The Milan system for reporting salivary gland cytopathology: Single center experience with cell blocks.
MSRSGC
Milan system
cell blocks
cytopathology
salivary gland
Journal
Diagnostic cytopathology
ISSN: 1097-0339
Titre abrégé: Diagn Cytopathol
Pays: United States
ID NLM: 8506895
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
04
03
2020
revised:
05
05
2020
accepted:
19
05
2020
pubmed:
9
6
2020
medline:
15
10
2021
entrez:
8
6
2020
Statut:
ppublish
Résumé
Salivary gland fine needle aspiration (FNA) has a well-established role in the evaluation of salivary gland lesions. The Milan system for reporting salivary gland cytopathology (MSRSGC) was developed in 2018 to accomplish a standardized reporting across institutions. This classification is predominantly based on the use of direct smears. This single center study aims to evaluate and further validate the MSRSGC based on the sole use of cell blocks and carry out a risk assessment based on follow up histopathology. A total of 359 FNA specimens from 343 patients processed as cell blocks between 2012 and 2018 were retrieved, with histologic follow-up available in 235 cases. The cytological diagnosis were reclassified according to the MSRSGC categories: non-diagnostic, non-neoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SFM), and malignant. The use of ancillary immunohistochemistry or molecular testing was recorded. The risk of malignancy (ROM) was calculated for each diagnostic category. Overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 92.9%, 75.9%, 97.9%, 91.7%, and 95%, respectively. The ROM for the non-diagnostic, non-neoplastic, AUS benign neoplasms, SUMP, SFM and malignant categories were 13.8%, 14.2%, 30%, 6.3%, 20.8%, 60%, and 100%, respectively. This large single center retrospective series further validates the MSRSGC. The proposed diagnostic classification is reproducible with use of cell blocks. Discrepancies in number of cases per category and ROM are based on cross-institution variabilities, pre-FNA diagnostics (imaging) and ancillary tests.
Sections du résumé
BACKGROUND
BACKGROUND
Salivary gland fine needle aspiration (FNA) has a well-established role in the evaluation of salivary gland lesions. The Milan system for reporting salivary gland cytopathology (MSRSGC) was developed in 2018 to accomplish a standardized reporting across institutions. This classification is predominantly based on the use of direct smears. This single center study aims to evaluate and further validate the MSRSGC based on the sole use of cell blocks and carry out a risk assessment based on follow up histopathology.
METHODS
METHODS
A total of 359 FNA specimens from 343 patients processed as cell blocks between 2012 and 2018 were retrieved, with histologic follow-up available in 235 cases. The cytological diagnosis were reclassified according to the MSRSGC categories: non-diagnostic, non-neoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SFM), and malignant. The use of ancillary immunohistochemistry or molecular testing was recorded. The risk of malignancy (ROM) was calculated for each diagnostic category.
RESULTS
RESULTS
Overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 92.9%, 75.9%, 97.9%, 91.7%, and 95%, respectively. The ROM for the non-diagnostic, non-neoplastic, AUS benign neoplasms, SUMP, SFM and malignant categories were 13.8%, 14.2%, 30%, 6.3%, 20.8%, 60%, and 100%, respectively.
CONCLUSION
CONCLUSIONS
This large single center retrospective series further validates the MSRSGC. The proposed diagnostic classification is reproducible with use of cell blocks. Discrepancies in number of cases per category and ROM are based on cross-institution variabilities, pre-FNA diagnostics (imaging) and ancillary tests.
Types de publication
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
972-978Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Contucci AM, Corina L, Sergi B, Fadda G, Paludetti G. Correlation between fine needle aspiration biopsy and histologic findings in parotid masses. Personal Experience. Acta Otorhinolaryngol Ital. 2003;23(4):314-318.
Ashraf A, Shaikh AS, Kamal F, Sarfraz R, Bukhari MH. Diagnostic reliability of FNAC for salivary gland swellings: a comparative study. Diagn Cytopathol. 2010;38(7):499-504.
Layfield LJ, Gopez E, Hirschowitz S. Cost efficiency analysis for fine-needle aspiration in the workup of parotid and submandibular gland nodules. Diagn Cytopathol. 2006;34(11):734-738.
Rohilla M, Singh P, Rajwanshi A, et al. Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification. Cancer Cytopathol. 2017;125(10):767-775.
Liu CC, Jethwa AR, Khariwala SS, Johnson J, Shin JJ. Sensitivity, specificity, and posttest probability of parotid fine-needle aspiration: a systematic review and meta-analysis. Otolaryngol: Head Neck Surg (United States). 2016;154(1):9-23.
