Comparative Analysis of Cytologic and Histologic Grading of Malignant Salivary Gland Tumors and Salivary Gland Neoplasms of Uncertain Malignant Potential: A 6-Year Review at a Single Institution

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology Pub Date : 2025-06-03 DOI:10.1002/dc.25490

Agnes I. Udoh, Cecilia G. Clement

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引用次数: 0

Abstract

Background

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) developed and published in 2018 recommends grading salivary gland neoplasms into high-grade (HG) or low-grade (LG), given its impact on clinical management. Although this cytologic grading can be done, in certain cases it can be challenging. Herein we assess the accuracy of cytologic grading of salivary gland neoplasms at our institution.

Method

A retrospective review of medical records identified 365 patients who underwent salivary gland FNA between 2017 and 2022. Cases categorized as malignant, suspicious for malignancy, and salivary gland neoplasms of uncertain malignant potential (SUMP) by the Milan system and with available follow-up histology were selected. FNA cases were reviewed and blindly assigned a cytologic grade. No ancillary testing or cell blocks associated with study cases were examined. The cytologic grade was correlated with the final surgical diagnosis and grade. The diagnostic performance of cytologic tumor grading was determined using histologic grading as the gold standard. One case with intermediate (INT) histologic grade was excluded from this analysis.

Results

Out of 40 cases included in the study, 70% (n = 28) were SUMPs, 5% (n = 2) were suspicious of malignancy, and 25% (n = 10) were malignant. Among the 39 cases analyzed (12 histologic HG, 27 histologic LG), cytologic grading correctly identified 7 of the 12 HG cases, yielding a sensitivity of 58.3% (95% CI: 30.4%–82.5%). Twenty-six of 27 LG cases were accurately categorized as LG on cytology, resulting in a specificity of 96.3% (95% CI: 81.7%–99.8%). The positive predictive value for cytologically diagnosed HG cases was 87.5% (7 of 8; 95% CI: 52.9%–97.8%), and the negative predictive value (LG accuracy) was 83.9%. Overall, cytologic grading demonstrated an accuracy of 84.6% (33 of 39; 95% CI: 69.5%–93.0%). The most common diagnosis among the LG cases accurately graded was acinic cell carcinoma. HG-mucoepidermoid carcinoma (MEC) was the most common diagnosis among HG cases accurately graded. There were seven cases (17.5%) with cytology–histology discordances, four of which involved SUMP tumors that were HG malignancies by histology. Three of the discrepancies involved a histologic diagnosis of adenoid cystic carcinoma.

Conclusion

The study showed an overall high accuracy for cytologic grading of salivary gland neoplasms. Discordance in cytologic grading was more frequent in the SUMP category and involved a histologic diagnosis of HG adenoid cystic carcinoma. Communication with the clinical team should be in place, especially when grading cannot be provided with confidence, and in that situation, suggesting intraoperative consultation for management decisions seems appropriate.

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恶性唾液腺肿瘤和不确定恶性潜能的唾液腺肿瘤的细胞学和组织学分级的比较分析：在单一机构的6年回顾。

背景：米兰唾液腺细胞病理学报告系统（MSRSGC）于2018年开发并发布，考虑到其对临床管理的影响，建议将唾液腺肿瘤分为高级别（HG）或低级别（LG）。虽然这种细胞学分级可以完成，但在某些情况下它可能具有挑战性。在此，我们评估唾液腺肿瘤细胞学分级的准确性。方法：回顾性分析2017年至2022年期间接受唾液腺FNA治疗的365例患者的医疗记录。选择米兰系统分类为恶性、可疑恶性和恶性潜能不确定的唾液腺肿瘤（SUMP）并有随访组织学的病例。对FNA病例进行回顾，并盲目地进行细胞学分级。未检查与研究病例相关的辅助测试或细胞块。细胞学分级与最终的手术诊断和分级相关。以组织学分级为金标准确定细胞学肿瘤分级的诊断效能。1例中等（INT）组织学分级的病例被排除在本分析之外。结果：纳入研究的40例病例中，sump占70% (n = 28)，可疑恶性肿瘤占5% (n = 2)，恶性肿瘤占25% （n = 10）。在分析的39例病例中（12例组织学HG， 27例组织学LG），细胞学分级正确识别了7例HG，敏感性为58.3% （95% CI: 30.4%-82.5%）。27例LG病例中有26例在细胞学上被准确地归类为LG，特异性为96.3% （95% CI: 81.7%-99.8%）。细胞学诊断的HG病例阳性预测值为87.5% (7 / 8；95% CI: 52.9% ~ 97.8%)，阴性预测值（LG准确率）为83.9%。总体而言，细胞学分级的准确性为84.6% (33 / 39；95% ci: 69.5%-93.0%)。在准确分级的LG病例中，最常见的诊断是腺泡细胞癌。HG-黏液表皮样癌（MEC）是HG病例中最常见的诊断。有7例（17.5%）细胞学与组织学不一致，其中4例为组织学上为HG恶性肿瘤的SUMP肿瘤。其中三个差异涉及腺样囊性癌的组织学诊断。结论：该研究显示唾液腺肿瘤的细胞学分级总体上具有较高的准确性。在SUMP分类中，细胞学分级的不一致更为常见，并涉及HG腺样囊性癌的组织学诊断。与临床团队的沟通应该到位，特别是当分级不能可靠地提供时，在这种情况下，建议术中咨询管理决策似乎是合适的。

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来源期刊

Diagnostic Cytopathology 医学-病理学

CiteScore

2.60

自引率

7.70%

发文量

163

审稿时长

3-6 weeks

期刊介绍： Diagnostic Cytopathology is intended to provide a forum for the exchange of information in the field of cytopathology, with special emphasis on the practical, clinical aspects of the discipline. The editors invite original scientific articles, as well as special review articles, feature articles, and letters to the editor, from laboratory professionals engaged in the practice of cytopathology. Manuscripts are accepted for publication on the basis of scientific merit, practical significance, and suitability for publication in a journal dedicated to this discipline. Original articles can be considered only with the understanding that they have never been published before and that they have not been submitted for simultaneous review to another publication.