Reappraisal of bone and soft tissue cytopathology classification using the modified Milan system.
Milan system
World Health Organization (WHO) system
accuracy
bone and soft tissue
cytology
Journal
Cancer cytopathology
ISSN: 1934-6638
Titre abrégé: Cancer Cytopathol
Pays: United States
ID NLM: 101499453
Informations de publication
Date de publication:
29 Jul 2024
29 Jul 2024
Historique:
revised:
21
06
2024
received:
14
03
2024
accepted:
02
07
2024
medline:
29
7
2024
pubmed:
29
7
2024
entrez:
29
7
2024
Statut:
aheadofprint
Résumé
A standardized reporting system for bone and soft tissue tumor cytopathology has not yet been established. The objective of this study was to explore the potential utility of a classification modified from the Milan System for Salivary Gland Cytopathology and compared it with the upcoming World Health Organization (WHO) system for fine-needle aspiration of soft tissue lesions. The authors reviewed 285 cytology cases of bone/joint (n = 173) and soft tissue (n = 112) lesions, scoring each within diagnostic categories. The results were compared with histologic diagnoses and the risk of malignancy (ROM) for each category, and diagnostic reliability was analyzed. All 285 cases were successfully classified into one of the following categories: nondiagnostic (6.3%), non-neoplastic (11.9%), atypia of uncertain significance (11.9%), benign neoplasm (5.6%), bone and soft tissue neoplasm of uncertain malignant potential (25.3%), suspicious for malignancy (1.4%), and malignant (37.5%). The ROM was 44.4% (eight of /18 cases) in nondiagnostic, 0% (zero of 34 cases) in non-neoplastic, 32.4% (11 of 34 cases) in atypia of uncertain significance, 0% (zero of 16 cases) in benign neoplasm, 16.7% (12 of 72 cases) in bone and soft tissue neoplasm of uncertain malignant potential, 75.0% (three of four cases) in suspicious for malignancy, and 100% (107 of 107 cases) in malignant categories. Using the WHO system, the proportion and ROM of the benign category (non-neoplastic and benign neoplasm) was 17.5% and 0%, respectively. Among benign and malignant lesions, the diagnostic accuracy, sensitivity, and specificity for detecting malignancy were 99.4%, 100%, and 98.0%, respectively. The modified Milan system as well as the WHO system may be a useful cytopathologic classification tool for both bone and soft tissue lesions.
Sections du résumé
BACKGROUND
BACKGROUND
A standardized reporting system for bone and soft tissue tumor cytopathology has not yet been established. The objective of this study was to explore the potential utility of a classification modified from the Milan System for Salivary Gland Cytopathology and compared it with the upcoming World Health Organization (WHO) system for fine-needle aspiration of soft tissue lesions.
METHODS
METHODS
The authors reviewed 285 cytology cases of bone/joint (n = 173) and soft tissue (n = 112) lesions, scoring each within diagnostic categories. The results were compared with histologic diagnoses and the risk of malignancy (ROM) for each category, and diagnostic reliability was analyzed.
RESULTS
RESULTS
All 285 cases were successfully classified into one of the following categories: nondiagnostic (6.3%), non-neoplastic (11.9%), atypia of uncertain significance (11.9%), benign neoplasm (5.6%), bone and soft tissue neoplasm of uncertain malignant potential (25.3%), suspicious for malignancy (1.4%), and malignant (37.5%). The ROM was 44.4% (eight of /18 cases) in nondiagnostic, 0% (zero of 34 cases) in non-neoplastic, 32.4% (11 of 34 cases) in atypia of uncertain significance, 0% (zero of 16 cases) in benign neoplasm, 16.7% (12 of 72 cases) in bone and soft tissue neoplasm of uncertain malignant potential, 75.0% (three of four cases) in suspicious for malignancy, and 100% (107 of 107 cases) in malignant categories. Using the WHO system, the proportion and ROM of the benign category (non-neoplastic and benign neoplasm) was 17.5% and 0%, respectively. Among benign and malignant lesions, the diagnostic accuracy, sensitivity, and specificity for detecting malignancy were 99.4%, 100%, and 98.0%, respectively.
CONCLUSIONS
CONCLUSIONS
The modified Milan system as well as the WHO system may be a useful cytopathologic classification tool for both bone and soft tissue lesions.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Japan Society for the Promotion of Science
ID : 22K06941
Organisme : Japan Society for the Promotion of Science
ID : 23H02694
Informations de copyright
© 2024 The Author(s). Cancer Cytopathology published by Wiley Periodicals LLC on behalf of American Cancer Society.
Références
Ariizumi T, Kawashima H, Yamagishi T, et al. Diagnostic accuracy of fine needle aspiration cytology and core needle biopsy in bone and soft tissue tumor: a comparative study of the image‐guided and blindly performed procedure. Ann Diagn Pathol. 2022;59:151936. doi:10.1016/j.anndiagpath.2022.151936
The 1988 Bethesda System for reporting cervical/vaginal cytologic diagnosis. National Cancer Institute Workshop. JAMA. 1989;262:931‐934.
