Diagnosis Of Salivary Gland Lesions Research Articles

The Milan system for reporting salivary gland cytopathology - Assessment of utility and the risk of malignancy.

Cytological diagnosis of salivary gland lesions furnishes several challenges to pathologists and clinicians owing to their diverse morphology and varying reporting terminology. The Milan system for reporting salivary gland cytopathology was proposed to overcome these defects. The aim of this study was to grade histopathologically diagnosed cases of salivary gland pathology using Milan system and to correlate Milan system with histopathological diagnosis. The study aims to assess the utility of the Milan system and the risk of malignancy in each category. This is a retrospective study of 4 years duration. All the cases of salivary gland pathology with fine-needle aspiration cytology findings from January 2015 to December 2018 were retrieved and classified according to the Milan system. Histopathology follow-up of these cases were reviewed from the archives, and risk of malignancy was calculated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using histopathological diagnosis as the gold standard. Cytology slides of 151 cases were reviewed, and the Milan system was applied. Histopathology follow-up was obtained in 94 cases (attrition rate = 37.74%). The percentage of cases in each category were as follows: nondiagnostic = 9.27%, nonneoplastic = 4.64%, atypia of undetermined significance = 3.97%, benign neoplasm = 23.84%, neoplasm of uncertain malignant potential = 8.61%, suspicious for malignancy = 11.92%, and malignant = 37.75%. Sensitivity, specificity, positive predictive value, and negative predictive value of the Milan system were 94.20%, 96.00%, 98.48%, and 85.71%, respectively. The Milan system has high sensitivity and specificity in comparison with histopathology. This system proves helpful to the pathologist as well as the clinician in achieving uniformity of reporting terminology by classifying salivary gland lesions into subcategories with prognostic relevance.

Importance of radio-histo-cytopathological correlation, A retrospective study of cyto-histological and radiological correlation of salivary gland lesions using Milan System for Reporting Salivary Gland Cytopathology

ABSTRACT Background: Fine-needle aspiration cytology (FNAC) for salivary gland tumors can be challenging to due to the diversity of lesions and cytomorphological convergence between the tumors. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was hence developed and introduced to provide enhanced communication in salivary gland cytopathology. To evaluate the diagnostic utility and validity of MSRSGC in combination with ancillary radiological investigations, we aim to find correlation between Milan system and the radiological impression comparing with final histopathological diagnosis. Aims and Objective: Correlate the Milan category with the radiological and final histopathological diagnosis of salivary gland lesions. Review the FNAC diagnosis of salivary gland lesions and identify cytomorphological predictors of malignancy. Correlate the FNAC and the radiological diagnosis with final diagnosis in histopathology. Material and Methods: A five year retrospective study, comprising fifty four cases of salivary gland FNAC were included in the study. Results: Majority of the cases belong to Milan VI—Malignant followed by Milan IVa—Benign and rest of cases were among other categories. The sensitivity, specificity, positive predictive value, and negative predictive value of adjuvant radiological diagnosis in differentiating benign and malignant salivary gland lesions was found to be 80%, 62.5%, 72.7%, and 71.4%, respectively. We could observe that the concurrent radiological assessment along with Milan system of reporting in salivary gland FNAC especially under suspicious categories (Milan Category IVb as well as Milan Category V) is a useful and sensitive predictor of malignancy. Conclusion: A correlation with any form of ancillary radiological assessment is a helpful adjuvant with Milan system to derive a relatable diagnosis in salivary gland neoplasm especially those in categories describing the suspicious entities.

Reliability of Fine Needle Aspiration Cytology for Salivary Gland Tumours Meta-Analytical Study

Abstract Background Fine needle aspiration (FNA) cytology is a safe, reliable, minimally invasive and cost- effective technique for the diagnosis of salivary gland lesions. Aim and objectives to assess the accuracy, sensitivity and specificity of FNAC for diagnosis of salivary gland tumors in comparison with biopsy as definite diagnostic tool for these tumors. Subjects and methods This is a Retrospective and prospective studies, was carried out on Patients diagnosed with salivary gland tumors, treated with surgical management. Result FNA was associated with statistically significant fewer nondiagnostic results, Pooled analysis of all studies (n = 3605) revealed that rate of nondiagnostic results is 2.992% with 95% CI of rate 91.10–95.09 with absence of publication bias. Conclusion Fine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2 cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results Funding Sources This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

The diagnostic accuracy of pleomorphic adenoma in fine needle aspiration: Features leading to false positive and false negative diagnoses and the utility of cell blocks.

