Risk of malignancy in “atypia of undetermined significance” category of salivary gland fine‐needle aspiration: A bi‐institutional experience

Alruwaii, Fatimah; Hang, Jen‐Fan; Zeng, Bao-Rung; Cramer, Harvey; Lai, Chiung‐Ru; Sancha, Carlo De la; Wu, Howard H.

doi:10.1002/dc.24347

Cited by 9 publications

(13 citation statements)

References 28 publications

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“…Similar to previous reports, nearly one‐half of the AUS samples in the current study were lymphocyte‐rich aspirates, with the majority of cases representing non‐Hodgkin lymphoma 9,13‐15 . The most common reason to classify an aspirate containing lymphocytes as AUS was a lack of a monomorphic population as well as the presence of only rare atypical lymphocytes, which should be interpreted with caution because reactive lymphoid tissue and chronic sialadenitis can demonstrate similar cytomorphologic features.…”

Section: Discussionsupporting

confidence: 85%

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Risk stratification and clinical outcome in the atypia of undetermined significance category in the Milan System for Reporting Salivary Gland Cytopathology

Wangsiricharoen

Maleki

2020

Cancer Cytopathology

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Background Atypia of undetermined significance (AUS) is a category of the Milan System for Reporting Salivary Gland Cytopathology that refers to salivary gland fine‐needle aspiration (FNA) specimens that cannot be definitively diagnosed as neoplastic or nonneoplastic. Methods The AUS FNA samples were selected from a large academic institution from 2008 through 2018. The AUS cases were divided into 6 subgroups. The risk of malignancy (ROM), risk of neoplasm (RON), and clinical outcomes for each subgroup were evaluated. Results A total of 123 cases were found (76 males and 47 females with a mean age of 62 years [range, 6‐94 years]). The parotid gland was the most common FNA site (103 cases), followed by the submandibular gland (9 cases). The overall RON and ROM were 63% and 47%, respectively. Among the subgroups, salivary gland lymph nodes or lymphoid lesions was the most common diagnosis (42%), whereas mucinous cystic lesions with no or a scant epithelial component was the least common (2%). The specimens with preparation artifacts category had the highest RON and ROM (100% for both), whereas the reactive and reparative atypia indefinite for a neoplasm category had the lowest RON and ROM (7% for both). The salivary gland lymph nodes or lymphoid lesions indefinite for a lymphoproliferative disorder category had the second highest RON and ROM at 77% and 74%, respectively. Conclusions The overall RON and ROM for the AUS category were 63% and 47%, respectively. The RON and ROM varied among the different AUS subgroups, being highest in the specimens with preparation artifacts category and lowest in the reactive and reparative atypia category, thereby demonstrating the importance of subgrouping in the AUS specimens.

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Section: Discussionsupporting

confidence: 85%

“…This is not surprising because the ROM for the AUS category was not a well‐defined entity by the time the MSRSGC was published because there was a lack of literature regarding salivary gland aspirates classified as AUS. Since then, more studies have shown that the ROM for AUS was higher and ranged from 34% to 44% 9‐12 …”

Section: Discussionmentioning

confidence: 99%

Risk stratification and clinical outcome in the atypia of undetermined significance category in the Milan System for Reporting Salivary Gland Cytopathology

Wangsiricharoen

Maleki

2020

Cancer Cytopathology

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“…In recent research, Alruwaii et al [30] observed prominent lymphocytic components in 50% of cases in the AUS category and reported that most of them were lymphoma, reactive lymphoid tissue, or sialadenitis. In the present study, 5 lymphocytic lesions were observed in AUS (5/31, 16.1%): 2 cases of low-grade lymphoma, 2 lymphocytic sialadenitis, and 1 follicular hyperplasia (Table 5).…”

