Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Diagn Cytopathol. 2021 Jul;49(7):822-831. doi: 10.1002/dc.24748. Epub 2021 Apr 6.
Fine-needle aspiration (FNA) is a well-established modality for diagnosing salivary gland pathologies. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized uniform framework leading to an evidence-based risk of malignancy (ROM). Based on the current literature, ROM in the 6-tier MSRSGC ranges from <5% for neoplasm-benign to >90% for the malignant category. Here, we report our institutional experience adopting MSRSGC.
The cytopathology group at our institution implemented MSRSGC at the end of 2018. Through a query of our laboratory information system, we identified all salivary gland FNA cases from 27 November 2018 to 26 October 2020. The pertinent surgical pathology follow-up was also extracted. After manual curation, data was analyzed in Rv4.0.2.
Our cohort comprised of 315 patients undergoing 343 salivary gland FNA biopsies, predominantly on the parotid (90%), 162 with a surgical pathology follow-up. The risk of malignancy ranged from 3.2% in neoplasm-benign (IVA) to 100% in suspicious for malignancy (V) and malignant (VI) categories. ROM in the other categories was: 12.5% for non-diagnostic, 0 for non-neoplastic, 33.3% for atypia of undetermined significance, and 41.9% for salivary gland neoplasm of uncertain malignant potential (SUMP). Most SUMP cases had a basaloid or oncocytoid cytomorphology with similar ROM. In distinguishing benign and malignant salivary gland lesions, FNA had adequacy of 93.6%, a diagnostic yield of 62.2%, a sensitivity of 93.1% and a specificity of 100%.
MSRSGC was successfully adopted by our cytology group and clinicians, with overall diagnostic performance similar to previous studies.
细针抽吸（FNA）是诊断唾液腺病变的一种成熟方法。米兰唾液腺细胞病理学报告系统（MSRSGC）提供了一个标准化的统一框架，导致基于证据的恶性风险（ROM）。根据目前的文献，MSRSGC 的 6 级系统中，ROM 从良性肿瘤的 <5%到恶性肿瘤的 >90%不等。在这里，我们报告我们机构采用 MSRSGC 的经验。
我们机构的细胞病理学组于 2018 年底采用了 MSRSGC。通过查询我们的实验室信息系统，我们确定了 2018 年 11 月 27 日至 2020 年 10 月 26 日期间所有的唾液腺 FNA 病例。还提取了相关的外科病理随访。经过人工整理，数据在 Rv4.0.2 中进行分析。
我们的队列包括 315 名接受 343 次唾液腺 FNA 活检的患者，主要是在腮腺（90%），162 例有外科病理随访。恶性风险从良性肿瘤（IVA）的 3.2%到可疑恶性（V）和恶性（VI）的 100%不等。其他类别的 ROM 分别为：非诊断性 12.5%，非肿瘤性 0%，意义未确定的非典型性 33.3%，唾液腺恶性潜能不确定肿瘤（SUMP）41.9%。大多数 SUMP 病例具有基底细胞样或嗜酸性细胞形态学特征，具有相似的 ROM。在区分良性和恶性唾液腺病变时，FNA 的充分性为 93.6%，诊断率为 62.2%，敏感性为 93.1%，特异性为 100%。
我们的细胞学组和临床医生成功地采用了 MSRSGC，总体诊断性能与以前的研究相似。
