Risk of high‐grade malignancy in parotid gland tumors as classified by the Milan System for Reporting Salivary Gland Cytopathology

Park, Woori; Bae, Hwallip; Park, Min‐Hae; Hwang, Na Young; Sohn, Insuk; Cho, Junhun; Jeong, Han‐Sin

doi:10.1111/jop.12816

Cited by 25 publications

(38 citation statements)

References 32 publications

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“…A distinct advantage of MSRSGC was that it maximizes clinical discretion and when coupled with appropriate clinical and imaging findings results in optimal follow‐up for the majority of patients . Park et al reported that combining the Milan system category (malignant) with the presence of nodal metastasis is suggestive of high‐grade malignancy with an acceptable diagnostic sensitivity (0.889‐0.963) and negative predictive value (0.900‐0.966) …”

Section: Discussionsupporting

confidence: 87%

Implementation of the MILAN system for reporting salivary gland cytopathology: Interobserver concordance and cytohistological correlation of discordant cases

Garg

Diwaker

Pathak

et al. 2019

Diagnostic Cytopathology

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Background: Fine needle aspiration cytology (FNAC) plays a pivotal role in evaluating salivary gland (SG) tumors. Several studies have shown diagnostic utility of MILAN system for reporting salivary gland cytopathology (MSRSGC) by examining risk of malignancy but only an occasional study has focused on interobserver variability.Hence, the present study was undertaken to assess the agreement among cytopathologists with varying experience in SG cytopathology using MSRSGC and to re-evaluate discordant cytohistological diagnoses for possible causes of misinterpretation.Methods: All SG lesions subjected to FNAC over a period of 3½ years were studied. The cases were critically reviewed by 2 pathologists with variable experience in cytopathology using MSRSGC and concordance level among them was calculated.Cytohistological discordant diagnoses were reclassified and possible causes of misinterpretation during routine reporting were evaluated.Results: Of 150 SG aspirates categorized according to MSRSGC, diagnostic disagreement between 2 pathologists was found in 10. Unweighted Cohen's Kappa score between consultant and resident was 0.812 (high). Among 55 cases with histological correlation, cytohistological discordance was seen in 12. True pitfalls constituted 50% of discordant cases while rest 50% were attributed to practical issues (turnaround time and heavy case load) during routine reporting.Conclusion: MSRSGC can be used with good reproducibility between observers with variable cytopathology experience. Heterogeneous nature of SG neoplasm is a known pitfall in FNA diagnosis of SG neoplasms. During routine reporting turnaround time, heavy case load and reporting by cytopathologists with variable experience add on to challenges faced in reporting cytopathology of SG neoplasm. K E Y W O R D S FNAC, MILAN system, MSRGC, salivary gland

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Section: Discussionsupporting

confidence: 87%

Implementation of the MILAN system for reporting salivary gland cytopathology: Interobserver concordance and cytohistological correlation of discordant cases

Garg

Diwaker

Pathak

et al. 2019

Diagnostic Cytopathology

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“…A high proportion (25.6%) of cases were considered ND. This is somewhat higher than that reported in other studies by [4,[7][8][9][10][11]. This may be related to the method of sample collection.…”

Section: Discussioncontrasting

confidence: 62%

“…Using ICC and/or FISH analysis, the ROM for the M category was determined to be 100%. Park et al, observed a similar risk for this category, in accordance with the MSRSGC [4].…”

Section: Discussionsupporting

confidence: 59%

“…In M category, it is recommended to specify if the malignancy is either low-grade (LG-M) or high-grade (HG-M) as the malignancy grade is clinically relevant in order to plan extension of the surgical treatment. The MSRSGC has shown an accuracy of 0.67 for HG-M [4] which can be improved when associated with clinically or pathologically substantiated cervical metastases (0.77). Moreover, the precise cytological identification of a neoplasm helps to determine whether it is benign or LG-M.…”

Section: Introductionmentioning

confidence: 99%

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A 4-Year Retrospective Analysis of Salivary Gland Cytopathology Using the Milan System for Reporting Salivary Gland Cytology and Ancillary Studies

