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“Atypical” salivary gland fine needle aspiration: Risk of malignancy and interinstitutional variability
Author(s) -
Wang He,
Malik Aatika,
Maleki Zahra,
Rossi Esther Diana,
Ping Bo,
Chandra Ashish,
Ali Syed Z.,
Fadda Guido,
Wang Jindong,
Arab Seyedeh Elham,
Zhao Huaqing,
Jhala Nirag
Publication year - 2017
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.23826
Subject(s) - medicine , salivary gland , fine needle aspiration , malignancy , cytopathology , pathology , biopsy , cytology
Background Fine needle aspiration (FNA) is widely used in the diagnosis of salivary gland lesions. Salivary gland FNAs are often difficult to diagnose because of morphologic heterogeneity, a small but significant number of the FNAs yield “atypical” diagnosis. However, systematic evaluation of the risk of malignancy (ROM) of the atypical diagnoses across institutions and the variability of ROM among institutions are still lacking. Methods Salivary gland FNAs from five tertiary medical centers of United States, Europe and China were reviewed. Cases with “atypical” diagnosis and histological follow‐up were included in this study. The diagnostic category of “atypical” was adopted from Milan System for Reporting Salivary Gland Cytopathology (MSRSGC, personal communication). Results Among the 12,606 salivary gland FNAs, 504 (4.0%) cases were reported as “atypical”, with 154 cases (30.6%) having histological follow‐ups. Histological follow‐ups revealed 94 malignant tumors (61.0%, 57 lymphomas, 33 carcinomas, 2 sarcomas, 1 metastatic melanoma, 1 metastatic neuroblastoma), 33 benign tumors (21.4%), and 25 benign lesions (16.2%). ROM in the subset of “atypical” cases with histological follow‐up from different institutions vary from 73.08% to 0.00%, the Pearson chi 2 = 24.38 and P < .001. Conclusions More than half of the subset of “atypical” salivary gland FNAs with histological resection turned out to be malignant tumors; another one‐fourth were benign neoplasms. Further, the highly variable ROMs of the “atypical” category amongst different institutions likely reflect the variable practices at each individual institution.