Edmund SC, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009;132(5):658‐665. doi:10.1309/ajcpphlwmi3jv4la
Barkan GA, Wojcik EM, Nayar R, et al. The Paris System for Reporting Urinary Cytology: the quest to develop a standardized terminology. Acta Cytol. 2016;60(3):185‐197. doi:10.1159/000446270
Faquin WC, Rossi ED, Baloch Z, et al., eds. The Milan System for Reporting Salivary Gland Cytopathology. 2nd ed. Springer International Publishing; 2023.
American Society of Cytopathology (ASC). Symposia 6—The WHO System for Reporting Soft Tissue Cytopathology: The Rationale, Structure, Categories and Application in Routine Reporting. American Society of Cytopathology; 2023. Accessed June 21, 2024. https://education.cytopathology.org/content/symposia‐6‐who‐system‐reporting‐soft‐tissue‐cytopathology‐rationale‐structure‐categories‐and#group‐tabs‐node‐course|group‐tabs‐node‐course‐default1]
Köster J, Ghanei I, Domanski HA. Comparative cytological and histological assessment of 828 primary soft tissue and bone lesions, and proposal for a system for reporting soft tissue cytopathology. Cytopathology. 2021;32(1):7‐19. doi:10.1111/cyt.12914
Saoud C, Schowinsky J, Ali SZ. Myxoid soft tissue tumors: a 20‐year experience on fine needle aspiration with application of the proposed WHO Reporting System for Soft Tissue Cytopathology. Acta Cytol. 2023;67(5):468‐481. doi:10.1159/000531051
The WHO Classification of Tumours Editorial Board. WHO Classification of Tumours Soft Tissue and Bone Tumours. 5th ed. IARC Press; 2020.
Higuchi K, Urano M, Akiba J, et al. A multi‐institutional study of salivary gland cytopathology: application of the Milan System for Reporting Salivary Gland Cytopathology in Japan. Cancer Cytopathol. 2022;130(1):30‐40. doi:10.1002/cncy.22505
Jorda M, Rey L, Hanly A, Ganjei‐Azar P. Fine‐needle aspiration cytology of bone: accuracy and pitfalls of cytodiagnosis. Cancer. 2000;90(1):47‐54. doi:10.1002/(sici)1097‐0142(20000225)90:1<47::aid‐cncr7>3.3.co;2‐k
Khalbuss WE, Teot LA, Monaco SE. Diagnostic accuracy and limitations of fine‐needle aspiration cytology of bone and soft tissue lesions: a review of 1114 cases with cytological‐histological correlation. Cancer Cytopathol. 2010;118(1):24‐32. doi:10.1002/cncy.20058
Fleshman R, Mayerson J, Wakely PE Jr. Fine‐needle aspiration biopsy of high‐grade sarcoma: a report of 107 cases. Cancer. 2007;111(6):491‐498. doi:10.1002/cncr.23122
Ng VY, Thomas K, Crist M, Wakely PE Jr, Mayerson J. Fine needle aspiration for clinical triage of extremity soft tissue masses. Clin Orthop Relat Res. 2010;468(4):1120‐1128. doi:10.1007/s11999‐009‐1100‐7
Kilpatrick SE, Cappellari JO, Bos GD, Gold SH, Ward WG. Is fine‐needle aspiration biopsy a practical alternative to open biopsy for the primary diagnosis of sarcoma? Experience with 140 patients. Am J Clin Pathol. 2001;115(1):59‐68. doi:10.1309/yn14‐k8u4‐5flj‐dgje
Yang YJ, Damron TA. Comparison of needle core biopsy and fine‐needle aspiration for diagnostic accuracy in musculoskeletal lesions. Arch Pathol Lab Med. 2004;128(7):759‐764. doi:10.5858/2004‐128‐759‐concba
Dey P, Mallik MK, Gupta SK, Vasishta RK. Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours and tumour‐like lesions. Cytopathology. 2004;15(1):32‐37. doi:10.1046/j.0956‐5507.2003.00102.x
Jakowski JD, Mayerson J, Wakely PE Jr. Fine‐needle aspiration biopsy of the distal extremities: a study of 141 cases. Am J Clin Pathol. 2010;133(2):224‐231. doi:10.1309/ajcpbwjp3cg6jzka
Nagira K, Yamamoto T, Akisue T, et al. Reliability of fine‐needle aspiration biopsy in the initial diagnosis of soft‐tissue lesions. Diagn Cytopathol. 2002;27(6):354‐361. doi:10.1002/dc.10200
Wakely PEJ, Kneisl JS. Soft tissue aspiration cytopathology. Cancer. 2000;90(5):292‐298. doi:10.1002/1097‐0142(20001025)90:5<292::aid‐cncr5>3.0.co;2‐8
Rakheja G, Handa U, Punia RS, Attri AK. Fine‐needle aspiration cytology in soft tissue tumors‐5‐year institutional experience. Diagn Cytopathol. 2022;50(10):463‐470. doi:10.1002/dc.25017
Shahab J, Maheshwari R, Singh M, et al. Cytomorphology of mesenchymal lesions in a tertiary care centre and its correlation with histopathology. Cytojournal. 2023;20:36. doi:10.25259/cytojournal_2_2023
Saoud C, Lam H, Gross JM, Ali SZ. Fine needle aspiration of bone lesions: a tertiary care centre experience. Cytopathology. 2023;34(6):562‐572. doi:10.1111/cyt.13270