Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

Pantanowitz, Liron; Thompson, Lester D.�R.; Rossi, Esther Diana

doi:10.1007/s12105-018-0904-8

Cited by 42 publications

(74 citation statements)

References 75 publications

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“…The morphologic heterogeneity may occur in a single tumor type because of tumor differentiation, metaplasia, tissue change, or reaction. For example, it is not uncommon to observe squamous metaplasia or cystic change in a pleomorphic adenoma, which causes diagnostic confusions . Moreover, even a single cell type can present with diverse cytomorphology.…”

Section: Introductionmentioning

confidence: 99%

“…For example, it is not uncommon to observe squamous metaplasia or cystic change in a pleomorphic Cancer Cytopathology November 2018 adenoma, which causes diagnostic confusions. [2][3][4][5] Moreover, even a single cell type can present with diverse cytomorphology. For instance, myoepithelial cells can be spindle-shaped, epithelioid, plasmacytoid, or even clear.…”

Section: Introductionmentioning

confidence: 99%

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Subtyping salivary gland neoplasm of uncertain malignant potential based on cell type demonstrates differential risk of malignancy

Hang

Alruwaii

Zeng

et al. 2018

Cancer Cytopathology

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BACKGROUND The newly unveiled Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has proposed salivary gland neoplasm of uncertain malignant potential (SUMP) as an indeterminate category. The category is reserved for fine‐needle aspiration (FNA) cases that are diagnostic of a salivary gland neoplasm but cannot be further designated as a specific tumor type. The objective of the current study was to evaluate the clinical utility of subtyping SUMP cases based on different cell types. METHODS A retrospective search of cytology databases at 2 institutions for salivary gland FNAs from 2006 through 2017 was conducted. The cytologic diagnosis of each case was reclassified according to the MSRSGC. Histologic follow‐up was retrieved for correlation. Cases reclassified as SUMP that had a follow‐up pathologic diagnosis were subject to cytology review and subtyping into oncocytic/squamoid, basaloid, or myoepithelial subtypes based on cytomorphology. The risk of malignancy (ROM) for each subtype was analyzed. RESULTS There were 92 SUMP cases, which comprised 5.9% of 1560 consecutive salivary gland FNAs within the 12‐year study period. Histologic follow‐up was available for 59 patients. After cytology review, there were 18 cases (30.5%) of oncocytic/squamoid subtype, 25 (42.4%) of basaloid subtype, and 16 (27.1%) of myoepithelial subtype. Pathologic correlation revealed an ROM of 61.1% (11 of 18 cases) for the oncocytic/squamoid subtype, 40.0% (10 of 25 cases) for the basaloid subtype, and 18.8% (3 of 16 cases) for the myoepithelial subtype. The differences in ROM among the 3 subtypes were statistically significant (P = .0476). CONCLUSIONS Subtyping SUMP cases into categories based on cell type demonstrated differential ROMs for better clinical stratification. Future prospective studies are mandatory to confirm this finding.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subtyping salivary gland neoplasm of uncertain malignant potential based on cell type demonstrates differential risk of malignancy

Hang

Alruwaii

Zeng

et al. 2018

Cancer Cytopathology

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“…This study contributes to the limited but growing literature on salivary gland FNA by demonstrating its utility for accurately grading nonbasaloid, non–matrix‐producing SGCs 7‐14,17,20,22,29‐48 . This work specifically examines the subject of grading SGCs using a broad range of types of SGC as well as employing a diverse panel of cytopathologists.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is generally accepted that salivary gland FNA can effectively differentiate between low‐ and high‐grade carcinomas, the evidence in the literature is limited 17,38‐41 . This is most likely due to the low incidence of primary salivary gland malignancies restricting the institutional ability to acquire a significant case load.…”

Section: Introductionmentioning

confidence: 99%

Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel

Johnson

Önenerk

Krane

et al. 2020

Cancer Cytopathology

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BACKGROUND: Fine needle aspiration (FNA) is commonly used for the preoperative evaluation of salivary gland tumors.Tumor grade is a key factor influencing clinical management of salivary gland carcinomas (SGCs). To assess the ability to grade nonbasaloid SGCs in FNA specimens, an international panel of cytopathologists convened to review and score SGC cases. METHODS: The study cohort included 61 cases of primary SGC from the pathology archives of 3 tertiary medical centers. Cases from 2005 to 2016 were selected, scanned, and digitized. Nineteen cytopathologists blinded to the histologic diagnosis reviewed the digitized cytology slides and graded them as low, high, or indeterminate. The panelists' results were then compared to the tumor grades based on histopathologic examination of the corresponding resection specimens. RESULTS:All but 2 of the 19 (89.5%) expert panelists review more than 20 salivary gland FNAs per year; 16 (84.2%) of the panelists work at academic medical centers, and 13 (68.4%) have more than 10 years' experience. Participants had an overall accuracy of 89.4% in the grading of SGC cases, with 90.2% and 88.3% for low-and high-grade SGC, respectively. Acinic cell carcinoma and mucoepidermoid carcinoma had the highest degree of accuracy, while epithelial-myoepithelial carcinoma and salivary duct carcinoma had the lowest degree of accuracy. As expected, the intermediate-grade SGC cases showed the greatest variability (high-grade, 42.1%; low-grade, 37.5%, indeterminate, 20.4%). CONCLUSION: This study confirms the high accuracy of cytomorphologic grading of primary SGC by FNA as low-or high-grade. However, caution should be exercised when a grade cannot be confidently assigned. Cancer Cytopathol 2020;128:392-402.

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“…The oncocytic cells have abundant granular cytoplasm, round nuclei, and nucleoli. Squamous, mucoid, and mast cells can also be seen in slides [4,5]. Despite the well documented histopathologic picture, various cytomorphologic appearances of WTs in FNAC may lead to wrong cytopathologic interpretations.…”

Section: Introductionmentioning

confidence: 99%

Cytomorphological findings in diagnosis of Warthin tumor

et al. 2020

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Background/aim: To define the cytomorphologic findings leading to difficulties in diagnosis of Warthin tumors (WTs). Materials and methods: Forty-eight histopathologically diagnosed WT patients who had fine needle aspiration cytology preoperatively were reevaluated for defining the presence or absence of lymphocytes, oncocytic cell layer, oncocytic cell papillae, granular debris background, mucoid background, macrophages, polymorphonuclear cells, mast cells, squamous-like cells, atypical vacuolated cytoplasmic cells, and giant cells. Results: Forty-seven tumors were in the parotid gland and one in the submandibular gland. There were 37 (77%) male and 11 (23%) female patients. Cytopathologically in 36 patients the diagnosis was benign neoplasm (WT); in 6, other benign entities; and in 6, suspicious for malignancy. The main characteristic cytomorphologic features of WTs were as follows: 92% lymphoid cells, 83% oncocytic cell layers, and 67% granular debris background. These percentages were 67%, 17%, and 17% in the benign cytology group and 67%, 50%, and 17% in the suspicious for malignancy group, respectively. Conclusion: Absence or lack of main features of WTs with or without presence of squamous-like cells, vacuolated cytoplasmic cells, and inflammatory reaction may cause diagnostic dilemma. The presence of the mast cells accompanied by epithelial tissue was striking for WT diagnosis.

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Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

Cited by 42 publications

References 75 publications

Subtyping salivary gland neoplasm of uncertain malignant potential based on cell type demonstrates differential risk of malignancy

Subtyping salivary gland neoplasm of uncertain malignant potential based on cell type demonstrates differential risk of malignancy

Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel

Cytomorphological findings in diagnosis of Warthin tumor

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