应用米兰系统报告儿科唾液腺细胞病理学：组织学随访、恶性风险和诊断准确性分析。
Application of the Milan System for Reporting Pediatric Salivary Gland Cytopathology: Analysis of histologic follow-up, risk of malignancy, and diagnostic accuracy.
机构信息
Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
出版信息
Cancer Cytopathol. 2021 Jul;129(7):555-565. doi: 10.1002/cncy.22415. Epub 2021 Feb 17.
BACKGROUND
The diagnosis and management of salivary gland tumors in pediatric patients can be challenging. The utility of fine-needle aspiration (FNA) cytopathology and the performance of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in this age group have not been systematically assessed. The paucity of data has contributed to the controversial role of FNA cytopathology in the presurgical management of these patients.
METHODS
The authors retrospectively analyzed 104 pediatric salivary gland FNAs (2000-2020). A correlation with the available histopathologic follow-up (n = 54) was performed. The distribution percentages, the risk of neoplasm (RON), and the risk of malignancy (ROM) were assessed for each category of the MSRSGC.
RESULTS
The overall sensitivity, specificity, negative predictive value, and positive predictive value of pediatric salivary gland FNAs were 80%, 97%, and 92%, respectively. The RON values for the nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant categories were 60%, 11%, 100%, 100%, 100%, 100%, and 100%, respectively, whereas the ROM values were 0%, 11%, 100%, 6%, 67%, 100%, and 100%, respectively. The percentage of nonneoplastic FNAs was greater in comparison with the adult population (52% vs 8%). All neoplasms in patients aged 0 to 10 years were malignant, whereas benign neoplasms occurred only in patients aged ≥11 years; this supported an inverse correlation between age and malignancy rate in salivary gland neoplasms.
CONCLUSIONS
FNA cytopathology demonstrates excellent diagnostic performance in differentiating malignant and benign pediatric salivary gland lesions. The MSRSGC is a valuable tool for standardization of the reporting and preoperative risk stratification of these lesions.
背景
儿科患者唾液腺肿瘤的诊断和治疗具有挑战性。细针抽吸细胞学（FNA）在该年龄段的实用性以及米兰唾液腺细胞病理学报告系统（MSRSGC）的性能尚未得到系统评估。数据的缺乏导致 FNA 细胞学在这些患者的术前管理中的作用存在争议。
方法
作者回顾性分析了 104 例儿科唾液腺 FNA（2000-2020 年）。对 54 例可获得的组织病理学随访结果进行了相关性分析。评估了 MSRSGC 每个类别的分布百分比、肿瘤风险（RON）和恶性风险（ROM）。
结果
儿科唾液腺 FNA 的总体敏感性、特异性、阴性预测值和阳性预测值分别为 80%、97%和 92%。非诊断性、非肿瘤性、意义未明的非典型性、良性肿瘤、唾液腺低度恶性潜能肿瘤、疑似恶性和恶性类别的 RON 值分别为 60%、11%、100%、100%、100%、100%和 100%，而 ROM 值分别为 0%、11%、100%、6%、67%、100%和 100%。与成人相比，非肿瘤性 FNA 的比例更大（52% vs 8%）。0-10 岁患者的所有肿瘤均为恶性，而≥11 岁患者仅发生良性肿瘤；这表明唾液腺肿瘤的年龄与恶性率之间呈反比关系。
结论
FNA 细胞学在鉴别儿童唾液腺良恶性病变方面具有出色的诊断性能。MSRSGC 是标准化报告和术前风险分层这些病变的有用工具。
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