Reply to Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi‐institutional study

Allison, Derek B.; Wiles, Austin; Maleki, Zahra

doi:10.1002/cncy.22391

Cited by 10 publications

(20 citation statements)

References 8 publications

(9 reference statements)

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“…PA is the most common salivary gland tumor comprising 45%–74% of all salivary gland tumors 6,7 and its diagnostic accuracy in FNA has been shown to be 89.5%–96.2% 8 . After implementation of the MSRSGC, international, multi‐institutional study revealed 95.1% diagnostic accuracy for PA 21 . In the present study, a 10‐year‐period diagnostic accuracy of PA diagnosis in tertiary care center was 96.5%.…”

Section: Discussionmentioning

confidence: 48%

“…The most common false-negative benign neoplasm was basal cell adenoma (0.9%) and false-negative malignant neoplasm was carcinoma ex PA (36%) and adenoid cystic carcinoma (28%). 21 Memorial Sloan Kettering study showed 17.2% of PA placed in SUMP category. 25 Indian MSRSGC institutional series showed PA cases also in non-diagnostic and suspicious for malignancy categories with majority of cases in benign neoplasm category.…”

Section: Discussionmentioning

confidence: 98%

“…International, multi‐institutional study showed that 95.1% PA cases were placed in benign neoplasm MSRSGC diagnostic category and only 5.5% in SUMP category. The most common false‐negative benign neoplasm was basal cell adenoma (0.9%) and false‐negative malignant neoplasm was carcinoma ex PA (36%) and adenoid cystic carcinoma (28%) 21 . Memorial Sloan Kettering study showed 17.2% of PA placed in SUMP category 25 .…”

Section: Discussionmentioning

confidence: 99%

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The diagnostic accuracy of pleomorphic adenoma in fine needle aspiration: Features leading to false positive and false negative diagnoses and the utility of cell blocks

Tommola

Kholová

2023

Diagnostic Cytopathology

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Objective Fine needle aspiration (FNA) is a well‐established tool in preoperative diagnosis of salivary gland lesions with diagnostic accuracy of 90%. Pleomorphic adenoma (PA) is the most common salivary gland tumor comprising 45%–74% of all salivary gland tumors with FNA diagnostic accuracy of 89.5%–96.2%. The aim of the present study was to determine and analyze potential cytomorphological pitfalls and evaluate the diagnostic accuracy in FNA diagnosis of PA. Methods Salivary gland specimens with both cytological and histological diagnoses were searched over a 10‐year‐period (2009–2018) from a laboratory information system of Pathology Department, Fimlab Laboratories, Tampere and matched to determine concordant and discordant PA cases. Sufficient material in histological and cytological sample was found in 401 cases. In 218 cases (54.4%) diagnosis was true‐negative PA, in 169 cases (42.1%) diagnosis was true‐positive PA and there were 14 discordant cases: 4 false‐positive cases and 10 false‐negative cases. False‐negative cases were reclassified and subgrouped according to The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Results Cytomorphologically, cell type predominance was more often myoepithelial in true‐positive cases (65%) and epithelial both in false‐negative (70%, p = .007) and false‐positive cases (75%, p = .027). Well‐formed ducts were present in cytology in all true‐positive cases (p < .001). Only 10% of true‐positive cases did not show any matrix in cytology (p < .001). Nuclear changes were common in false‐negative cases (80%, p = .002) and false‐positive cases (75%, p = .003). Beneficial cell block (CB) was more common in true‐positive cases (85%) than in false‐negative cases (50%, p = .041) or in false‐positive cases (50%, p = .116) and a lack of beneficial CB led more often to a false diagnosis (70% false diagnosis without beneficial CB versus 29% false diagnosis with beneficial CB). Conclusion The present study showed diagnostic accuracy of 96.5% for FNA in PA diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value were 94.4%, 98.2%, 97.7%, and 95.6%, respectively. The benefit of CBs was more evident in true‐positive cases (85%).

