Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
Cancer Cytopathol. 2022 Aug;130(8):595-608. doi: 10.1002/cncy.22568. Epub 2022 Mar 7.
Although usually recognized as malignant, fine-needle aspiration (FNA) biopsy of salivary duct carcinoma (SDC) has been confused with other primary salivary gland (SG) neoplasms. This article undertook an analysis of a large collection of SDC FNA cases to assess diagnostic accuracy, specificity, and cytopathology.
Cytopathology files were searched for SDC with histopathologic validation. FNA biopsy smears were performed using standard techniques.
Seventy cases from 56 patients (M:F, 1.9:1; age range, 26-92 years; mean age, 65 years) met inclusion criteria. All had tissue confirmation of SDC. FNA sites included: parotid gland (42, 60% cases), neck (10), submandibular gland (7), pre-/post-auricular area (5), face/cheek (3), mediastinal lymph nodes (2), and clavicle (1). Aspirates were from primary (52, 74%), metastatic (12, 17%), and locally recurrent (6, 9%) neoplasms. FNA diagnoses included: SDC (19, 27%), favor/suspicious for SDC (7, 10%), high-grade carcinoma (11), adenocarcinoma (9), carcinoma (6), malignant (6), SG neoplasm (5), atypia (3), SDC versus another malignancy (2), and pleomorphic adenoma (2). Large polygonal cells in groups and single forms showed cribriforming, variable necrosis, pseudopapillae, and oncocytic change. Androgen receptor staining was positive in all cases.
FNA biopsy is accurate and reliable in classifying SDC as a malignant neoplasm, but much less so for identification as a specific tumor type. Using the Milan system, 86% of aspirates were classified as either malignant or suspicious for malignancy. A recurring pitfall includes sampling error in cases of SDC ex pleomorphic adenoma.
尽管细针穿刺活检（FNA）通常被认为是恶性的，但涎腺导管癌（SDC）的 FNA 活检曾与其他原发性涎腺（SG）肿瘤相混淆。本文对大量 SDC FNA 病例进行了分析，以评估诊断的准确性、特异性和细胞病理学。
通过组织病理学验证，在细胞病理学文件中搜索 SDC。使用标准技术进行 FNA 活检涂片。
从 56 名患者（男：女，1.9:1；年龄范围 26-92 岁；平均年龄 65 岁）中纳入 70 例符合纳入标准的病例。所有患者均有 SDC 的组织学证实。FNA 部位包括：腮腺（42 例，占 60%）、颈部（10 例）、颌下腺（7 例）、耳前/后区（5 例）、面部/脸颊（3 例）、纵隔淋巴结（2 例）和锁骨（1 例）。抽吸物来自原发性（52 例，74%）、转移性（12 例，17%）和局部复发性（6 例）肿瘤。FNA 诊断包括：SDC（19 例，27%）、倾向/疑似 SDC（7 例，10%）、高级别癌（11 例）、腺癌（9 例）、癌（6 例）、恶性（6 例）、SG 肿瘤（5 例）、不典型性（3 例）、SDC 与其他恶性肿瘤（2 例）和多形性腺瘤（2 例）。成群和单个形式的大多边形细胞表现出筛状、变异性坏死、假乳头和嗜酸性细胞改变。所有病例的雄激素受体染色均为阳性。
FNA 活检在将 SDC 归类为恶性肿瘤方面是准确和可靠的，但在确定特定肿瘤类型方面准确性较差。使用米兰系统，86%的抽吸物被归类为恶性或疑似恶性。一个反复出现的陷阱包括 SDC 源自多形性腺瘤的取样误差。