Fine needle aspiration (FNA) is a well-established tool in preoperative diagnosis of salivary gland lesions with diagnostic accuracy of 90%. Pleomorphic adenoma (PA) is the most common salivary gland tumor comprising 45%-74% of all salivary gland tumors with FNA diagnostic accuracy of 89.5%-96.2%. The aim of the present study was to determine and analyze potential cytomorphological pitfalls and evaluate the diagnostic accuracy in FNA diagnosis of PA. Salivary gland specimens with both cytological and histological diagnoses were searched over a 10-year-period (2009-2018) from a laboratory information system of Pathology Department, Fimlab Laboratories, Tampere and matched to determine concordant and discordant PA cases. Sufficient material in histological and cytological sample was found in 401 cases. In 218 cases (54.4%) diagnosis was true-negative PA, in 169 cases (42.1%) diagnosis was true-positive PA and there were 14 discordant cases: 4 false-positive cases and 10 false-negative cases. False-negative cases were reclassified and subgrouped according to The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Cytomorphologically, cell type predominance was more often myoepithelial in true-positive cases (65%) and epithelial both in false-negative (70%, p= .007) and false-positive cases (75%, p= .027). Well-formed ducts were present in cytology in all true-positive cases (p< .001). Only 10% of true-positive cases did not show any matrix in cytology (p< .001). Nuclear changes were common in false-negative cases (80%, p= .002) and false-positive cases (75%, p= .003). Beneficial cell block (CB) was more common in true-positive cases (85%) than in false-negative cases (50%, p= .041) or in false-positive cases (50%, p= .116) and a lack of beneficial CB led more often to a false diagnosis (70% false diagnosis without beneficial CB versus 29% false diagnosis with beneficial CB). The present study showed diagnostic accuracy of 96.5% for FNA in PA diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value were 94.4%, 98.2%, 97.7%, and 95.6%, respectively. The benefit of CBs was more evident in true-positive cases (85%).

Cytological Study of Salivary Gland Lesions in Accordance with the Milan System of Reporting Salivary Gland Cytopathology

Aim: Fine needle aspiration cytology is an essential diagnostic tool for preoperative diagnosis of salivary gland lesions. Due to overlapping cytological features and heterogenecity of the lesions, a universal classification system was proposed, known as the “Milan System of Reporting Salivary Gland Cytopathology (MSRSGC). This system helps clinicians to plan further diagnosis and management according to the risk of malignancy (ROM) in different categories. Therefore, the aim was to stratify the lesions according to the system and calculate the risk of malignancy.&#x0D; Study Design: Retrospective and prospective study.&#x0D; Place and Duration of Study: Department of Pathology, Dr.D.Y.Patil Medical College, Hospital and Research Centre, Pune, between August 2016 and July 2021.&#x0D; Methodology: A five year study was conducted on 100 cases. FNAC was performed and correlation to histopathological aspects of resected and/or biopsied lesions were carried out in which tissue specimens were available. The cytological diagnosis was re-evaluated as follows: Category 1: Non‑diagnostic (ND), Category 2: Non‑neoplastic (NN), Category 3: Atypia of undetermined significance (AUS), Category 4a: Neoplasm: Benign (NB),Category 4b: Neoplasm: Salivary gland neoplasm of uncertain malignant potential (SUMP),Category 5: Suspicious of malignancy (SM) and Category 6: Malignant (M).&#x0D; Results: Total 100 cases were studied. Histopathology reassessment was available in 38 cases. Case distribution in various categories were ND (0%), NN(36%), AUS(3%), NB(54%), SUMP(1%), SM(3%) and M(3%). Overall ROM reported were 0%, 11.11%, 100%, 0%, 100%, 100% and 100% respectively for each category. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the study was 94.74%, 75%, 100%, 100% and 100% respectively.&#x0D; Conclusion: The Milan system is an universal 6-tier reporting system of lesions of salivary gland that helps with risk assessment and guides the clinicians for appropriate treatment.

