Performance Characteristics of Adenoid Cystic Carcinoma of the Salivary Glands in Fine-Needle Aspirates: Results From the College of American Pathologists Nongynecologic Cytology Program

Tabatabai, Z. Laura; Auger, Manon; Kurtycz, Daniel F.I.; Laser, Alice; Souers, Rhona J.; Laucirica, Rodolfo; Barkan, Güliz A.; Crothers, Barbara A.; Khalbuss, Walid E.

doi:10.5858/arpa.2013-0173-cp

Cited by 26 publications

(35 citation statements)

References 20 publications

(58 reference statements)

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“…This morphologic overlap is perhaps most prominent in the area of basaloid neoplasms and is exemplified in a recent College of American Pathologists (CAP) survey focusing on the cytologic recognition of adenoid cystic carcinoma (AdCC). 4 This study concluded that the accurate identification of AdCC on cytologic samples is a problematic area with a false negative rate for malignancy of 36.4%. Misinterpretation of aspirates from AdCC as pleomorphic adenoma (PA) or monomorphic adenoma was the most common reason for false negative results.…”

Section: Introductionmentioning

confidence: 82%

A pattern‐based risk‐stratification scheme for salivary gland cytology: A multi‐institutional, interobserver variability study to determine applicability

Griffith

Schmitt

Pantanowitz

2017

Cancer Cytopathology

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Background Salivary gland aspiration cytology is useful in preoperative management of patients but remains challenging due to extensive morphologic overlap of some tumors limiting the ability to always determine the presence of malignancy. In response to this challenge, there has been increasing drive to develop a risk-based categorization scheme for salivary gland aspirates. Herein we examine the interobserver variability of one such pattern and risk-based system. Methods Select smears and cell block sections from 50 salivary gland aspirates from two large academic centers were digitally imaged. These scanned slides were independently and blindly reviewed by four cytopathologists and each aspirate was assigned to one of the proposed pattern-based categories if it was considered neoplastic by the observer. Interobserver agreement was scored and aggregated risks of malignancy calculated for cases with available surgical follow-up. Results 42 (84%) were considered neoplastic by at least two observers and scored for interobserver agreement. 23.8% (10 of 42) had uniform agreement, 33.3% (14 of 42) majority agreement, and 11.9% (5 of 42) divided agreement. Only 21.4% (9 of 42) had minimal agreement and 9.5% (4 of 42) had no agreement. Condensation of similar categories was able to improve interobserver agreement and still maintain stratified risk of malignancy. Conclusions This proposed pattern-based risk stratification scheme, which could be implemented with the forthcoming Milan System, has good overall interobserver agreement and successfully stratifies risk of malignancy. Some simplification is possible to make the system easier to use and improve interobserver agreement while maintaining stratification of risk.

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Section: Introductionmentioning

confidence: 82%

A pattern‐based risk‐stratification scheme for salivary gland cytology: A multi‐institutional, interobserver variability study to determine applicability

Griffith

Schmitt

Pantanowitz

2017

Cancer Cytopathology

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“…These neoplastic cells show similar features to previous reports in that they have a high nuclear:cytoplasmic ratio with angulate nuclei, however, the discrete formation of well‐circumscribed “cookie cutter” clusters of extracellular matrix with associated epithelial cells has not been previously noted. The architecture of these sharp‐bordered matrix globules were appropriately identified as a feature of adenoid cystic carcinoma …”

Section: Discussionmentioning

confidence: 99%

Well‐differentiated fetal adenocarcinoma of the lung mimicking adenoid cystic carcinoma on fine needle aspiration: A case report

Rerkpichaisuth

Collins

Boonyaarunnate

et al. 2016

Diagnostic Cytopathology

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Well-differentiated fetal adenocarcinoma (WDFA) of the lung is a rare variant of adenocarcinoma with an unusual morphology. Although the histologic features of this rare neoplasm have been well established, there is a deficit in the literature with regards to its discrete cytomorphologic features. We report the fine needle aspiration (FNA) findings of a case of this unusual malignancy in a 44-year-old man with an incidental lung nodule. FNA revealed three-dimensional clusters of epithelial cells with scant cytoplasm, hyperchromatic nuclei that are associated with an extracellular metachromatic matrix. The original cytology report was signed out as an epithelial neoplasm favor adenoid cystic carcinoma. Consequently, a wedge resection of the lung was done and the histologic diagnosis was WDFA of the lung. The findings of minimal nuclear atypia in association with focally abundant spheres of extracellular matrix can mimic adenoid cystic carcinoma. WDFA has good prognosis and therefore, pre-operative cytologic diagnosis is critical to clinical management. We present the cytomorphologic features of this neoplasm with particular emphasis on a potential diagnostic pitfall of this rare entity. Diagn. Cytopathol. 2016;44:917-920. © 2016 Wiley Periodicals, Inc.

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“…Multiple studies have shown high sensitivity, specificity and accuracy in the differentiation of benign versus malignant tumors (sensitivity 80-89% and specificity 97% for malignancy). 3 Likewise, non-basaloid tumors (so called "oncocytoid tumors") can also show low cytonuclear grade and low grade malignancies may be falsely diagnosed as benign neoplasms or non-specifically categorized simply as positive for neoplasm. Related to this, the diagnosis of neoplasia is more accurate than that of malignancy.…”

Section: Introductionmentioning

confidence: 99%

Ancillary testing strategies in salivary gland aspiration cytology: A practical pattern‐based approach

Griffith

Siddiqui

Schmitt

2017

Diagnostic Cytopathology

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Fine needle aspiration of salivary gland tumors is a common preoperative triage as it is useful in determining which patients should undergo surgical resection and in guiding the extent of surgery in those cases deemed appropriate for resection. While a specific diagnosis can be achieved on a cytologic specimen in many cases, there is also a considerable amount of morphologic diversity that prevents such confident preoperative classification and in these cases it can be a challenge to confidently determine if a tumor is benign or malignant. Recently, a pattern based risk stratification approach was proposed for salivary gland cytology in which basaloid neoplasms are separated by stromal characteristics and oncocytoid neoplasms are separated primarily by background material such as mucus. In addition to potentially providing a stratification in risk of malignancy for salivary gland tumors, this approach is also useful to narrow differential diagnostic considerations and guide ancillary testing. In this review we use this proposed pattern based approach as a framework to discuss immunostains and fluorescence in situ hybridization studies which we find useful in our practice.

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Performance Characteristics of Adenoid Cystic Carcinoma of the Salivary Glands in Fine-Needle Aspirates: Results From the College of American Pathologists Nongynecologic Cytology Program

Cited by 26 publications

References 20 publications

A pattern‐based risk‐stratification scheme for salivary gland cytology: A multi‐institutional, interobserver variability study to determine applicability

A pattern‐based risk‐stratification scheme for salivary gland cytology: A multi‐institutional, interobserver variability study to determine applicability

Well‐differentiated fetal adenocarcinoma of the lung mimicking adenoid cystic carcinoma on fine needle aspiration: A case report

Ancillary testing strategies in salivary gland aspiration cytology: A practical pattern‐based approach

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