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
Department of Laboratory Medicine and Pathology, Temple University Hospital, Pennsylvania.
Department of Pathology, The Johns Hopkins Hospital, Maryland.
Diagn Cytopathol. 2017 Dec;45(12):1088-1094. doi: 10.1002/dc.23826. Epub 2017 Sep 29.
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.
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).
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 = 24.38 and P < .001.
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.
细针穿刺抽吸活检（FNA）广泛应用于涎腺病变的诊断。由于形态学异质性，涎腺FNA往往难以诊断，少数FNA会得出“非典型”诊断结果。然而，目前仍缺乏对不同机构非典型诊断的恶性风险（ROM）进行系统评估以及各机构之间ROM变异性的研究。
回顾了来自美国、欧洲和中国五个三级医疗中心的涎腺FNA病例。本研究纳入了诊断为“非典型”且有组织学随访结果的病例。“非典型”的诊断类别采用米兰涎腺细胞病理学报告系统（MSRSGC，个人交流）。
在12606例涎腺FNA中，有504例（4.0%）报告为“非典型”，其中154例（30.6%）有组织学随访结果。组织学随访发现94例恶性肿瘤（61.0%，57例淋巴瘤、33例癌、2例肉瘤、1例转移性黑色素瘤、1例转移性神经母细胞瘤）、33例良性肿瘤（21.4%）和25例良性病变（16.2%）。不同机构有组织学随访结果的“非典型”病例子集的ROM从73.08%到0.00%不等，Pearson卡方值=24.38，P＜0.001。
经组织学切除的“非典型”涎腺FNA病例子集中，超过一半最终被证实为恶性肿瘤；另外四分之一为良性肿瘤。此外，不同机构“非典型”类别的ROM差异很大，这可能反映了各机构的不同操作方式。