Seethala RR, Stenman G. Update from the 4th edition of the World Health Organization classification of head and neck tumours: Tumors of the salivary gland. Head Neck Pathol. 2017;11(1):55-67.
Rossi ED, Faquin WC, Baloch Z, et al. The Milan system for reporting salivary gland cytopathology: analysis and suggestions of initial survey. Cancer Cytopathol. 2017;125(10):757-766.
Faquin WC, Rossi ED, Baloch Z, et al. The Milan System for Reporting Salivary Gland Cytopathology. Switzerland: Springer International Publishing; 2018.
Rossi ED, Baloch ZW, Pusztaszeri M, Faquin WC. The Milan system for reporting salivary gland cytopathology (MSRSGC): an ASC-IAC-sponsored system for reporting salivary gland fine-needle aspiration. Acta Cytol. 2018;62(3):157-165.
Bhutani N, Sen R, Gupta M, Kataria SP. Moving toward a systematic approach for reporting salivary gland cytopathology: cytohistological correlation with the application of the Milan system for risk stratification at a tertiary care center. Diagn Cytopathol. 2019;47(11):1125-1131.
Chen Y, Wu C, Yang C. Application of the Milan system for reporting salivary gland cytopathology: a retrospective study in a tertiary institute. Diagn Cytopathol. 2019;47(11). 1160-1167.
Viswanathan K, Sung S, Scognamiglio T, Yang GCH, Siddiqui MT, Rao RA. The role of the Milan system for reporting salivary gland cytopathology: a 5-year institutional experience. Cancer Cytopathol. 2018;126(8):541-551.
LPH B. On the diagnostic results of the microscopical examination of the ascitic fluid in two cases of carcinoma involving the peritoneum. Cleveland Med Gaz. 1896;11:274-278.
Chapman CB, Whalen EJ. The examination of serous fluids by the cell-block technic. N Engl J Med. 1947;237(7):215-220.
Saqi A. The state of cell blocks and ancillary testing: past, present, and future. Arch Pathol Lab Med. 2016;140(12):1318-1322.
Krogerus L, Kholová I. Cell block in cytological diagnostics: review of preparatory techniques. Acta Cytol. 2018;62(4):237-243.
Nationale R. Bewaartermijn van de coupes en paraffineblokken voor de anatoompathologie. 154. https://www.ordomedic.be/nl/adviezen/advies/bewaartermijn-van-de-coupes-en-paraffineblokken-voor-de-anatoompathologie. Published 2016.
van Ginderdeuren R, van Calster J, Stalmans P, van den Oord J. A new and standardized method to sample and analyse vitreous samples by the Cellient automated cell block system. Acta Ophthalmol. 2014;92(5):388-392.
Wagner DG, Russell DK, Benson JM, Schneider AE, Hoda RS, Bonfiglio TA. CellientTM automated cell block versus traditional cell block preparation: a comparison of morphologic features and Immunohistochemical staining. Diagn Cytopathol. 2011;39:730-736.
Tommola E, Tommola S, Porre S, Kholová I. Salivary gland FNA diagnostics in a real-life setting: one-year-experiences of the implementation of the Milan system in a tertiary care center. Cancers (Basel). 2019;11(10):1589.
Layfield LJ, Baloch ZW, Hirschowitz SL, Rossi ED. Impact on clinical follow-up of the Milan system for salivary gland cytology: a comparison with a traditional diagnostic classification. Cytopathology. 2018;29(4):335-342.
Hollyfield JM, O'Connor SM, Maygarden SJ, et al. Northern Italy in the American south: assessing interobserver reliability within the Milan system for reporting salivary gland cytopathology. Cancer Cytopathol. 2018;126(6):390-396.
Hughes JH, Volk EE, Wilbur DC. Pitfalls in salivary gland fine-needle aspiration cytology: lessons from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic cytology. Arch Pathol Lab Med. 2005;129(1):26-31.
Wang H, Malik A, Maleki Z, et al. “Atypical” salivary gland fine needle aspiration: risk of malignancy and interinstitutional variability. Diagn Cytopathol. 2017;45(12):1088-1094.
Rossi ED, Wong LQ, Bizzarro T, et al. The impact of FNAC in the management of salivary gland lesions: institutional experiences leading to a risk-based classification scheme. Cancer Cytopathol. 2016;124(6):388-396.