Mutlu Fatih, Yaprak Bayrak Busra, Ozturk Murat
Department of Otorhinolaryngology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
Department of Pathology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
Diagn Cytopathol. 2025 Mar;53(3):111-120. doi: 10.1002/dc.25426. Epub 2024 Dec 2.
Parotid gland masses encompassing both neoplastic and non-neoplastic conditions present diagnostic challenges. Fine-needle aspiration cytology (FNAC) is commonly used to differentiate between benign and malignant lesions but has limitations such as variable sensitivity and potential sampling errors. This study assesses FNAC's accuracy for parotid gland lesions, evaluates the Milan Salivary Gland Cytopathology Reporting System (MSRSGC), and compares FNAC results with histopathological findings.
This retrospective study at our medical center analyzed data from 2321 patients who underwent parotid gland FNAC followed by surgical resection over 20 years. Patients were included if they had both cytological analysis and surgery between January 2004 and July 2024. Surgical procedures varied based on mass characteristics and FNAC results, and all samples were assessed using MSRSGC. Statistical analysis compared FNAC results with histopathology findings, calculating sensitivity, specificity, and accuracy.
This study included 352 patients who underwent both FNAC and surgical resection. FNAC had an overall accuracy of 93.9%, with a sensitivity of 78.3% and specificity of 91.5%. The risk of malignancy was 30% for Milan Category I (nondiagnostic), 6.3% for Category II (non-neoplastic), 0% for Category III (Atypia of Undetermined Significance), 2.3% for Category IVa (benign neoplasm), 5.8% for Category IVb (neoplasm of uncertain malignant potential), 58.8% for Category V (suspicious for malignancy), and 95% for Category VI (malignant). The false negative rate was 2.4%, while the false positive rate was 3.4%. The malignancy risk increased with age, and malignant masses were larger and more likely to cause facial paralysis.
FNAC is a key diagnostic tool for parotid gland masses, offering high specificity and accuracy despite some limitations. Patients with young ages and inappropriate histories should be assessed more carefully. MSRSGC is a useful system to show appropriate risk of malignancy.
腮腺肿物涵盖肿瘤性和非肿瘤性疾病，带来了诊断挑战。细针穿刺细胞学检查（FNAC）常用于区分良性和恶性病变，但存在诸如敏感性不一和潜在抽样误差等局限性。本研究评估FNAC对腮腺病变的准确性，评价米兰唾液腺细胞病理学报告系统（MSRSGC），并将FNAC结果与组织病理学结果进行比较。
我们医疗中心的这项回顾性研究分析了2321例在20年期间接受腮腺FNAC并随后进行手术切除的患者的数据。纳入2004年1月至2024年7月期间同时进行了细胞学分析和手术的患者。手术程序根据肿物特征和FNAC结果而异，所有样本均使用MSRSGC进行评估。统计分析将FNAC结果与组织病理学结果进行比较，计算敏感性、特异性和准确性。
本研究纳入了352例同时接受FNAC和手术切除的患者。FNAC的总体准确率为93.9%，敏感性为78.3%，特异性为91.5%。米兰I类（无法诊断）的恶性风险为30%，II类（非肿瘤性）为6.3%，III类（意义未明的非典型性）为0%，IVa类（良性肿瘤）为2.3%，IVb类（恶性潜能不确定的肿瘤）为5.8%，V类（怀疑恶性）为58.8%，VI类（恶性）为95%。假阴性率为2.4%，假阳性率为3.4%。恶性风险随年龄增加而升高，恶性肿物更大且更易导致面瘫。
FNAC是腮腺肿物的关键诊断工具，尽管存在一些局限性，但具有较高的特异性和准确性。年龄较小且病史不典型的患者应更仔细地评估。MSRSGC是显示适当恶性风险的有用系统。