Ancillary studies on cell blocks from fine needle aspiration specimens of salivary gland lesions: A multi-institutional study.

BackgroundAncillary studies are commonly performed on cell blocks prepared from fine‐needle aspiration (FNA) specimens. There are limited studies in application of ancillary studies on cell blocks from salivary gland (SG) FNAs. This multi‐institutional study evaluates the role of ancillary studies performed on cell blocks in the diagnosis of SG lesions, and their impact on clinical management.MethodThe electronic pathology archives of three large academic institutions were searched for SG FNAs with ancillary studies performed on cell blocks. The patient demographics, FNA site, cytologic diagnosis, ancillary studies, and surgical follow‐up were recorded. If needed, the cytologic diagnoses were reclassified as per the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).Results117 SG FNA cases were identified including 3, 10, 11, 6, 23, 4, and 60 cases in MSRSGC categories I, II, III, IVa, IVb, V, VI, respectively with surgical follow‐up available ranging from 27% to 100% within each category. Ancillary studies including histochemistry, immunocytochemistry (IHC), and in situ hybridization (ISH) were beneficial in 60%–100% of cases in each category. Risk of malignancy was 100% in both the suspicious for malignancy (V) and malignant (VI) categories. Ancillary studies improved diagnosis in 60% of non‐neoplastic cases (II, 6/10), 100% of benign neoplasm cases (IVa, 6/6), and 98.3% of malignant cases (VI, 59/60).ConclusionJudicious and case‐based ancillary studies performed on SG FNA cell blocks with sufficient material can improve the diagnostic yield by further characterization of the atypical/neoplastic cells, particularly in MSRSGC categories IVa‐VI.

Categorisation of Salivary Lesions According to the Novel Milan’s System of Reporting Salivary Gland Cytopathology: A Retro-prospective Study

Introduction: Fine Needle Aspiration Cytology (FNAC) is an important diagnostic tool for salivary lesions, which has decreased the number of unnecessary invasive surgeries for benign conditions. But, cytopathology of salivary lesions is complex presenting with similarity in cytological features albeit with histological heterogeneity. The novel Milan’s System for Reporting Salivary Gland Cytopathology (MSRSGC) is a six tiered classification, providing standard reporting terminology for salivary gland lesions in fine needle aspirates. Aim: To categorise the salivary lesions cytologically based on MSRSGC and to assess its utility in simplification of routine diagnosis of salivary gland lesions. Materials and Methods: A retroprospective study was conducted in a tertiary care centre over a period of five years from 2017 to 2021. All patients suspected to have salivary gland lesions were subjected to FNAC in the Department of Cytology. The cases were reported according to the MSRSGC criteria and assigned one of the categories. The statistical analysis was performed using Microsoft excel software, for calculation of descriptive statistical parameters such as measures of central tendency viz., mean, median, mode, percentage, range and ratio. Results: A sample size of 82 patients with salivary gland lesions was studied. Parotid gland was most commonly involved, among others. Most of the lesions were classified as category 4a (Neoplasm benign) (39%) and category 2 (Non neoplastic) (36.6%). Non Diagnostic (ND) constituted only 2.43% while malignancies constituted 4.9%. Ambiguous categories like Salivary gland neoplasm of Uncertain Malignant Potential (SUMP) and suspicious of malignancy constituted 13.4% and 3.6%, respectively. Conclusion: The introduction of MSRSGC has to a large extent standardised the reporting patterns, thereby assisting the clinicians to render improved patient care. The present study in comparison with other studies conducted worldwide, recommends the usage of MSRSGC for routine reporting.

