The Milan System for Reporting Salivary Gland Cytopathology: A 3-year Retrospective Analysis in Patan Hospital
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Introduction: The characteristics of salivary gland lesions identified by fine-needle aspiration cytology are varied and may overlap, which makes diagnosis difficult for cytopathologists. To provide consistency in the reporting of salivary gland cytology and to enhance clinic-pathologic communication, the "Milan system for reporting salivary gland cytopathology" has been introduced, which offers guidelines for diagnosis and treatment based on various categories of malignancy risk. Material and Methods: In this retrospective study, Fine needle aspiration cytology was done for all salivary gland lesions for three years and were retrieved from the Department of pathology, Patan hospital. All the cases were recategorized according to the Milan system for reporting salivary gland cytology with histopathology follow-up wherever available. Consistency of the two different types of assessment techniques (Milan category and primary cytology diagnosis) were assessed and the k score was calculated Results: A total of 58 cases were included in the study of which histological follow-up was available in 27 cases. Out of 58 cases, maximum cases 32 (55.1%) were classified under IVA followed by 15.5% cases classified under II, 8.6% of cases under Category IVB), 6.8% under category Vand 5.1% cases under category VI. Kappa's score was 0.58 which represents a moderate agreement. Conclusions: Milan system for reporting salivary gland cytopathology is a recently proposed six-category scheme, which places salivary gland fine needle aspiration cytology into well-defined categories that limit the possibilities of false negative and false positive cases.Keywords:
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Objectives: Fine needle aspiration cytology (FNAC) is a well-established technique for initial assessment of salivary gland lesions. The Milan system for reporting salivary gland cytopathology (MSRSGC) was introduced to provide a guide for diagnosis and management of salivary gland lesions according to risk of malignancy (ROM) in different categories. Methods: A 5-year retrospective study was conducted to reclassify the salivary gland lesions from previous diagnosis. Clinical data, FNAC, and histopathology report was retrieved and cases were reclassified according to the Milan system of classification. Risk of malignancy was calculated for each category. The positive predictive value, negative predictive value, and diagnostic accuracy of FNAC was calculated. Results: A total of 314 cases were evaluated cytologically. Histopathology was available in 81 cases. The distribution of cases in different categories according to the Milan system was 1.27% (Cat I), 48.4% (Cat II), 1.91% (Cat III), 38.21%, (Cat IV A), 2.22% (Cat IV B), 3.18% (Cat V), and 4.77% (Cat VI). Overall risk of malignancy reported was 0%, 0%, 50%, 14.7% (Cat IV A), 66.66% (Cat IV B), 83.3%, and 100%, respectively. Overall sensitivity, specificity, positive predictive value, and negative predictive value was 70.58%, 93.75%, 75%, and 92.30%, respectively. Diagnostic accuracy was 88.89%. Conclusion: MSRSGC is a useful system for conveying risk of malignancy (ROM) and deciding further treatment protocol and, hence, improves overall patient care and management.
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Background: A wide variety of benign and malignant tumours originate in the salivary glands and insufficient tumour cells make their diagnosis difficult in some patients. The aim of this study was to evaluate the efficacy of fine-needle aspiration cytology in the diagnosis of salivary gland lesions and to correlate cytological findings with histopathology. Materials and Methods: This was a prospective study done from September 2002 to May 2004. Fine needle aspiration cytology was performed in 58 patients with clinically significant salivary gland masses. Results: Fine needle aspiration cytology categorized 67.24% of the salivary gland lesions as neoplastic and 32.76% as non-neoplastic lesions. Amongst the neoplastic lesions, 76.9% were benign and 23.1% were malignant cases. Histopathological examination revealed that 81.05% of the cases were benign and 18.95% were malignant. Fine needle aspiration cytology had a sensitivity, specificity and diagnostic accuracy of 81.82%, 100% and 96.55%, respectively. The positive predictive value and negative predictive value was 100% and 95.9%, respectively. Conclusion: Fine needle aspiration of the salivary gland is a safe and reliable technique in the primary diagnosis of salivary gland lesions. Although, limitations are encountered while predicting specific lesions on cytology, especially when dealing with cystic and some malignant lesions, this study has shown that fine needle aspiration cytology has a high sensitivity, specificity and diagnostic accuracy in diagnosing salivary gland lesions. Keywords: Salivary glands; Fine needle aspiration cytology; Histopathology DOI: http://dx.doi.org/10.3126/jpn.v1i2.5403 JPN 2011; 1(2): 108-113
