Diagnostic challenges in cytology of mucoepidermoid carcinoma: Report of 6 cases with histopathological correlation

Joseph, Tessy P.; Joseph, Cicy Petta; Jayalakshmy, P. S.; Poothiode, Usha

doi:10.4103/0970-9371.155226

Cited by 29 publications

(30 citation statements)

References 12 publications

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“…Several authors have reported difficulties in the diagnosis of high grade MEC. 6,11,14,15 Table 4 showed FNAC cases categorized as AUS and SUMP. The AUS category at our institution showed an overall frequency of 5.3%, in agreement with the MSRSGC recommendation to keep them as <10% of all salivary gland diagnoses.…”

Section: Illustrative Casesmentioning

confidence: 99%

Salivary gland fine‐needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6‐year study

Rolon

Schnadig

Faiz

et al. 2020

Diagnostic Cytopathology

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Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is based on risk stratification. We presented our experience with fineneedle aspiration cytology (FNAC) for the diagnosis of salivary glands lesions by applying the MSRSGC categorization to the cytological diagnoses, and determined risk of malignancy (ROM) for each category. Methods: Fine-needle aspiration cytology of salivary gland lesions performed over a 6-year period was retrieved. FNAC results were retrospectively categorized according to the MSRSGC criteria, and correlated with corresponding histologic follow-up. ROM for each diagnostic category was calculated. Results: A total of 208 FNAC of salivary gland lesions were reviewed and retrospectively categorized as: non-diagnostic (ND) 23 (11%), non-neoplastic (NN) 54 (26%), atypia of undetermined significance (AUS) 10 (4.8%), benign neoplasms (BN) 77 (37%), salivary gland of uncertain malignant potential (SUMP) 13 (6.3%), suspicious for malignancy (SM) 7 (3.4%), and malignant (M) 24 (11.5%). Histopathological follow-up was available for 84 of 208 cases (40.4%). Overall concordance rate between FNAC and histology was 78.8%. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 93.3%, 94.6%, 82.4%, and 98.2%, respectively. Diagnostic accuracy to distinguish benign from malignant disease was 94.4%. ROM for each category was ND 0%, NN 0%, AUS 75%, BN 2.2%, SUMP 28.6%, SM 50%, and M 100%. Conclusion: Fine-needle aspiration cytology continues to be an accurate diagnostic tool for most salivary gland neoplasms showing classical morphologic features. However, difficult cases with unusual or overlapping features will occur. In these situations, the use of MSRSGC risk-stratification could be helpful to define appropriate management.

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Section: Illustrative Casesmentioning

confidence: 99%

Salivary gland fine‐needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6‐year study

Rolon

Schnadig

Faiz

et al. 2020

Diagnostic Cytopathology

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“…Because of the mucin secretion, FNAs are often not very cellular, and sometimes glandular goblet cells are lacking. Differential diagnoses include benign cysts (especially in the submandibular gland) or mucin‐rich variants of salivary duct carcinoma . Indeed, the oncocytic variant of mucoepidermoid carcinoma may be impossible to differentiate from other oncocytic tumours.…”

Section: Discussionmentioning

confidence: 99%

“…However, these data are variable according to different publications and are dependent upon the learning curve of the observer. Among the main pitfalls of FNA, mucoepidermoid carcinoma may be missed or misinterpreted as pleomorphic adenoma or squamous cell carcinoma . Adenoid cystic carcinoma may share features with those observed in pleomorphic adenoma and mammary analogue secretory carcinoma (MASC) or may be misinterpreted as acinic cell carcinoma or mucoepidermoid carcinoma …”

