Salivary Gland Aspirates Research Articles

Application of the Milan system for reporting salivary gland cytopathology to core needle biopsies of the parotid gland.

The Milan system for reporting salivary gland cytopathology was developed by an international group of experts and first published in 2018 with the goal to standardise reporting of salivary gland aspirates. Seven categories with distinct risks of malignancy were proposed. Core needle biopsies (CNB) of salivary glands are also common, but reporting lacks standardisation. Here we explore the feasibility of a Milan-like reporting system on CNB of the parotid gland. Our laboratory information system was searched for parotid gland CNBs from 2010 to 2021. Reports were translated into a Milan-like reporting system. When available, CNB findings were correlated with cytology and resection specimens. In order to compare the performance of CNB with fine-needle aspirations (FNA), we established a second cohort of cases consisting of parotid FNA with surgical follow-up. The risk of neoplasia (RON) and risk of malignancy (ROM) was calculated for FNA and CNB Milan categories using cases with follow-up resection. We analysed 100 cases of parotid gland CNB. Of these cases, 32 underwent subsequent resection, while 52 had concurrent FNA. A total of 20 cases had concurrent FNA and underwent follow-up resection. In 63 (63%) cases, a specific diagnosis was provided on CNB, with 18 cases undergoing follow-up resection having an accuracy rate of 94%. This study confirms the feasible of using a Milan-like system in the setting of parotid gland CNB with differentiation in RON and ROM. CNB allows assessment of architectural features that may allow more specific diagnoses in some cases.

Application of the Milan System for Reporting Salivary Gland Cytology and Risk Stratification by Cytohistological Correlation

Introduction: Salivary gland neoplasms are uncommon tumors comprising <3%–10% of all head-and-neck neoplasms. Recent WHO classification of salivary gland tumor added many newer entities; however, no definite risk-stratification system is specified to predict the likelihood of malignancy for each diagnostic category. The present study is designed to evaluate the salivary gland aspirates using the Milan System for Reporting Salivary Gland Cytology for reporting correlating with histological diagnosis which will lead to determine the malignancy risk for each diagnostic category. Risk of malignancy is calculated by the ratio of cytopathology cases with a malignant histopathology to the total number of cytopathology cases with follow-up histopathology for that particular category. Materials and Methods: The present study was a cross-sectional study done prospectively over a period of 2 years, and a total of 72 participants were selected. This study characterized the cytological features of spectrum of salivary gland lesions varying from benign to malignant. The lesions were evaluated and classified cytologically according to “the Milan System for Reporting Salivary Gland Cytopathology” for reporting salivary gland neoplasms. Histopathological correlation was done with cytological diagnosis wherever possible. Results: In our study of 72 patients with salivary gland lesions with the mean age of the patient being 50.6 years and maximum number of lesions involved the parotid gland followed by the submandibular gland and sublingual gland. Majority of the lesions in the present study were nonneoplastic in nature followed by lesions benign in nature. Malignant lesions were least common in occurrence. Among 72 cases, majority of the cases were seen in Milan category II (nonneoplastic) consisting of 34 cases (47.2%), followed by 31 cases (43.1%) in Milan category IV (benign). Final diagnostic categorization of 72 cases of salivary gland lesions was done according to the Milan system and the histopathological correlation was available in 23 of these cases. Out of the 34 cases in Milan system category II (nonneoplastic), histopathological evaluation was done in 2 cases. Both the cases were benign in nature, 31 cases in Milan system category IV (benign) histopathological evaluation was done in 16 cases where 15 cases were benign in nature and 1 lesion was malignant. Four cases were put in category VI of the Milan system, histopathological evaluation was done in all the 4 cases which were all malignant in nature. Conclusion: The current study validates fine-needle aspiration cytology as a cost-effective and noninvasive procedure for differentiating between benign and malignant lesions of the salivary gland, information of critical importance when determining the patient's next course of treatment.

Effectiveness of Milan Classification in Salivary Gland Aspirations.