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Background IgG4‐related disease (IgG4‐RD) is a tumefactive fibro‐inflammatory lesion that can affect any organ system in the body. Till date, no cytological data on IgG4‐RD are available and this is the first study depicting the cytopathology features of IgG4‐RD. Aim and Objective To describe the cytopathological features and potential diagnostic errors of IgG4‐RD. Materials and Methods The cytological features of 10 histopathology proven IgG4‐RD cases (11 samples) were retrospectively reviewed along with corresponding histopathology. Results The cellularity of the cytology smears was low (36.4%) to moderate (45.4%) to high (18.1%). The low cellularity correlated well with the pattern C in histopathology (predominant fibrosis pattern). The non‐epithelial background showed a preponderance of lymphocytes along with polymorphs and spindle‐shaped fibroblasts. Most of these cases showed the presence of plasma cells and eosinophils. Epithelial atypia was seen in 18.2% cases. Conclusion The causes of misdiagnosis were low cellularity, epithelial atypia, and non‐representative background. The important diagnostic clues to suspect a diagnosis of IgG4‐RD include low cellularity despite adequate effort, inflammatory background rich in lymphocytes and spindle cells admixed with a few plasma cells and eosinophils along with radiological features and raised serum IgG4 Diagn. Cytopathol. 2017;45:14–21. © 2016 Wiley Periodicals, Inc.
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BACKGROUND Fine‐needle aspiration (FNA) cytology of salivary glands is a well‐established technique that plays a critical role in the preoperative diagnosis of lesions. A risk stratification of FNA diagnostic categories has been recently proposed to be useful in reporting. The aims of this study were to evaluate the diagnostic accuracy of salivary gland FNA and to apply the proposed Milan system for reporting salivary gland lesions. METHODS A retrospective audit of FNA specimens of salivary gland lesions reported from 2014 to 2016 was performed. A correlation with the follow‐up histopathology, wherever it was available, was performed. The aspirates were then categorized according to the Milan system as follows: nondiagnostic, nonneoplastic, atypical, benign neoplasm, neoplasm of uncertain malignant potential (NUMP), suspicious for malignancy, or positive for malignancy. Furthermore, the risk of malignancy and the risk of high‐grade malignancy were calculated for all diagnostic categories. RESULTS A total of 631 salivary gland aspirates were evaluated: 2.2% were nondiagnostic, 55.8% indicated nonneoplastic lesions, and 40.4% indicated neoplastic lesions. Histopathology was available for 94 cases (14.9%). FNA had a sensitivity of 79.4% and a specificity of 98.3% with an overall diagnostic accuracy of 91.4% for differentiating malignant tumors from benign tumors. The overall risk of malignancy was 17.4% for the nonneoplastic category, 100% for the atypical category, 7.3% for the benign neoplasm category, 50% for the NUMP category, and 96% for the positive‐for‐malignancy category. CONCLUSIONS Salivary gland FNA continues to have high diagnostic accuracy and is thus helpful for guiding management. Neoplasms with classic cytomorphology are easily diagnosed; however, in difficult cases showing overlapping features, the use of the Milan system could be beneficial. Cancer Cytopathol 2017;125:767‐75 . © 2017 American Cancer Society .
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BACKGROUND Fine‐needle aspiration (FNA) cytology is well accepted as a safe, reliable, minimally invasive, and cost‐effective method for the diagnosis of salivary gland lesions. Salivary gland neoplasms are often difficult to diagnose because of morphologic heterogeneity and a variety of epithelial metaplastic changes. Hence, a number of salivary gland FNA specimens yield indeterminate results. For indeterminate FNA specimens, the suspicious‐for‐malignancy (SFM) category is used when a specific neoplasm falls short in quantity or quality for the criteria for malignancy. Therefore, the findings are not sufficient for a conclusive diagnosis of malignancy. METHODS This study was designed to evaluate the risk of malignancy (ROM) for the SFM group at 5 tertiary medical centers worldwide with the aforementioned criteria. Among 12,606 salivary gland FNA cases between 1997 and 2014, 276 (2.2%) were reported to be SFN. Specifically, 114 suspicious cases (41%) had histological follow‐up. RESULTS Histological follow‐up of the 114 suspicious cases showed 95 malignant tumors indicating a risk of malignancy (ROM) of 83.3%. The ROM varied between 74% and 88% for the 5 participating institutions, and a Fisher's exact test with significance set to p<.05 showed no significant difference in ROM among the institutions (p = .78). CONCLUSIONS Overall, 83.3% of SFM salivary gland FNA specimens turned out to be malignant; there was no significant interinstitutional variability in the ROMs. The SFM category for salivary gland FNA is very homogeneous, and the ROMs are quite similar worldwide. Cancer Cytopathol 2018;126:94‐100. © 2017 American Cancer Society .