Dubucs

Basset

d’Aure³

et al. 2019

Cancers

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The cytopathology of salivary glands presents major challenges due to the heterogeneity of benign and malignant neoplasms, which is reflected in the large range of WHO 2017 Classifications. Fine needle aspiration (FNA) of salivary gland tumours is still the favoured initial approach as it results in good sensitivity and specificity. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was published in 2018 and comprises seven categories. We report results from a 4-year retrospective analysis of 328 salivary gland FNAs which were reviewed and classified according to the MSRSGC. We assess the risk of neoplasm, the risk of malignancy and the contribution of ancillary studies to the diagnosis. Benign neoplasms were the most frequent diagnosis (44.2%). Malignant and suspicious for malignancy were identified in 11.3% and 4.9% of diagnosed cases, respectively. Histopathological analysis after surgery was available for 216 (65.8%) of the cases. All malignant cases were confirmed post-surgery, and 68.8% of suspicious for malignancy were confirmed as malignant tumours. Immunocytochemistry was informative in 72.3% of cases. Immunocytochemistry and FISH provided the definitive diagnosis in 23.7% and 33% of cases, respectively. In conclusion, the MSRSGC is more effective when specific features of neoplasms can be identified. Ancillary studies help to further characterise salivary gland tumours and thereby increase the accuracy of MSRSGC.

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“…A recent study estimated the risk of high‐grade malignancy to be 16.7% for SFM and 55.9% for the malignant category of MSRSGC, but it did not comment on the accuracy of predicting a low grade versus a high grade with a cytologic specimen . Our study, though admittedly limited by its small sample size, showed high accuracy in favoring a high‐grade malignancy on FNA because all 5 cases deemed high‐grade on cytology showed high‐grade carcinoma on resection.…”

Section: Discussioncontrasting

confidence: 55%

Cytohistologic correlation of basaloid salivary gland neoplasms: Can cytomorphologic classification be used to diagnose and grade these tumors?

Gargano

Sebastiano

Solomides

et al. 2019

Cancer Cytopathology

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BACKGROUND: Basaloid salivary gland neoplasms (BSNs), which include benign primary tumors and primary or metastatic malignancies, show overlapping morphology in fine-needle aspiration (FNA). The Milan system recommends assigning a grade (low or high) to malignant salivary neoplasms because of the impact on surgical planning. This study investigated cytomorphologic features of BSNs on FNA that would help to favor a high-grade malignancy over a low-grade malignancy or a benign tumor. METHODS: Two pathologists performed a double-blinded cytologic evaluation of FNA cases diagnosed as BSNs that had corresponding surgical resections. The diagnosis made with the Milan system was correlated with the final surgical diagnosis and grade. Cytologic sensitivity, specificity, and predictive values were calculated. RESULTS: There were 132 BSN FNA cases; cytology slides were available for 77 of 87 patients who had undergone resection. The risk of malignancy for the benign neoplasm (BN), salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SFM), and malignant categories were 13.6%, 22%, 100%, and 100%, respectively. The sensitivity of the malignant/SFM category was 51.7%; another 37.9% of confirmed malignancies were diagnosed as SUMP. The specificity of the BN category was 86%. Favoring a high-grade malignancy on FNA had 100% accuracy (5 of 5). Favoring a low-grade malignancy on FNA had 75% accuracy (6 of 8). The most specific cytomorphologic clues for a high-grade malignancy were necrotic/ apoptotic debris, mitoses, discohesion, and anisonucleosis. CONCLUSIONS: BSNs encompass a broad spectrum of primary and metastatic tumors. Necrotic/apoptotic debris, mitotic activity, discohesion, and significant anisonucleosis, alone or especially in combination, should make a cytopathologist suspect a high-grade malignancy. Cancer Cytopathol 2020;128:92-99.

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Risk of high‐grade malignancy in parotid gland tumors as classified by the Milan System for Reporting Salivary Gland Cytopathology

Cited by 25 publications

References 32 publications

Implementation of the MILAN system for reporting salivary gland cytopathology: Interobserver concordance and cytohistological correlation of discordant cases

Implementation of the MILAN system for reporting salivary gland cytopathology: Interobserver concordance and cytohistological correlation of discordant cases

A 4-Year Retrospective Analysis of Salivary Gland Cytopathology Using the Milan System for Reporting Salivary Gland Cytology and Ancillary Studies

Cytohistologic correlation of basaloid salivary gland neoplasms: Can cytomorphologic classification be used to diagnose and grade these tumors?

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