To determine the effectiveness of Milan system for the evaluation of aspiration cytology to salivary gland lesions classification. Cross-sectional observational study. Department of Pathology, Tertier Centre, University of Health Sciences, Adana City Education and Research Hospital, Adana, Turkey from January 2014 to December 2020. Salivary gland aspiration cytology of the last six years was recategorised, according to Milan classification. Risk of malignancy (ROM) and risk of neoplasm (RON) were determined among the subgroups in the cytological materials of 233 patients, who had undergone excisional biopsy. Forty hundred and eighty salivary gland aspiration cytologies were available, in which 250 (52.1%) cases were males and 230 (47.1%) were females. The mean age was 52.36 ± 16.05 years. When aspiration cytology of 233 patients with resection were evaluated, according to Milan classification, ROM in non-diagnostic category was 9.5%, ROM in non-neoplastic category was 19.2%, and ROM in neoplasm-benign category was 8.2%. ROM were found 100% in the suspected malignancy and malignancy categories. There were no patients in the atypia category of undeterminate significance. In aspiration cytology of salivary gland lesions, Milan system provides useful information in classifying patients for clinical follow-up and treatment. However, it can be said that it is difficult to distinguish between the atypia of uncertain significance and neoplasm categories. Key Words: Salivary glands, Biopsy, Fine-needle, Milan classification.

Reclassification of Salivary Gland Aspirates Based on "The Milan System for Reporting Salivary Gland Cytology": A Five-Year Retrospective Study.

Introduction:The Milan System for reporting salivary gland cytopathology helps standardize reporting systems across institutions, improve communication between clinicians and pathologists and guide the clinical management of patients.Aims:This study was undertaken to evaluate the utility of the Milan system classification in cytology reporting.Settings and Design:The present study is a retrospective study conducted over a period of five years in tertiary care centre.Methods and Materials:All the cases of salivary gland aspirates were reviewed and reclassified into six diagnostic categories according to the Milan system of reporting salivary gland cytology (MSRSGC). Cytological diagnosis was correlated with the histopathological diagnosis wherever available.Results:A total of 258 cases were classified using the Milan system as non-diagnostic (20.9%), non-neoplastic (26.3%), atypia of undetermined significance (4.7%), neoplasm benign (37.5%), neoplasm of uncertain malignant potential (3.5%), suspicious for malignancy (0.4%), and malignancy (6.6%). Cytohistological discordance was noted among 8/76 cases (10.5%). The sensitivity and specificity of FNAC were 75% and 98.5%, respectively. The risk of malignancy was 14.2% for Category I, 9% for II, 50% for III, zero for IVA and IVB, and 83.3% for category VI.Conclusions:The new classification system helps pathologists to standardize reporting leading to better clinical and surgical management.

Utility of the Milan system for reporting salivary gland cytopathology during rapid on-site evaluation (ROSE) of salivary gland aspirates.

Rapid on-site evaluation (ROSE) is a fine needle aspiration (FNA) technique for ensuring sampling adequacy and triaging samples. The Milan system for reporting salivary gland cytopathology (MSRSGC) is a standardised reporting system which aims to improve risk stratification. There is scant literature on the diagnostic value and agreement of MSRSGC on ROSE with final cytological diagnosis in salivary gland FNAs. We aimed to assess the concordance of MSRSCG categorisation and diagnosis on ROSE with final cytological and histological diagnosis. This prospective study included consecutive salivary gland FNAs for which ROSE was performed over a six-month period. MSRSGC category and diagnosis on ROSE were compared with the final cytological diagnosis and MSRSGC category, and histopathological diagnosis, where available. Sixty salivary gland aspirates were included. The adequacy rate with ROSE was 100%. Using the MSRSGC classification during ROSE, 26 (43.2%) samples were categorised as benign neoplasm, 21 (35%) as malignant neoplasm, 9 (15%) as non-neoplastic, and one each (1.7%) belonged to the remaining four categories. MSRSGC categorisation on ROSE concurred with final the cytological diagnosis in 58/60 cases (96.7%). Discrepancies in MSRSGC categories on ROSE included one atypia of undetermined significance with final report as non-neoplastic, and one non-diagnostic as suspicious for malignancy. Good correlation of MSRSGC categories on ROSE with final histopathological diagnosis (88.9% concordance) was also noted. MSRSGC on ROSE shows good concordance with final cytology and histopathology diagnosis, indicating that categorisation according to MSRSGC has utility in ensuring that adequate material is obtained and triaged appropriately for the diagnosis of salivary gland aspirates.

Oncocytic Salivary Gland Tumours: Cytological Features and Diagnostic Pitfalls.