English

BACKGROUND Salivary gland swelling presents with a variety of neoplastic and non-neoplastic conditions. Predicting the nature of a swelling on clinical grounds alone is rarely possible hence, further assessment with accurate imaging is a necessity. Ultrasonography is a diagnostic tool that is widely available, relatively inexpensive, non-invasive, and easily reproducible. This study was undertaken to assess the role of ultrasonography as a diagnostic aid in various salivary gland swellings. METHODS Cross sectional study was conducted for consecutive patients who came to the Radiology Department, Govt. Medical College, Thrissur, from January 2014 to January 2015. Ultrasound for clinically suspected salivary gland lesions was done. USG scanning was done by Mindray DC – 08 high resolution real time multiplanar diagnostic Ultrasound System with linear array high frequency 6 to 10 MHZ transducer having scan head of 60mm. RESULTS Out of the 67 patients who were included in the study, 34 cases were identified correctly by ultrasound examination and confirmed by clinical follow up or by histopathology. Fifteen cases were A/C sialadenitis which were confirmed clinically, 11 cases were salivary gland abscess which were confirmed clinicopathologically. Eight cases were sialolithiasis which were confirmed by histopathology. Thirtythree cases were neoplastic of which 6 were malignant and 27 were benign which were confirmed by histopathology. Of the 6 malignant lesions which were confirmed by histopathology, ultrasonography correctly identified 5 cases. All these 27 benign cases were diagnosed as benign through sonography also. However out of the 18 pleomorphic adenoma cases, 15 were correctly diagnosed by USG. Out of the 9 cases of Warthin’s tumour confirmed by histopathology, USG correctly identified 7 cases. CONCLUSIONS Ultrasonography is a valuable supplement in the diagnosis of salivary gland lesions and to distinguish neoplastic/ non-neoplastic lesion so that further management can be decided accordingly. KEY WORDS Pathology, Salivary Gland Neoplasm, Ultrasonography

Milan scoring system in the diagnosis of salivary gland lesions for assessment of risk of malignancy

Salivary gland lesions are one of the most common encounters in clinical practice for the evaluation of which Fine needle aspiration cytology is a well-established technique nowadays. Owing to the heterogenecity and morphological overlap between the various categories of these salivary gland lesions, there was a need for a standardised procedure. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardised evidence based reporting system to assess the risk of malignancy and thus helpful for the management of these lesions. We have undertaken this study for evaluation of salivary gland lesions by this newly introduced grading system for predicting the malignant potential of these lesions.: We have done a prospective study of all the salivary gland lesions received in our department for a period of 3 years from 2016 to 2019. The clinical history, aspiration cytology and histopathological examination was done for all the cases.: We have received 225 salivary gland lesions for aspiration, but histological follow up was done in only 105 lesions, which were thus included in our study. Case distribution into different categories was done in the following way:ND (5.71%), NN (38.01%), AUS (2.57%), NB (33.34%), SUMP (1.9%), SM (2.85%), and M (15%). Overall, ROM reported were 25%, 5%, 20%, 4.4%, 33.3%, 85.7%, and 97.5%, respectively for each category. Overall, sensitivity was 83.34%, specificity was 98.01%, positive predictive value was 94.87%, and negative predictive value was 91.89%. MSRSGC is a six category scheme that was recently proposed that separates the salivary gland FNAC into distinct categories, thus increasing the specificity by limiting the number of false negative and false positive cases.

Fine-Needle Aspiration Cytology: A Reliable Tool in the Diagnosis of Salivary Gland Lesions.

Salivary gland lesions comprise for about 2-6.5% of all head and neck neoplasms in adults. They are accessible for FNAC (Fine Needle Aspiration Cytology). The risk of fistula formation and/or tumour implantation are low compared to surgical biopsy. FNAC can also provide a distinction between asalivary and non-salivary lesion, benign and malignant lesions. 67 patients were studied prospectively over 5years. FNAC was performed pre-operatively and histopathological examination post-operatively in patients who underwent surgery and were willing to participate in the study. 59.7% of the lesions were non-neoplastic and 58.2% were neoplastic (37.3% benign and 20.8% malignant). Pleomorphic adenoma was the most common benign neoplasm while mucoepidermoidand adenoid cystic carcinoma both were the most frequent malignant lesion. Among the non-neoplastic lesions, the most number of cases were of chronic sialadentis. In our study, FNAC has a sensitivity of 94.54% specificity of 80.95% for neoplastic lesions. It was seen that FNAC was a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.

