Rohilla Manish, Singh Priya, Rajwanshi Arvind, Gupta Nalini, Srinivasan Radhika, Dey Pranab, Vashishta Rakesh K
Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Cancer Cytopathol. 2017 Oct;125(10):767-775. doi: 10.1002/cncy.21900. Epub 2017 Aug 7.
Fine-needle aspiration (FNA) cytology of salivary glands is a well-established technique that plays a critical role in the preoperative diagnosis of lesions. A risk stratification of FNA diagnostic categories has been recently proposed to be useful in reporting. The aims of this study were to evaluate the diagnostic accuracy of salivary gland FNA and to apply the proposed Milan system for reporting salivary gland lesions.
A retrospective audit of FNA specimens of salivary gland lesions reported from 2014 to 2016 was performed. A correlation with the follow-up histopathology, wherever it was available, was performed. The aspirates were then categorized according to the Milan system as follows: nondiagnostic, nonneoplastic, atypical, benign neoplasm, neoplasm of uncertain malignant potential (NUMP), suspicious for malignancy, or positive for malignancy. Furthermore, the risk of malignancy and the risk of high-grade malignancy were calculated for all diagnostic categories.
A total of 631 salivary gland aspirates were evaluated: 2.2% were nondiagnostic, 55.8% indicated nonneoplastic lesions, and 40.4% indicated neoplastic lesions. Histopathology was available for 94 cases (14.9%). FNA had a sensitivity of 79.4% and a specificity of 98.3% with an overall diagnostic accuracy of 91.4% for differentiating malignant tumors from benign tumors. The overall risk of malignancy was 17.4% for the nonneoplastic category, 100% for the atypical category, 7.3% for the benign neoplasm category, 50% for the NUMP category, and 96% for the positive-for-malignancy category.
Salivary gland FNA continues to have high diagnostic accuracy and is thus helpful for guiding management. Neoplasms with classic cytomorphology are easily diagnosed; however, in difficult cases showing overlapping features, the use of the Milan system could be beneficial. Cancer Cytopathol 2017;125:767-75. © 2017 American Cancer Society.
唾液腺细针穿刺（FNA）细胞学检查是一项成熟的技术，在病变的术前诊断中起着关键作用。最近有人提出对FNA诊断类别进行风险分层有助于报告。本研究的目的是评估唾液腺FNA的诊断准确性，并应用提议的米兰系统报告唾液腺病变。
对2014年至2016年报告的唾液腺病变FNA标本进行回顾性审核。与可获得的随访组织病理学结果进行相关性分析。然后根据米兰系统将吸出物分类如下：无法诊断、非肿瘤性、非典型、良性肿瘤、恶性潜能不确定的肿瘤（NUMP）、恶性可疑或恶性阳性。此外，计算所有诊断类别的恶性风险和高级别恶性风险。
共评估了631例唾液腺吸出物：2.2%无法诊断，55.8%提示非肿瘤性病变，40.4%提示肿瘤性病变。94例（14.9%）有组织病理学结果。FNA区分恶性肿瘤和良性肿瘤的敏感性为79.4%，特异性为98.3%，总体诊断准确性为91.4%。非肿瘤性类别的总体恶性风险为17.4%，非典型类为100%，良性肿瘤类为7.3%，NUMP类为50%，恶性阳性类为96%。
唾液腺FNA仍具有较高的诊断准确性，因此有助于指导治疗。具有典型细胞形态学的肿瘤易于诊断；然而，在表现出重叠特征的疑难病例中，使用米兰系统可能有益。《癌症细胞病理学》2017年；125：767 - 75。©2017美国癌症协会
