Salivary gland lesions with a prominent lymphoid component: Cytologic findings and differential diagnosis by fine-needle aspiration biopsy
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Abstract:
Fine-needle aspiration (FNA) is an accepted technique for the preoperative diagnosis of salivary gland nodules. The majority of salivary gland nodules are pleomorphic adenomas and offer little difficulty in diagnosis. Most diagnostically difficult lesions fall into one of four morphologic categories represented by squamous-cell-containing lesions, clear cell neoplasms, neoplasms with a prominence of stromal material, and lymphocyte-containing lesions. Herein, we describe our experience with a series of 61 histologically confirmed cases in which the smears contained a prominent or predominant number of lymphocytes. The differential diagnosis is discussed and points of diagnostic aid enumerated.Keywords:
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An international and multi‐institutional cohort of salivary gland fine‐needle aspiration cases has been used to investigate the diagnosis and reporting of pleomorphic adenomas and Warthin tumors in the Milan System for Reporting Salivary Gland Cytopathology. This work helps to clarify important cytological reporting aspects of these 2 common salivary gland tumors.
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The cytopathology of benign and malignant breast lesions is described and correlated with the histopathology. Problems in diagnosis and the advantages of fine-needle aspiration are discussed. The diagnostic accuracy is approximately 93% with this technique.
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目的 : 新たに提唱された唾液腺領域の穿刺吸引細胞診の報告様式であるミラノシステムを用いて後方視的な検討を行い, カテゴリー別の細胞学的所見を明らかにする.
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Salivary Gland Diseases
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In this issue of Cancer Cytopathology , Gargano et al. describe their experience using the Milan System for Reporting Salivary Gland Cytopathology for the diagnosis and grading of a subset of salivary gland tumors with basaloid features. Among salivary gland tumors, this subset of basaloid tumors is considered by many to be the most problematic to classify cytologically.
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Diagnosis of malignant lymphoma by fine-needle aspiration biopsy (FNAB) remains a topic of skepticism and controversy. Because of the limitations of pure morphology, subclassfication of non-Hodgkin malignant lymphoma (NHML) by FNAB often requires ancillary studies which impose a challenge not typically required of other FNAB diagnoses. Despite the dubiousness expressed by many, the evidence shows that a large percentage of NHML cases can be recognized and correctly classified using FNAB. Diagnostic accuracy is dependent on several factors including the type of NHML. The emergent WHO classification of lymphomas is one that appears to more readily accommodate the cytologic methods for NHML diagnosis. Diagn. Cytopathol. 2000;22:120–125. © 2000 Wiley-Liss, Inc.
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Aspiration biopsy
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Background: Fine needle aspiration cytology (FNAC) is a well-established technique that plays a critical role in preoperative diagnosis of any salivary gland mass lesions. Because of heterogeneity of salivary gland lesions and cytomorphology overlap, a uniform 6 tier Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) helps standardize reporting systems and may aid in better communication between clinicians and pathologists and guide the clinical management of patients.Aims:We aimed to study the utility of FNAC in the diagnosis of salivary gland lesions and also study the cytomorphological features of various salivary gland lesions using Milan system classification. Methods and Material: We performed a retrospective analysis of salivary gland lesion FNAC in cytopathology department,tertiary care center from January 2018 to May 2019.All the cases of salivary gland aspirates were classified into six diagnostic categories according to the Milan system of reporting salivary gland cytology (MSRSGC) as follows: Category 1: Non-diagnostic (ND); Category 2: Non-neoplastic (NN); Category 3: Atypia of undetermined significance (AUS); Category 4a: Neoplasm: benign (NB), Category 4b: Neoplasm: salivary gland neoplasm of uncertain malignant potential (SUMP);Category 5:suspicious of malignancy (SM);and Category 6:Malignant (M). Results:A total of 54 cases of salivary gland aspirates were classified using the Milan system as non-diagnostic 2 cases (3.7%), non-neoplastic 12 (22.22%), atypia of undetermined significance 1 (1.85%), neoplasm 32 (59.3%), suspicious for malignancy 1 (1.86%), and malignancy 6 (11.1%).Pleomorphic Adenoma (23 cases;43%) was the most common benign salivary gland lesions and Mucoepidermoid Carcinoma (3 cases; 5.6%) was most common malignant lesion. Parotid gland (38 cases; 70.4%) was the most commonly involved in benign and malignant tumors. Commonly affected age group by benign salivary gland lesion was 31-40 years and those with malignant salivary gland lesion was 21-30 years. Conclusions: The MSRSGC helps pathologists to standardize reporting leading to better clinical and surgical management.