“ROLE OF FNAC IN THE DIAGNOSIS OF SALIVARY GLAND LESION”

Background: Fine needle aspiration cytology (FNAC) has been used for diagnosis of salivary gland lesions for many years. Various studies in the existing literature have shown a wide range of sensitivity and diagnostic accuracy of cytologic diagnosis. FNAC is a safe, simple, cost effective, 1-4 accurate and minimal invasive procedure for the evaluation of salivary gland lesions. FNAC is not only useful in planning denitive preoperative 2,5-6 diagnosis but also can prevent unnecessary surgical intervention. Salivary gland swelling occur more commonly in 3rd decade of life with equal sex incidence. Parotid is one of the most commonly involved glands in the head &amp; neck region swellings. FNAC appears to be highly sensitive for benign tumours and highly specic for malignant tumors and it should be the rst line of investigation in evaluating the salivary gland pathologies. 7 Early diagnosis and appropriate management carries good prognosis. Methods: Patients with suspected salivary gland enlargements, referred for FNAC, were included in this study. FNAC was performed by using the standard procedure. Cytologic diagnosis was compared with histopathologic diagnosis wherever it was available. Results: In the present study conducted in the department of pathology, Shyam Shah Medical College Rewa MP, over a period of 5 years, 152 Patients with suspected salivary gland enlargements were retrospectively appraised. The benign lesions of salivary gland were 133 (87.5%), out of which Pleomorphic adenoma was diagnosed in 75 (56.39%) cases, clinical correlation was found in 58 (77.33%) cases. 29 cases were subsequently correlated with histopathological examination 26 correctly correlated and the diagnostic accuracy of FNAC was found to be 89.65%. Inammatory lesions were proved correct in 08 out of 10 cases after histopathology. Therefore, accuracy of FNAC was 80.0%. Malignant lesions of salivary gland were found in 19 cases, out of which 15 (78.94%) cases correlated with clinical diagnosis. 13 cases were subjected to histopathology 10 correctly correlated and the diagnostic accuracy of FNAC was found to be 76.92%. Overall diagnostic accuracy of FNAC was 84.61%. Conclusion:In conclusions it can be established that FNAC is an efcient and accurate procedure with high sensitivity index, and its usefulness is enhanced due to it being a relatively easy procedure which can be carried out even on outdoor patients.

Correlation Between Fine Needle Aspiration Cytology (FNAC) and Permanent Histopathology Results in Salivary Gland Masses

ObjectiveFine-needle aspiration cytology (FNAC) has been widely accepted as a diagnostic safe method for preoperative assessment of salivary gland lesions. This diagnostic tool is inexpensive, easy to perform, relatively painless and it provides useful information to differentiate between benign and malignant salivary gland tumors that helps in the management and surgical planning. This study was undertaken to compare FNAC results with permanent histopathological findings of salivary gland tumors in order to assess its diagnostic accuracy.Materials and methodsA total of 37 archived salivary gland FNAC specimens collected between January 2001 and January 2018 were correlated with proven histopathology findings. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated. False negative and false positive cases were determined.ResultsThere were 20 female and 17 male patients. Parotid tumors count for 62.2% and submandibular tumors 37.8%. All cases of malignancy on FNAC were proven to be malignant on the final pathology findings. All cases that were suspicious for malignancy on FNAC were proven to be malignant as well. In addition, three false negative cases were seen and no false positive cases among all FNAC cases. In our series, the overall sensitivity and specificity were 90.3% and 100%, respectively. The positive and negative predictive values were 100% and 57.1%, respectively. The diagnostic accuracy was 91.4%.ConclusionThis study demonstrated that FNA cytology of the salivary gland is a useful technique for diagnosis of salivary gland lesions. Insufficient cellularity was the most important factor that resulted in incorrect cytological interpretation.

