups of specimens: FNA only, CB only, and combined FNA and CB.RESULTS: A total of 247 cases of FNA with 123 correlating CB and 101 follow-up nephrectomy specimens were identified.The diagnostic rate, sensitivity, and diagnostic accuracy were 72%, 78%, and 96%, respectively, for FNA; 87%, 92%, and 94%, respectively, for CB; and 92%, 92%, and 94%, respectively, for the combined FNA and CB group. Renal cell carcinoma and its variants were the most common histologic diagnoses (112 of 174 cases; 64%). Significant diagnostic discrepancy was noted in one case: a malignant melanoma that was misdiagnosed as renal cell carcinoma in both the preoperative FNA specimen and in the CB specimen. CONCLUSIONS: In the current study, both FNA and CB demonstrated excellent diagnostic accuracy (96% and 94%, respectively). The combination of FNA and CB was found to significantly improve the diagnostic rate when compared with either FNA alone (92% vs 72%; P<.05) or CB alone (92% vs 87%).
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