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Objective To summarize cytological feature, diagnosis and differentiated diagnosis for common salivary gland tumors to elevate diagnostic accuracy.Methods 147cases of common tumor of salivary gland, confirmed by needle aspiration cytodiagnosis were retrospectively analyzed and compared with findings from histopathology. Results Total diagnostic coincidence rate was 91.84%. Diagnostic coincidence rate and diagnostic accuracy of needle aspiration cytodiagnosis was 97.83% and 88.04%; respectively for salivary benign tumor as well as 96.36% and 78.18% respectively for salivary malignancies.Conclusion Needle aspiration is of high diagnostic accuracy and may provide reliable evidence for clinical therapy, as a simple and valuable diagnostic method.
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Introduction: Fine needle aspiration cytology (FNAC) is a well established technique for categorization of salivary gland lesions preoperatively .It has apt sensitivity and specificity to diagnose various salivary gland pathologies. However, there is lack of uniformity in reporting of various pathologists. This results in lack of appropriate communication and management of the patients. To overcome this problem ‘Milan system for reporting of salivary gland cytopathology’ (MSRSGC) was introduced.
Aims and Objectives: This is a retrospective study to reclassify the previously diagnosed salivary gland lesions and to evaluate the risk of malignancy in different categories.
Material and methods: The clinical details, FNAC smears, histological reports were retrieved from the hospital records and the cases were reclassified according to Milan system. False positive, false negative, true positive and true negative cases were calculated by comparing with the final histopathological diagnosis and then the accuracy and risk of malignancy of each diagnostic category were calculated.
Results: A total of 288 cases were included in the study of which histological follow up was present in 118 cases. The sensitivity, specificity, negative predictive value and positive predictive value were 78.57 %, 98.83 %, 90.43 % and 97.06 % respectively. The overall diagnostic accuracy to differentiate the benign and malignant cases was 92.19%. Also, the risk of malignancy in each category was 20%, 14.3%, 100%, 4.2%, 100%, 83.3% and 100% respectively. The highest risk of malignancy in the present study was noted in category III and V.
Conclusion: Milan system for reporting of salivary gland cytopathology provides a better communication between pathologists and clinicians. This also results in effectiveness along with lesser false positive and false negative results. The ROM in the present study were according to MSRSGC except category III, atypia of undetermined significance which was 100%.
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Background: Fine-needle aspiration (FNA) is an effective and safe procedure for analyzing salivary gland lesions. Various morphological and overlapping cytomorphology features can bring difficulty in diagnosis of the salivary gland lesions. This study aimed to evaluate the diagnostic accuracy of fine needle aspiration cytology of salivary glands lesions. Methods: There were 107 cases of cytology and 39 cases of histopathology of salivary gland lesions collected and reviewed from the archives of Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia / Cipto Mangunkusumo Hospital from 2005-2009. Seven cases of cytology were excluded, due to unsatisfactory specimens. Diagnostic test was applied to analyze the 39 pairs of cytology-histopathology cases. Results: There were 100 cases of salivary gland lesions cytology obtained, consisted of 27 negatives, eight cases inconclusive and 65 cases of neoplastic lesions. Of the 39 pair cases, fourteen cases showed result discrepancies between cytology and histopathology, with 3 false-negative cases and 1 false-positive case. The sensitivity and specificity of cytology analysis in differentiating malignant from non-malignant lesions were 82.35%, and 95.45% respectively, NPV 87.5% and PPV 93.34%. Conclusion: This study showed diagnostic accuracy of FNA cytology salivary gland lesions was varied, with 82.35% sensitivity and 95.45% specificity in differentiating malignant from non-malignant hence this information can still be used for case management. (Med J Indones. 2012;21:92-6)
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