Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland.
Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky.
Cancer Cytopathol. 2021 Mar;129(3):214-225. doi: 10.1002/cncy.22363. Epub 2020 Oct 1.
Cystic salivary gland lesions present diagnostic challenges on fine-needle aspiration (FNA) specimens that are related to sampling limitations and a broad differential diagnosis. This study evaluated the benefit of applying the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) to a series of cystic salivary gland lesions.
The pathology archives at the Johns Hopkins Hospital were searched to identify cystic salivary gland FNA specimens over a 19-year period (2000-2018). Patient demographics, cytomorphologic features, and clinical and surgical follow-up were recorded. The MSRSGC was applied to the cases. The risk of malignancy (ROM) and the risk of neoplasia (RON) were calculated for each category.
One hundred seventy-eight cases were identified (96 males and 82 females) with a mean age of 53 years (range, 4-90 years). After the MSRSGC was applied, there were 52 nondiagnostic cases (29.2%), 80 nonneoplastic cases (44.9%), 35 cases of atypia of undetermined significance (AUS; 19.7%), 3 benign neoplasms (1.7%), 3 salivary gland neoplasms of uncertain malignant potential (SUMP; 1.7%), 4 cases suspicious for malignancy (SFM; 2.2%), and 1 malignant case (0.6%). One hundred fifty-six of the 178 patients (87.6%) had follow-up data available. The RON and ROM values for cases with surgical follow-up were 33.3% (3 of 9) and 22.2% (2 of 9) for the nondiagnostic category, 42.9% (9 of 21) and 19% (4 of 21) for the nonneoplastic category, 76.5% (13 of 17) and 29.4% (5 of 17) for the AUS category, 100.0% (2 of 2) and 50.0% (1 of 2) for the SUMP category, and 100% (2 of 2) and 100% (2 of 2) for the SFM category, respectively.
Applying the MSRSGC to cystic salivary gland lesions improves patient management by preventing unnecessary surgery for nonneoplastic conditions. The ROM was highest in the SFM category (100%), which was followed by the SUMP, AUS, nondiagnostic, and nonneoplastic categories. Less than adequate specimens may increase the diagnosis of AUS.
细针吸取细胞学（FNA）标本中的囊性唾液腺病变存在诊断挑战，这与采样局限性和广泛的鉴别诊断有关。本研究评估了将米兰唾液腺细胞病理学报告系统（MSRSGC）应用于一系列囊性唾液腺病变的益处。
在约翰霍普金斯医院的病理档案中搜索了 19 年（2000-2018 年）的囊性唾液腺 FNA 标本。记录患者的人口统计学、细胞学特征以及临床和手术随访情况。对病例应用 MSRSGC。计算每个类别下的恶性肿瘤风险（ROM）和肿瘤风险（RON）。
共确定了 178 例病例（96 例男性和 82 例女性），平均年龄为 53 岁（范围 4-90 岁）。应用 MSRSGC 后，52 例为非诊断性病例（29.2%），80 例为非肿瘤性病例（44.9%），35 例为意义未明的非典型性（AUS；19.7%），3 例为良性肿瘤（1.7%），3 例为唾液腺交界性肿瘤（SUMP；1.7%），4 例为可疑恶性（SFM；2.2%），1 例为恶性肿瘤（0.6%）。178 例患者中有 156 例（87.6%）有随访数据。有手术随访的病例的 RON 和 ROM 值分别为非诊断性组的 33.3%（9/9）和 22.2%（2/9），非肿瘤性组的 42.9%（9/21）和 19%（4/21），AUS 组的 76.5%（13/17）和 29.4%（5/17），SUMP 组的 100.0%（2/2）和 50.0%（1/2），SFM 组的 100%（2/2）和 100%（2/2）。
将 MSRSGC 应用于囊性唾液腺病变可通过防止对非肿瘤性病变进行不必要的手术来改善患者的管理。SFM 类别中的 ROM 最高（100%），其次是 SUMP、AUS、非诊断性和非肿瘤性类别。不充分的标本可能会增加 AUS 的诊断。
