Department of Pathology, St. John Hospital and Medical Center, Detroit, Michigan.
Division of Cytopathology, Pathology Department, The Johns Hopkins Hospital, Baltimore, Maryland.
Cancer Cytopathol. 2018 Feb;126(2):101-111. doi: 10.1002/cncy.21949. Epub 2017 Nov 13.
Fine-needle aspiration (FNA) is routinely performed to evaluate salivary gland lesions, and provides valuable information regarding the cytomorphologic features of the lesions. Occasionally, there are overlaps between benign and malignant conditions due to heterogeneity of the cell types, metaplastic changes, and sampling issues. Herein, the authors present a retrospective study of diagnostic pitfalls in salivary gland cytology and the simulating conditions.
A 20-year retrospective review (1995-2015) of medical records was performed searching for the cytology reports of patients who underwent FNA of the salivary gland with the words "amendment" or "revision." Medical records of the revised cases were reviewed for the subsequent surgical follow-up. All cases with a diagnostic discrepancy between the primary cytologic diagnosis and the final histology diagnosis were included in the current study. The histologic diagnosis was considered the gold standard.
A total of 19 cases were included in the current study. The cases were divided into 7 categories based on their cytologic diagnoses: 1) nondiagnostic (1 case); 2) benign, nonneoplastic lesion (2 cases); 3) benign salivary gland neoplasm (2 cases); 4) salivary gland neoplasm (4 cases); 5) epithelial neoplasm, not otherwise specified (1 case); 6) markedly atypical cells suspicious for a malignant neoplasm (1 case); and 7) malignant neoplasms (8 cases).
The interpretation of salivary gland FNA can be influenced by several factors including prominent metaplasia, focal atypia, cystic changes, variable cellular components within the lesions, scant cellularity, variants of neoplasms, and a prior history of malignancy. Multiple passes representing the entire mass, imaging findings, and familiarity with salivary gland cytomorphology may improve the diagnostic accuracy. Cancer Cytopathol 2018;126:101-11. © 2017 American Cancer Society.
细针抽吸（FNA）通常用于评估唾液腺病变，并提供有关病变细胞形态特征的有价值信息。由于细胞类型的异质性、化生改变和采样问题，良性和恶性病变之间偶尔会有重叠。在此，作者回顾性研究了唾液腺细胞学诊断中的陷阱和模拟情况。
对 1995 年至 2015 年期间进行的 FNA 检查的患者的细胞学报告进行了 20 年的回顾性研究，搜索了包含“修正”或“修订”字样的细胞学报告。对修正病例的病历进行了审查，以进行随后的手术随访。所有细胞学诊断与最终组织学诊断不一致的病例均纳入本研究。组织学诊断被认为是金标准。
本研究共纳入 19 例患者。根据细胞学诊断，将病例分为 7 类：1）无法诊断（1 例）；2）良性、非肿瘤性病变（2 例）；3）良性唾液腺肿瘤（2 例）；4）唾液腺肿瘤（4 例）；5）上皮性肿瘤，未特指（1 例）；6）明显异型细胞疑恶性肿瘤（1 例）；7）恶性肿瘤（8 例）。
影响唾液腺 FNA 解读的因素有很多，包括明显的化生、局灶性异型性、囊性改变、病变内细胞成分的变化、细胞稀少、肿瘤变异型和恶性肿瘤病史。代表整个肿块的多次穿刺、影像学发现以及对唾液腺细胞学形态的熟悉程度可能会提高诊断的准确性。癌症细胞病理学 2018；126:101-11. © 2017 美国癌症协会。