Rare submandibular gland metastasis of hepatocellular carcinoma: case report and review of the literature

Hepatocellular carcinoma (HCC), the most common primary hepatic tumor, metastasizes in more than 50% of cases. However, metastasis of HCC to the submandibular glands is very rare. HCC rarely metastasizes to the salivary glands; only six cases of metastasis to the parotid gland have been reported in the English-language literature. Moreover, only one case of metastasis of HCC to the submandibular glands has been reported to date, and the affected patient died of hepatic failure. This clinical report describes a 55-year-old man who had undergone two surgeries for liver cancer and subsequently presented with a 2-week history of a right submandibular mass. We performed dissection of the right submandibular triangle, and metastatic HCC of the submandibular gland was diagnosed. Although HCC metastases to the oral cavity have been reported, this is only the second case of HCC metastasis to the submandibular gland. Fine-needle aspiration biopsy is recognized as a simple, direct approach for morphologic diagnosis of salivary gland lesions; however, histological and immunohistochemical examination of the surgical specimen remains necessary.

Remote cytological diagnosis of salivary gland lesions by means of precaptured videos

The objective of this study was to investigate the feasibility of implementing videos captured by static telecytological applications for remote cytological diagnosis of fine needle aspiration (FNA) specimens from salivary gland lesions. The current study was performed on 102 specimens from patients referred to the Alpha Prolipsis Cytopathology Department for preoperative evaluation of salivary gland lesions. In all cases, surgical excision followed the initial cytological diagnosis. (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23). Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of precaptured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71-0.89. Videos production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary glands FNAs. Videos of salivary glands FNAs can be used for accurate diagnosis, educational and second opinion purposes,. They can also be used for archiving, teleconsultation and educational purposes, improving the performance of the already existing static telecytology stations and small cytology departments' quality indices.

Histopathological Review of Diagnostic Categories of the Milan System for Reporting Salivary Gland Cytopathology - An Institutional Experience of 6 Years.

Introduction:Salivary gland malignancies account for 2 to 4% of head and neck cancers. Fine needle aspiration cytology (FNAC) is used in preoperative diagnosis of salivary gland lesions. Although FNAC is a highly reliable technique for preoperative diagnosis, there were no consensus on salivary gland cytopathology reporting. Recently, an international group has recommended a classification system for salivary gland FNAC reporting titled “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC). In this study, we aimed to evaluate the usability of the Milan System, its ability to determine the risk of malignancy for each category, with comparisons of inital cytologic and final histopathological diagnosis.Materials and Methods:We performed a retrospective analysis of salivary gland lesion FNAC in our department from 2013 to 2019. A total of 578 FNACs were performed in 514 patients. Of these, 85 cases had surgical follow-up (parotid gland, n = 73, submandibular gland, n = 12). The cytological samples were categorized according to the MSRSGC into six categories by two pathologists. The risk of malignancy (ROM) and diagnostic accuracy values were calculated for each diagnostic categories.Results:A total of 85 aspirates of the patients with follow-up, the MSRSGC diagnostic categories were as follows: non-diagnostic in 7 aspirates (8.2%), non-neoplastic in 3 (3.5%), atypia of undetermined significance (AUS) in 9 (10.5%), benign neoplasm in 43 (50.5%), salivary gland neoplasm of undetermined malignant potential in 7 (8.2%), suspicious for malignancy in 10 (11.7%), and malignant in 6 (7%). The ROM for each category was 28, 5%, 0%, 33%, 0%, 28.5%, 90%, and 100%, respectively.Conclusion:FNAC plays a critical role in the evaluation of patients with salivary gland lesions. The MSRSGC helps in the standardization of the process of diagnosis and clinical management of salivary gland lesions, especially of AUS and SUMP categories that are indeterminate categories in nature.