Section: Introductionmentioning

confidence: 99%

Use of fluorescent in‐situ hybridisation in salivary gland cytology: A powerful diagnostic tool

et al. 2017

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Funding informationClinical research project in CHU Toulouse (France).Objective: Salivary gland cytology is challenging because it includes a diversity of lesions and a wide spectra of tumours. Recently, it has been reported that many types of salivary gland tumours have specific molecular diagnostic signatures that could be identified by fluorescent in-situ hybridisation (FISH). The aim of the present study was to demonstrate the feasibility and efficiency of FISH on routine cytological salivary gland smears.Methods: FISH was conducted on 37 cytological salivary gland smears from 34 patients. According to the cytological diagnosis suspected, MECT1/MAML2 gene fusion and rearrangements of PLAG1, MYB, or ETV6 were analysed. The presence and percentages of cells that had gene rearrangements were evaluated. Results were compared with the histological surgical samples, available from 26 patients.Results: The PLAG1 rearrangement was observed in 12/20 (60%) cases of pleomorphic adenoma. MECT1/MAML2 gene fusion was observed in 1:2 mucoepidermoid carcinomas but was not observed in five other tumours (two pleomorphic adenomas, one Warthin's tumour, one mammary analogue secretory carcinoma [MASC] and one cystic tumour). MYB rearrangement was observed in 4/4 adenoid cystic carcinomas. ETV6-gene splitting identified one MASC. Conclusion:Overall, FISH had a specificity of 100% and a sensitivity of 66.7%.When FISH and cytological analyses were combined, the overall sensitivity was increased to 93.3%. It can thus be concluded that when the FISH analysis is positive, the extent of surgery could be determined with confidence pre-operatively without needing a diagnosis from a frozen section. Indeed, the sensitivity of salivary gland FNA ranges from 66% to 90% and specificity from 86% to 98%. 2-7In two trained groups of cytologists, cytological and histological diagnoses of malignant tumours were concordant in 80% and 88.8% of cases and cytological and histological diagnoses of benign tumours were concordant in 95.6% and 91.8% of cases. 4,7 However, these data are variable according to different publications 5,6 and are dependent upon the learning curve of the observer.

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“…Furthermore, PA, commonly followed by chronic sialadenitis and WT, may mimic low-grade MEC [31]. In a study of 6 cases of MEC by Joseph et al [36], the correct diagnosis was rendered only in 2 cases. The remaining cases were misdiagnosed as neoplastic with cystic degeneration (n = 2) and PA (n = 2).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of the Pattern-Based Approach in the Cytodiagnosis of Salivary Gland Lesions

Krishnappa

et al. 2016

Acta Cytologica

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Objective: The aim of this study is to investigate, primarily, the effectiveness of the application of pattern-based analysis in the diagnosis of salivary gland (SG) lesions. Secondarily, an attempt was made to study the cytomorphology of the various lesions in detail and discuss the pitfalls and solutions involved in the challenging conditions at cytology. Materials and Methods: This was a prospective, cross-sectional study. All SG lesions over 2 years were subjected to fine-needle aspiration cytology with patients' prior informed consent. The lesions were classified based on the predominant pattern, and a provisional diagnosis was made. The secondary pattern and other features, such as background, were then taken note of, and a combined cytological diagnosis was rendered. The entire spectrum of lesions was divided into 6 morphological categories. Results: We had a total of 72 SG lesions. The most commonly affected gland was the parotid gland in 79.16% (57/72) of the cases. Surgery was performed in 26 cases (36.11%). A concordant diagnosis was obtained in 22 cases. The sensitivity, specificity and diagnostic accuracy by the pattern-based approach was 75, 100 and 88.46%, respectively. There were no false-positive cases, but 2 false-negative cases were recorded. Conclusion: The precise cytological preoperative diagnosis of SG lesions is important for the management of patients. The pattern-based approach can be used routinely in the cytological diagnosis of SG lesions.

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Diagnostic challenges in cytology of mucoepidermoid carcinoma: Report of 6 cases with histopathological correlation

Cited by 29 publications

References 12 publications

Salivary gland fine‐needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6‐year study

Salivary gland fine‐needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: A retrospective 6‐year study

Use of fluorescent in‐situ hybridisation in salivary gland cytology: A powerful diagnostic tool

Effectiveness of the Pattern-Based Approach in the Cytodiagnosis of Salivary Gland Lesions

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