Subcategorizing salivary gland neoplasm of uncertain malignant potential (SUMP) in the Milan System for Reporting Salivary Gland Cytopathology

BACKGROUND

Fine-needle aspiration cytology (FNAC) has proven its value as an essential step in the diagnosis of salivary gland lesions. Although the majority of salivary gland lesions, especially those that are common and benign, can be diagnosed with ease on FNAC, limited cellularity and morphologic lesion heterogeneity can pose diagnostic challenges and lead to false-positive and false-negative diagnoses. This study presents the institutional experience of FNAC of salivary gland lesions from 2 academic centers.



METHODS

A retrospective analysis was conducted on 1729 salivary gland FNAC specimens that were diagnosed over an 8-year period from January 2008 to March 2015. All samples were processed either with liquid-based cytology alone or in combination with air-dried, Diff-Quik–stained or alcohol-fixed, Papanicolaou-stained smears.



RESULTS

Surgical excision was performed in 709 of 1749 FNACs (41%) that were diagnosed as nondiagnostic/inadequate (n = 29), benign (n = 111), neoplasm (n = 453), atypical (n = 15), suspicious for malignancy (n = 28), and malignant (n = 73). The overall concordance between cytologic and histologic diagnoses was 92.2%, with 91.8% concordance in the benign category and 89.5% concordance in cases diagnosed as suspicious for malignancy and malignant. The most frequent benign and malignant lesions were pleomorphic adenoma and squamous cell carcinoma, respectively. There were 46 false-negative and 13 false-positive results, leading to an overall specificity of 97.6% and diagnostic accuracy of 91.3%.



CONCLUSIONS

FNAC is a reliable diagnostic modality for the diagnosis and management of salivary gland lesions based on its high specificity and diagnostic accuracy. Cancer Cytopathol 2016. © 2016 American Cancer Society.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/cncy.21710

The impact of FNAC in the management of salivary gland lesions: Institutional experiences leading to a risk-based classification scheme

J Oral Pathol Med (2012) 41: 106–112

Background:  Fine-needle aspiration cytology (FNAC) is used as the main initial diagnostic investigation for lumps in the head and neck region. Major salivary glands and some minor salivary glands are easily accessible; therefore, they are optimal targets for FNAC. The aim of this study was to discuss the advantages and pitfalls of FNAC as compared to histopathology in the salivary gland lesions.

Material and methods:  A total of 127 FNAC were carried out on salivary gland lesions from January 2006 to December 2010 – a 5-year period. Histopathological follow-up data were obtained in 56 cases. The study was conducted to examine the sensitivity, specificity, and accuracy of FNAC for salivary gland swellings in comparison with histopathology.

Results:  The male-to-female ratio was 2.4:1. Parotid gland was involved in 51.1%, submandibular gland in 37%, sublingual gland in 4.7%, and minor salivary glands in 7% of patients. There were 55.9% cases of non-neoplastic lesions and 44.1% cases of neoplastic lesions on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for malignant neoplastic lesions were 84.61%, 86.48%, 68.75%, and 94.11%, respectively, whereas for benign neoplastic lesions, they were 84.61%, 91.66%, 91.6%, and 85%, respectively.

Conclusion:  Fine-needle aspiration cytology is found to be a good sensitive and specific technique for the diagnosis of most of the salivary gland lesions. FNAC should be adopted as an initial investigation for all salivary gland swellings in conjunction with other investigations where appropriate.

Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions.

Background

Our aim was to evaluate the diagnostic accuracy of fine-needle aspiration cytology (FNAC) for Warthin tumors of the parotid gland.



Methods

All cytologic diagnoses of Warthin tumor between 1990 and 2007 were correlated with available histology. In addition, our results were compared to current literature.



Results

In 310 cases, Warthin tumor was diagnosed by FNAC. In 133 cases, (43%) both cytology and histology were available. In 127 of these 133 cases (95.5%), the diagnosis Warthin tumor was confirmed by histology. In 4 cases (3%), a benign lesion was diagnosed and 2 (1.5%) revealed a malignant lesion. On review, those cytologic diagnoses were not certain. In the literature, 11 missed malignancies (5.4%) in 202 cases were reported.



Conclusion

The diagnostic accuracy of FNAC for the diagnosis of Warthin tumor is high and the percentage of missed malignant tumors is very low. Our results imply that a cytologic diagnosis of Warthin tumor may justify conservative treatment. © 2010 Wiley Periodicals, Inc. Head Neck, 2010

Diagnostic accuracy of fine-needle aspiration cytology in warthin tumors

Warthin tumour is the second most common benign neoplasm of the parotid gland. It has a low rate of growth and exhibits malignant transformation in 0.3% of cases. Although its aggressiveness has not been a concern, surgical resection remains the most common treatment modality. This entails the risk of a general anaesthetic and those pertaining to the procedure itself, most notably permanent facial nerve damage. This has led some authors to use conservative management, albeit rarely. There are those who condemn such a policy despite the encouraging results reported thus far. To understand the rationale underpinning non-operative management, it is imperative that one has a comprehensive understanding of the pathogenesis, clinical presentation and diagnosis of Warthin tumour. The aim of this review therefore is to detail these elements and clarify the current controversies in managing this lesion.

Current controversies in the management of Warthin tumour.

Introduction: Bien que la precision generale de la cytoponction dans l'investigation d'une neoplasie parotidienne soit bien etablie, des resultats specifiques pour la tumeur de Warthin (TW) n'existent pas. Pour la majorite des tumeurs salivaires, la chirurgie est recommandee a cause du risque de croissance et de transformation maligne. Ce comportement est inhabituel avec la TW et l'indication chirurgicale vient plutot du besoin de confirmation pathologique. Un diagnostic precis par cytoponction justifierait donc un traitement conservateur chez les patients asymptomatiques. Par contre si la procedure diagnostique n'est pas fiable, on n'hesitera pas a recommander une parotidectomie. Methode: Etude retrospective de toutes les parotidectomies faites entre 1992 et 2000 pour lesquelles un resultat de cytoponction etait disponible. Tous les cas suggerant une TW ont ete identifies et les resultats de cytoponction et de pathologie compares. Sensibilite et valeur predictive positive (VPP) ont ete calculees. Resultats: Un total de 41 patients ont ete inclus dans l'etude. Trente-trois sont de vrais positifs, c'est-a-dire que la cytoponction et la pathologie finale etaient similaires. Quatre patients avaient une cytoponction suggerant une TW qui n'a pas ete confirmee a la pathologie (faux positifs). Quatre autres patients etaient de faux negatifs. La sensibilite et la VPP etaient donc de 89.2% et 89.2% respectivement. Conclusion: Bien que la sensibilite et la VPP soient elevees dans cette etude, le taux de faux-positifs est cliniquement significatif etant donne le type de pathologies manquees. Trois carcinome a cellules acinaires et un adenome pleomorphe ont ete diagnostiques erronement comme TW a la cytoponction. Il faut donc demeurer prudent quand on recommande un traitement conservateur pour une tumeur de la parotide meme si la cytoponction suggere une TW.

C Megan McLachlin

Papers

Accuracy of fine-needle aspiration biopsy for Warthin's tumours.