Preoperative fine needle cytology and imaging facilitates the management of submandibular salivary gland lesions

Taylor, Martyn; Serpell, Jonathan W.; Thomson, Peter

doi:10.1111/j.1445-2197.2010.05347.x

Cited by 15 publications

(10 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite its wide acceptance as a diagnostic tool with low rates of complication and patient morbidity, interpretation of salivary gland FNA specimens remains one of the most challenging areas within cytopathology. Factors contributing to this difficulty include overlapping morphological features between benign and malignant entities, the vast heterogeneity of tumour nodules, lesional cell resemblance to normal salivary gland elements, metaplastic or cystic changes mimicking neoplasms, the need to evaluate capsular invasion (which cannot be done on FNA) and the presence of focal atypia—all of which can preclude precise categorisation of salivary gland lesions .…”

Section: Discussionmentioning

confidence: 99%

The utility of the Milan System as a risk stratification tool for salivary gland fine needle aspiration cytology specimens

et al. 2018

View full text Add to dashboard Cite

Objective: To perform a retrospective investigation of our institutional experience with salivary gland fine needle aspirations (FNA) through the framework of The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and assess the risks of neoplasm and malignancy for each diagnostic category.were retrospectively categorised according to the MSRSGC. When available, preoperative cytological results were correlated with subsequent histological follow-up. Results: In total, 893 FNAs were reviewed. The specimens were retrospectively classified as nondiagnostic (ND: 13.5%), non-neoplastic (NN: 16.1%), atypia of undetermined significance (AUS: 10.8%), benign neoplasm (BN: 34.9%), salivary gland neoplasm of uncertain malignant potential (SUMP: 8.2%), suspicious for malignancy (SM: 2.7%) and malignant (M: 13.8%). Histological follow-up was available for 429 cases (48%); the majority (68.1%) were benign. The risks of neoplasm and malignancy for each category were as follows: ND: 64.5%, 16.1%; NN: 42.9%, 17.9%; AUS: 79.6%, 30.6%; BN: 100%, 2.2%; SUMP: 100%, 46.6%; SM: 94.7%, 78.9%; and M: 100%, 98.5%. Conclusions: The MSRSGC is a useful classification scheme for stratifying salivary gland lesions according to their associated risk of malignancy and guiding clinicians toward appropriate management. Diagnostic pitfalls are seen in a small proportion of cases and a multidisciplinary approach for assessing salivary gland pathology is essential in their evaluation. K E Y W O R D S cytology, fine needle aspiration, Milan system, risk of malignancy, salivary gland 1 | INTRODUCTION Fine needle aspiration (FNA) is a well established, cost-effective, and minimally invasive diagnostic tool for sampling salivary gland lesions. 1,2FNA cytology can be useful for distinguishing between non-neoplastic and neoplastic entities. 3 However, due to intratumoral heterogeneity and frequent overlapping cytomorphological features between many tumours, precise subtyping of neoplasms can be challenging. 4-7 This distinction is important as the treatment options vary across the spectrum of salivary gland pathologies. Non-neoplastic lesions can be managed conservatively, whereas a neoplastic diagnosis warrants surgical excision-in most cases with extensive surgery for high-grade malignancies, lymph node dissection for metastases and a haematology-oncology referral for haematological malignancies. Hence, cytological diagnoses that are descriptive without proper categorisation can be confusing for clinicians who need more definitive diagnoses to guide their management decisions. 8Until recently, there has been a lack of a uniform reporting scheme for cataloguing salivary gland lesions. It is in this setting that an international panel of experts under the joint efforts of the American

show abstract

Section: Discussionmentioning

confidence: 99%

The utility of the Milan System as a risk stratification tool for salivary gland fine needle aspiration cytology specimens

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Ultrasound is frequently used together with FNA, and is an effective guidance tool to facilitate the aspiration procedures (6). The first published study discussing the combination of multiple strategies to obtain higher diagnostic accuracy for salivary gland lesions, was carried out by Taylor et al in 2011 (5). The authors concluded that sonography, sialography and FNA are effective diagnostic tools guiding the decision for surgical intervention, with CT, MRI and core biopsies declared as useful adjuncts in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Salivary gland tumors: A 20-year review of clinical diagnostic accuracy at a single center

et al. 2013

View full text Add to dashboard Cite

Obtaining reliable pre-operative diagnosis is crucial in planning treatment for patients with salivary gland tumors. The purpose of this study was to evaluate the accuracy of pre-operative clinical diagnosis of salivary gland tumors managed at a single tertiary university hospital over a period of 20 years. A retrospective analysis of the period between 1992 and 2011 was carried out to review the cases of patients with salivary gland tumors. A total of 101 patients were enrolled and general data were described. Clinical diagnosis was compared with the final pathological diagnosis to reveal the clinical diagnostic accuracy. Of the parotid and submandibular gland tumors, 86 and 67% were benign, respectively. The clinical diagnostic accuracies for diagnosis of parotid tumors as benign or malignant were 100 and 57%, respectively. The clinical diagnostic accuracies for diagnosis of submandibular tumors as benign or malignant were 67%. Therefore, the overall clinical judgment of benign and malignant tumors in the submandibular gland is unreliable. The accuracy for a parotid tumor to be clinically interpreted as benign was 100%. While it is difficult to draw any conclusion for non-parotid gland tumors, surgical intervention should be recommended in patients with parotid tumors clinically suspected to be malignant, and all submandibular, sublingual and minor salivary gland tumors.

show abstract

“…In contrast, approximately 10% to 15% of all salivary gland tumors occur in the submandibular glands, and approximately 50% of these are malignant . Although less commonly performed, FNA is also the diagnostic method of choice for diagnosing submandibular gland lesions The literature review shows an overall diagnostic accuracy higher than 80% with a sensitivity of 71.4% and a specificity of 94.4% …”

Section: Introductionmentioning

confidence: 99%

Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi‐institutional study

Maleki

Baloch

et al. 2019

Cancer Cytopathology

View full text Add to dashboard Cite

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 fineneedle 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.

show abstract

Preoperative fine needle cytology and imaging facilitates the management of submandibular salivary gland lesions

Cited by 15 publications

References 33 publications

The utility of the Milan System as a risk stratification tool for salivary gland fine needle aspiration cytology specimens

The utility of the Milan System as a risk stratification tool for salivary gland fine needle aspiration cytology specimens

Salivary gland tumors: A 20-year review of clinical diagnostic accuracy at a single center

Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi‐institutional study

Contact Info

Product

Resources

About