A comparative study to assess diagnostic efficacy of fine needle aspiration cytology versus histopathology in diagnosis of salivary gland lesions

A comparative study to assess diagnostic efficacy of fine needle aspiration cytology versus histopathology in diagnosis of salivary gland lesions

Cytohistological correlation of salivary gland tumours with emphasis on Milan system for reporting: A novel step towards internal quality assurance

Fine needle aspiration cytology (FNAC) is a cost-effective diagnostic technique for evaluation of salivary gland lesions. But, then, cytological evaluation of salivary gland lesions also has lot of challenges. To overcome the difficulties, “The Milan system for reporting salivary gland cytopathology” (MSRSGC) was introduced for diagnosis and management and establishing the risk of malignancy (ROM) in different categories. The present study was conducted to grade the salivary gland lesions according to Milan system of reporting and to correlate with their histopathological findings. The current study was conducted in the department of Pathology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry for a period of 5 years. Around 153 salivary gland lesions were aspirated. Salivary gland swellings were examined clinically, correlated with the details on the request forms and ultrasound findings, palpated and aspirated. The cytological features were evaluated and categorized according to Milan System for Reporting Salivary Gland Cytopathology”: Category 1: Nondiagnostic (ND); Category 2: Non-neoplastic (NN); Category 3: Atypia of undetermined significance (AUS); Category 4a: Neoplasm: benign (NB), Category 4b: Neoplasm: salivary gland neoplasm of uncertain malignant potential (SUMP); Category 5: suspicious of malignancy (SM); and Category 6: Malignant (M). They were further correlated with histopathological findings. All data were entered in MS excel sheet.Total 153 cases were evaluated cytologically, and histological followup was available in 134 cases. The distribution of cases into different categories were as follows Non-Diagnsotic (2.6%), Non-Neoplastic (20.9%), Atypia of Undetermined Significance (1.9%), Neoplastic-Benign (41.1%),Salivary gland neoplasm of Uncertain Malignant Potential (0%), Suspicious of Maligancy (0%) and Malignancy (33.3 %). Risk of malignancy were observed in categories 2 and 6 and were 3.84 % and 78.2 %. Sensitivity of FNAC in diagnosing salivary gland lesions was 84.2 %, specificity was 98.21%,positive predictive value was 94.64%, and negative predictive value was 91.70% with an accuracy of 93.60%.MSRSGC is a novel reporting system in cytological diagnosis of salivary gland lesions. Implementation of this reporting system in cytological diagnosis has enabled establishment of adequate diagnosis, assessment of risk stratification and facilitating clinicians to take further step in management plan.

Fine-needle aspiration cytology in the diagnosis of salivary gland lesions. The role of the Milan system for reporting cytopathology

BackgroundFine needle aspiration cytology (FNAC) is an established technique in the management of salivary gland lesions. The Milan System for reporting salivary gland cytopathology (MSRSGC) intents to standardize diagnostic categories. Current studies are trying to evaluate the diagnostic approach of this system. MethodsFNAC of salivary gland lesions were retrieved over an 11-year period. 185 FNAC specimens from 182 patients were reviewed blindly and classified according to the criteria established by the MSRSGC. 136 (74.7%) patients had follow-up of their processes. ResultsThe total number of diagnostic categories and risk of malignancy (ROM) in 185 specimens were the following: non-diagnostic 39 (21.1%; ROM 12%), non-neoplastic 35 (18.9%; ROM 0%), atypia of undetermined significance (AUS) 17 (9.2%; ROM 46.1%), benign neoplasm 75 (40.5%; ROM 4.9%), salivary gland neoplasm of uncertain malignant potential 4 (2.2%; ROM 100%), suspicious for malignancy 7 (3.8%; ROM 100%), malignant 8 (4.3%; ROM 100%). No false positives were observed in groups IVb, V, and VI in this series. The overall sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy were 88%, 91.8%, 96.3%, 76.7%, and 91% respectively. ConclusionThe ROM reported in our study was in keeping with ROM published by the MSRSGC. This system provides standardized information for risk stratification. The category AUS encompassed cases causing uncertainty representing a challenge in management. Defining criteria for AUS category need to be refined. The system facilitates communication between pathologists and clinicians favoring improvement in patient care.