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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The diagnostic accuracy of pleomorphic adenoma in fine needle aspiration: Features leading to false positive and false negative diagnoses and the utility of cell blocks

Tommola

Kholová

2023

Diagnostic Cytopathology

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“…PA is characterized by a variable proportion of bland myoepithelial cells, bland appearing ductal epithelial cells, and fibrillary chondromyxoid matrix. 19 PAs present as a solid mass and may occasionally present as a cystic lesion. 4 PAs can routinely be diagnosed based on morphology alone on FNA material, however, the diagnosis of PA can be challenging due to associated metaplastic changes.…”

Section: Pleomorphic Adenomamentioning

confidence: 99%

“…[20][21][22] PAs can also be mistaken for adenoid cystic carcinoma (AdCC) or salivary duct carcinoma. 19 While this may not be the most common presentation, it is still an important entity to consider in the differential diagnosis of mucinous cystic lesions of the salivary gland due to its benign nature. As such, it is important to consider additional sampling to generate a cell block that may be used for additional diagnostic testing in these cases.…”

Section: Pleomorphic Adenomamentioning

confidence: 99%

Cystic Salivary Gland Neoplasms: Diagnostic Approach With a Focus on Ancillary Studies

Ribeiro

Maleki

2022

Advances in Anatomic Pathology

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Cystic salivary gland cytology can be challenging due to the fact that a cystic mass can be the clinical presentation of both non-neoplastic and neoplastic conditions. Neoplastic lesions consist of both benign and malignant neoplasms. The cytomorphologic features of these entities can overlap and the cystic background may additionally contribute to the complexity of these lesions and their interpretation. Ancillary studies have been reported in several studies to be beneficial in further characterization of the cellular components and subsequent diagnosis of the cystic lesions of the salivary gland. Fluorescence in situ hybridization, real-time polymerase chain reaction, and next-generation sequencing are now being utilized to detect molecular alterations in salivary gland neoplasms. MALM2 rearrangement is the most common gene fusion in mucoepidermoid carcinoma. PLAG1 rearrangement is present in more than half of pleomorphic adenomas. AKT1:E17K mutation is the key diagnostic feature of the mucinous adenocarcinoma. NR4A3 overexpression is highly sensitive and specific for the diagnosis of acinic cell carcinoma. MYB fusion is noted in adenoid cystic carcinoma. ETV6:NTRK3 fusion is helpful in diagnosis of secretory carcinoma. p16 and human papillomavirus (HPV) studies differentiate HPV-related squamous cell carcinoma from non-HPV-related neoplasms with overlapping features. NCOA4:RET fusion protein is the main fusion in intraductal carcinoma.

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The Milan system for reporting salivary gland cytopathology—A single‐center study of 2156 cases

et al. 2023

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Background: Fine-needle aspiration cytology (FNAC) represents an important diagnostic tool for the workup of salivary gland (SG) lesions. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a six-tiered system for standardizing diagnoses and improvement of communication between pathologists and clinicians, providing risk of malignancy (ROM) rates for every category.The aims of the present study were (i) to validate the use of MSRSGC in a large series of SG FNAC in a tertiary center in Switzerland, (ii) to determine ROM for each category and compare them with data from MSRSGC and similar studies, and (iii) to investigate whether there were relevant differences of non-diagnostic results between fine-needle aspirations (FNA) performed by cytopathologists compared to non-cytopathologists. Methods:The files of the department of Pathology in the University Hospital Zurich (UHZ) were searched for SG FNAC between 2010 and 2019. The MSRSGC guidelines were applied retrospectively. Furthermore, ROM, risk of neoplasia (RON), sensitivity, and specificity were calculated based on the cases with histopathological follow-up. Results: A total of 2156 SG FNAC including 753 cases with histopathological follow-up were evaluated. Generally, ROM was within the range of values provided by MSRSGC, with some minor deviations. Sensitivity was 94.6%, and specificity was 99.3%. Conclusions:Our study confirms the usefulness of MSRSGC. In addition, it provides a detailed insight into the wide spectrum of SG FNAC. Finally, we showed that the rate of non-diagnostic FNA was significantly lower in FNAs performed by cytopathologists compared to non-cytopathologists. K E Y W O R D Scytology, fine-needle aspiration (FNA), Milan system for reporting salivary gland cytopathology (MSRSGC), risk of malignancy (ROM), salivary gland tumors

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Reply to Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi‐institutional study

Cited by 10 publications

References 8 publications

The diagnostic accuracy of pleomorphic adenoma in fine needle aspiration: Features leading to false positive and false negative diagnoses and the utility of cell blocks

The diagnostic accuracy of pleomorphic adenoma in fine needle aspiration: Features leading to false positive and false negative diagnoses and the utility of cell blocks

Cystic Salivary Gland Neoplasms: Diagnostic Approach With a Focus on Ancillary Studies

The Milan system for reporting salivary gland cytopathology—A single‐center study of 2156 cases

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