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Tertiary care
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Introduction: Salivary gland shows various pathological conditions ranging from cystic, inflammatory, tumor like and neoplastic lesions. Fine needle aspiration cytology (FNAC) plays an important role in evaluating salivary gland (SG) tumors. Salivary gland tumors are one of the most heterogeneous groups of neoplasms with cytopathological features overlapping among the entities and making it difficult to assign to specific category. Due to these facts, salivary gland cytopathology is one of the most challenging areas of cytology. The lack of a uniform reported guidelines in salivary gland cytopathology leads to inter-observer variability and disagreements. The present study was undertaken to assess the degree of inter-observer reproducibility for diagnostic categorization of salivary gland lesions utilizing MSRSGC among pathologists with varying experience along with its role in providing a framework for reporting salivary gland lesions.
Materials and Methods: In this cross sectional study, total of 44 cases of salivary gland lesions subjected to FNAC over a period of 7 year were studied. The cases were critically reviewed by 2 pathologists and a pathology resident with variable experience in cytopathology using MSRSGC in our institution. Inter-observer variability was assessed by comparing the agreement between two cytopathologists and pathology resident by using Cohen’s kappa statistics (Io score) and interpretation of the results was done using scale of Landis and Koch.
Results: All the salivary gland aspirates were categorized according to MSRSGC.Out of 44 cases, maximum cases 22 (50%) were classified under IVA (BN) followed by 27.27% to 29.5% cases classified under II (NN), 2.27-4.55% of cases under Category IVB (SUMP), 4.55% under category V( SM) and 6.82% cases under category VI ( M). Inter-observer variability (IOV) was calculated for individual category in Milan system using Cohens kappa test, which was found to be in the almost perfect agreement range as per Landis and Koch, for categories II, IVA, V, VI ( Io score 0.89- 1). Kappa score ranged from 0.645 - 1 for category I (ND), which showed substantial to an almost perfect agreement. Whereas, category IVB (SUMP) showed variable results, with substantial agreement (Io score 0.656) to no agreement (Io score 0) between different observers.The overall IOV showed an almost perfect agreement with a kappa score of 0.861(obs1 vs 2) ,0.896 (obs1 vs R), 0.965 (obs 2 vs R). The data was found to be statistically significant (p=< .0001).
Conclusion: MSRSGC is a very efficient system and has the potential to standardize salivary gland FNA diagnoses, providing clear prognostic and management information to clinicians and surgeons. This system can be used with good reproducibility between observers with variable cytopathology experience. Placing lesions in categories using MSRSGC can result in optimal management of discordant cases without using a specific diagnosis. Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC.Hence we recommend the use of Milan system for reporting salivary gland cytopathology.
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Salivary Gland Diseases
Anatomical pathology
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Background: The thyroid gland is responsible for various functions, but it is susceptible to pathologies. The gold standard for preliminarily diagnosing thyroid abnormalities is fine-needle aspiration cytology (FNAC), although it has some limitations; thus, postoperative histopathological examination confirms the diagnosis. The aim of the present study was to compare preoperative FNAC results with postoperative histopathological examination. Methods: This study is a retrospective study based on FNAC and postoperative histopathology examination, which were compared and analyzed. Results: This study included 344 patients between 18 and 86 years old (mean age: 53.06 ± 13.89), comprising 274 females and 70 males (mean ages 52.72 ± 13.86 and 54.39 ± 14.05, respectively) with a 3.9:1 female-to-male ratio. Statistical significance between the FNAC and histopathology results was observed (p = 0.0000), and 86 (25.00%) patients were found to have been diagnosed incorrectly based on FNAC. The sensitivity of FNAC was 92.31%, and its specificity was 82.08%, with positive and negative predictive values of 68.57% and 96.08%, respectively. Conclusions: Due to many factors, FNAC may lead to over- or under-diagnosis, increasing the chances of complications associated with the selected treatment. However, we do not have any other more accurate tools; therefore, FNAC should still remain as the gold standard of preliminary examination.
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Histopathological examination
Gold standard (test)
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Salivary Gland Diseases
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