Farahani Sahar J, Baloch Zubair
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania.
Diagn Cytopathol. 2019 Feb;47(2):67-87. doi: 10.1002/dc.24097. Epub 2018 Oct 29.
Fine needle aspiration (FNA) has been widely utilized in establishing the nature of salivary gland lesions and guiding the clinical management. This study aimed to determine the accuracy of FNA in detecting salivary gland neoplasms and malignancies, employing the "Milan System for Reporting Salivary Gland Cytopathology" (MSRSGC).
A systematic search was conducted. The data on FNA and histologic diagnosis were extracted and categorized based on the MSRSGC and risk of malignancy (ROM) was calculated. The risk of publication bias and level of heterogeneity were evaluated. A mixed-effects model was used to estimate FNA accuracy. Meta-regression was conducted to assess the potential effect of different variables on FNA accuracy.
Ninety-two studies with a total of 16 456 FNA with surgical follow-up were included. ROM was estimated as 17%, 8%, 34%, 4%, 42%, 58%, and 91%, in nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant groups, respectively. High level of heterogeneity was detected (P-value <.001). Including cases with definite FNA diagnosis of neoplasm or malignancy, summary estimates of FNA sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratio in detecting neoplasms and malignancies were 96.9%, 95.3%, 636.8, 20.5, and 0.03, and 80.5%, 97.9%, 189.5, 37.8, and 0.2, respectively. Meta-regression showed several variables significantly impacting FNA accuracy; however, subgroup analysis did not reduce the level of heterogeneity.
FNA can be used as a reliable diagnostic tool in the preoperative evaluation and management of salivary glands lesions. Concise of abstract is using Milan system for reporting salivary gland FNA could increase FNA reliability, facilitate communication, and improve patient care.
细针穿刺抽吸活检（FNA）已被广泛用于确定涎腺病变的性质并指导临床治疗。本研究旨在采用“涎腺细胞病理学报告米兰系统”（MSRSGC）来确定FNA检测涎腺肿瘤和恶性肿瘤的准确性。
进行系统检索。提取FNA和组织学诊断数据，并根据MSRSGC进行分类，计算恶性风险（ROM）。评估发表偏倚风险和异质性水平。使用混合效应模型估计FNA的准确性。进行Meta回归以评估不同变量对FNA准确性的潜在影响。
纳入92项研究，共16456例FNA病例并进行了手术随访。非诊断性、非肿瘤性、意义未明的不典型性、良性肿瘤、恶性潜能不确定的涎腺肿瘤、可疑恶性和恶性组的ROM分别估计为17%、8%、34%、4%、42%、58%和91%。检测到高度异质性（P值<.001）。纳入FNA明确诊断为肿瘤或恶性肿瘤的病例后，FNA在检测肿瘤和恶性肿瘤时的敏感性、特异性、诊断比值比、阳性和阴性似然比的汇总估计分别为96.9%、95.3%、636.8、20.5和0.03，以及80.5%、97.9%、189.5、37.8和0.2。Meta回归显示几个变量对FNA准确性有显著影响；然而，亚组分析并未降低异质性水平。
FNA可作为涎腺病变术前评估和治疗的可靠诊断工具。使用米兰系统报告涎腺FNA摘要可以提高FNA的可靠性，促进交流并改善患者护理。