English

BACKGROUND Salivary gland swellings are one of the common presenting symptoms in the outpatient department. These swellings are referred to the pathology department for determining the exact nature of the lesion to reach a diagnosis. Fine needle aspiration (FNA) of the salivary gland and diagnosis of the disease represents one of the most challenging areas in cytopathology. FNAC is widely used for preoperative diagnosis of many swellings and masses, including salivary gland lesions. It is a cost-effective, safe and straightforward procedure that provides valuable information for planning appropriate management. The present study aims to evaluate the efficacy and cytological spectrum of FNA of salivary gland lesions done over a fixed period in Government Medical College / Government General Hospital, Anantapuramu. METHODS This cross-sectional study was conducted in the Department of Pathology of Government Medical College / Government General Hospital, Anantapuramu, during the period January 2017 to December 2019. Patients with suspected salivary gland enlargements, who were referred for FNAC, were included in this study. FNAs of 80 patients were studied in the present study. FNAC was performed by using a 10 mL syringe with a 23 g needle. Smears were stained by using the H &amp; E stain (Haematoxylin and Eosin). The data collected was entered into an Excel sheet and analysed. Chi-square and p-value were calculated using Open Epi software. RESULTS Cytology slides prepared were studied, interpreted, and the diagnosis made was analysed. Out of the 80 FNAC salivary gland lesions, 44 were non-neoplastic lesions, and 36 were neoplastic lesions. Of the non-neoplastic lesions, chronic sialadenitis was predominant (30), and among the neoplastic lesions, pleomorphic adenoma cases were dominant, accounting for 30 cases. In our study, the most common major salivary gland involved was the parotid gland. CONCLUSIONS FNAC of the salivary gland lesion is a simple, safe, rapid, cost-effective, convenient, harmless, well-tolerated procedure by patients, and it remains an accurate method for the diagnosis of salivary gland lesion for pathologists and physicians. Our study reflected a varied spectrum of lesions in patients referred for FNAC for the diagnosis of swellings of salivary glands. KEYWORDS FNAC, Cytology, Salivary Gland, Parotid, Pleomorphic Adenoma

MYOEPITHELIOMA VS ADENOID CYSTIC CARCINOMA OF PALATE: CHALLENGES IN DIFFERENTIAL DIAGNOSIS

A 46-year-old male melanoderm patient presented hard palate swelling with 4-year history, pain, and sporadic bleeding, with a previous diagnosis of tubular epithelial neoplasia compatible with epithelioid myoepithelioma after immunohistochemical study. The patient was submitted to total surgical excision with margins. Histopathologic and immunohistochemical analysis of the removed lesion revealed an adenoid cystic carcinoma. Because of pT1 staging with no perineural and no angiolymphatic invasion, adjuvant treatment was not proposed. There are no signs of relapse after 5-month follow-up by the multidisciplinary medical/dental team. Diagnosis of salivary gland lesions is complex because of the various similarities between the various subtypes of neoplasms, including benign and malignant tumors. The divergence between incisional biopsy and postoperative diagnosis shows the clinical challenge for surgeons and pathologists. A 46-year-old male melanoderm patient presented hard palate swelling with 4-year history, pain, and sporadic bleeding, with a previous diagnosis of tubular epithelial neoplasia compatible with epithelioid myoepithelioma after immunohistochemical study. The patient was submitted to total surgical excision with margins. Histopathologic and immunohistochemical analysis of the removed lesion revealed an adenoid cystic carcinoma. Because of pT1 staging with no perineural and no angiolymphatic invasion, adjuvant treatment was not proposed. There are no signs of relapse after 5-month follow-up by the multidisciplinary medical/dental team. Diagnosis of salivary gland lesions is complex because of the various similarities between the various subtypes of neoplasms, including benign and malignant tumors. The divergence between incisional biopsy and postoperative diagnosis shows the clinical challenge for surgeons and pathologists.