Section: Discussion/conclusionmentioning

confidence: 99%

Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

et al. 2020

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Objective: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a recently published evidence-based categorization system for salivary gland fine-needle aspiration (FNA). We applied MSRSGC to Japanese cases and evaluated its utility. Study Design: A total of 480 FNA cases were reviewed. We recategorized each case into one of the MSRSGC categories. The risk of neoplasm (RON) and the risk of malignancy (ROM) for each diagnostic category in MSRSGC, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for malignancy and for neoplasms were calculated for cases with histological follow-up. In addition, the overall ROM (O-ROM) was calculated for all FNA cases. Results: RON, ROM, and O-ROM rates were as follows – non-diagnostic: 51.3, 5.1, and 1.0%; non-neoplastic: 0, 0, and 0%; atypia of undetermined significance: 83.9, 12.9, and 7.3%; neoplasm, benign: 100, 0, and 0%; salivary gland neoplasm of uncertain malignant potential: 100, 32.1, and 23.7%; suspicious for malignancy: 100, 85.7, and 60%; and malignant: 100, 100, 81.8%. The sensitivity, specificity, and accuracy with (without) indeterminate cases for malignancy were 65 (100), 99 (99), 92% (99%) and PPV and NPV were 96 and 100%, respectively, and those for neoplasms were 84 (100), 100 (100), 85% (100%), and PPV and NPV were 100 and 100%, respectively. Conclusions: The MSRSGC is useful for stratification of ROM and for promoting the performance of salivary gland FNA. The MSRSGC could be easily introduced in Japan and may improve the Japanese salivary gland FNA status.

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“…Results of several studies that analysed distribution of cases and estimated ROM in each MSRSGC category show that FNA cytology is an effective diagnostic procedure and confirmed the validity and diagnostic utility of MSRSGC, further revealing that ROMs of each category were broadly in line with those suggested in MSRSGC. In some of these studies, higher ROM for AUS category than in MSRSGC was observed, which probably resulted from the lower number or heterogeneity of AUS patients in these studies …”

Section: Diagnostic Accuracy Of Cytopathology For Salivary Gland Lesimentioning

confidence: 92%

Cytopathology and diagnostics of Warthin's tumour

Sučić

Ljubić²,

Perković³

et al. 2020

Cytopathology

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Warthin's tumour (WT) is a benign epithelial salivary tumour, one type of salivary adenoma. Histologically, WT is structured of two components, epithelial tissue that often lines cystic formations and lymphoid tissue in the tumour stroma. FNA is a reliable diagnostic approach in the diagnosis of salivary gland lesions allowing a highly accurate categorization of benign tumour‐like lesions, benign tumours and malignant tumours. In the proposed Milan reporting system of salivary gland lesions, WT is categorized in the IVA group of benign neoplasms. Accurate cytological diagnosis is straightforward when three characteristic components are present: oncocytes, either isolated or associated in clusters, lymphocytes and lymphoid cells and often an inflammatory/necrotic‐like substance. Also, specific features of scintigraphy and radiological imaging contribute to the diagnosis of WT. WT is categorized according to Seifert G. et al in 4 types, depending on the proportions of the epithelial component and lymphoid stroma. Differential cytopathological and pathohistological diagnosis include other salivary gland lesions with lymphoid, oncocytic epithelial and cystic components. In some cases, such as the metaplastic WT variant, there are additional cytopathological and histological diagnostic difficulties. Moreover, bilateral, multicentric or multiple and infrequently seen extra‐salivary localizations of WT are associated with further cytopathological diagnostic difficulties. Also, a rare possibility of malignant transformation of the epithelial or lymphoid component of WT as well as possible association with other primary tumours remains a challenge in accurate cytopathological and histological diagnosis of WT.

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Risk of malignancy in “atypia of undetermined significance” category of salivary gland fine‐needle aspiration: A bi‐institutional experience

Cited by 9 publications

References 28 publications

Risk stratification and clinical outcome in the atypia of undetermined significance category in the Milan System for Reporting Salivary Gland Cytopathology

Risk stratification and clinical outcome in the atypia of undetermined significance category in the Milan System for Reporting Salivary Gland Cytopathology

Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

Cytopathology and diagnostics of Warthin's tumour

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