Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.
Cancer Cytopathol. 2018 Aug;126(8):541-551. doi: 10.1002/cncy.22016. Epub 2018 May 24.
Fine-needle aspiration (FNA) is widely accepted in the preoperative management of salivary gland lesions. The proposed Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) aims to standardize reporting terminology. Studies regarding the risk of malignancy (ROM) for the proposed categories continue to evolve. The current retrospective study applied the MSRSGC to assess ROM for salivary gland lesions and focused on the "indeterminate" categories.
A total of 627 salivary gland FNA specimens obtained from 2011 through 2016 were retrieved, with follow-up available for 373 cases. The original diagnoses were recategorized using MSRSGC by 2 independent cytopathologists as: 1) non-diagnostic; 2) non-neoplastic; 3) atypia of undetermined significance (AUS); 4a) benign neoplasms; 4b) salivary gland neoplasm of uncertain malignant potential (SUMP); 5) suspicious for malignancy (SFM); and 6) malignant. The ROM and overall ROM for each diagnostic category were determined, with characterization of "indeterminate" (AUS, SUMP, and SFM) lesions.
There was near-perfect agreement regarding categorization (626 of 627 cases; 99.8%) between the 2 cytopathologists, with discordance observed for 1 case. The sensitivity, specificity, negative predictive value, and positive predictive value of salivary gland FNA specimens at the study institution were 79%, 98%, 94%, and 92%, respectively. The ROM for non-diagnostic, non-neoplastic, benign neoplasms, AUS, SUMP, SFM, and malignant were 6.7%, 7.1%, 38.9%, 5.0%, 34.2%, 92.9%, and 92.3%, respectively. The indeterminate category had an overall ROM of 47.1%.
The MSRSGC is a valuable tool that can help to standardize reporting and stratify cases preoperatively. Having a better understanding of the indeterminate diagnoses will help further refine risk classification criteria. Cancer Cytopathol 2018. © 2018 American Cancer Society.
细针吸取活检（FNA）广泛应用于唾液腺病变的术前管理。拟议的米兰唾液腺细胞病理学报告系统（MSRSGC）旨在标准化报告术语。关于所提出类别的恶性肿瘤风险（ROM）的研究仍在不断发展。本回顾性研究应用 MSRSGC 评估唾液腺病变的 ROM，并重点关注“不确定”类别。
共检索了 2011 年至 2016 年期间获得的 627 例唾液腺 FNA 标本，其中 373 例可获得随访。2 位独立细胞病理学家应用 MSRSGC 重新分类原始诊断为：1）非诊断性；2）非肿瘤性；3）非典型意义不明确（AUS）；4a）良性肿瘤；4b）唾液腺肿瘤恶性潜能不确定（SUMP）；5）疑似恶性（SFM）；和 6）恶性。确定每个诊断类别的 ROM 和总体 ROM，并对“不确定”（AUS、SUMP 和 SFM）病变进行特征描述。
2 位细胞病理学家在分类方面几乎达成完全一致（626 例中有 627 例；99.8%），仅 1 例存在不一致。该研究机构的唾液腺 FNA 标本的灵敏度、特异性、阴性预测值和阳性预测值分别为 79%、98%、94%和 92%。非诊断性、非肿瘤性、良性肿瘤、AUS、SUMP、SFM 和恶性的 ROM 分别为 6.7%、7.1%、38.9%、5.0%、34.2%、92.9%和 92.3%。不确定类别总的 ROM 为 47.1%。
MSRSGC 是一种有价值的工具，可以帮助标准化报告并在术前分层病例。更好地了解不确定诊断将有助于进一步完善风险分类标准。癌症细胞病理学 2018. © 2018 美国癌症协会。