Oncocytes are epithelial cells having abundant eosinophilic cytoplasm. The presence of oncocytes in salivary glands pose a diagnostic challenge since they can be present in lesions ranging from non-neoplastic, benign to malignant. FNAC is a simple procedure which can aid in the pre-operative diagnosis of these lesions.This study is aneightyearretrospective study in which salivary gland aspiration cytology cases havingoncocyticcells and with available corresponding histopathology were included. These slides were reviewed for features like cellularity, presence ofoncocyticcells, glandular elements,squamoidcells, nuclear atypia, mitosis, lymphoid tissue, necrosis.Twenty cases were included in the study. The mean age of presentation was 60years showing male preponderance with parotid gland being the most common site of involvement. Concordant diagnosis on cytology and histopathology was seen in 16 cases and discordance was seen in 4 cases. All the discordant cases were reported as benign on cytology but on histopathology they were labelled as acinic cell carcinoma, squamous cell carcinoma, mucoepidermoid carcinoma and anintraparotidlymph node respectively. Review of discordant cases showed subtle findings like ill-formed acini, cytoplasmic vacuolation, goblet cells and dysplastic foci raising suspicion of a different diagnosis. The potential areas of pitfall and cause of discrepancy have been discussed in this study. It is crucial to be aware of the spectrum of lesions in which oncocytes are seen, to enable an accurate diagnosis on cytology. Careful evaluation of smears for subtle clues canminimizeerrors.

Application of Milan System for Reporting Salivary Gland Cytopathology: A 7 Year Study

Introduction: Salivary gland shows various pathological conditions ranging from cystic, inflammatory, tumor like and neoplastic lesions. Fine needle aspiration cytology (FNAC) plays an important role in evaluating salivary gland (SG) tumors. Salivary gland tumors are one of the most heterogeneous groups of neoplasms with cytopathological features overlapping among the entities and making it difficult to assign to specific category. Due to these facts, salivary gland cytopathology is one of the most challenging areas of cytology. The lack of a uniform reported guidelines in salivary gland cytopathology leads to inter-observer variability and disagreements. The present study was undertaken to assess the degree of inter-observer reproducibility for diagnostic categorization of salivary gland lesions utilizing MSRSGC among pathologists with varying experience along with its role in providing a framework for reporting salivary gland lesions. Materials and Methods: In this cross sectional study, total of 44 cases of salivary gland lesions subjected to FNAC over a period of 7 year were studied. The cases were critically reviewed by 2 pathologists and a pathology resident with variable experience in cytopathology using MSRSGC in our institution. Inter-observer variability was assessed by comparing the agreement between two cytopathologists and pathology resident by using Cohen’s kappa statistics (Io score) and interpretation of the results was done using scale of Landis and Koch. Results: All the salivary gland aspirates were categorized according to MSRSGC.Out of 44 cases, maximum cases 22 (50%) were classified under IVA (BN) followed by 27.27% to 29.5% cases classified under II (NN), 2.27-4.55% of cases under Category IVB (SUMP), 4.55% under category V( SM) and 6.82% cases under category VI ( M). Inter-observer variability (IOV) was calculated for individual category in Milan system using Cohens kappa test, which was found to be in the almost perfect agreement range as per Landis and Koch, for categories II, IVA, V, VI ( Io score 0.89- 1). Kappa score ranged from 0.645 - 1 for category I (ND), which showed substantial to an almost perfect agreement. Whereas, category IVB (SUMP) showed variable results, with substantial agreement (Io score 0.656) to no agreement (Io score 0) between different observers.The overall IOV showed an almost perfect agreement with a kappa score of 0.861(obs1 vs 2) ,0.896 (obs1 vs R), 0.965 (obs 2 vs R). The data was found to be statistically significant (p=< .0001). Conclusion: MSRSGC is a very efficient system and has the potential to standardize salivary gland FNA diagnoses, providing clear prognostic and management information to clinicians and surgeons. This system can be used with good reproducibility between observers with variable cytopathology experience. Placing lesions in categories using MSRSGC can result in optimal management of discordant cases without using a specific diagnosis. Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC.Hence we recommend the use of Milan system for reporting salivary gland cytopathology.

Fine needle aspiration of salivary gland carcinomas with high-grade transformation: A multi-institutional study of 22 cases and review of the literature.

High-grade transformation (HGT) is a rare process whereby conventional low- to intermediate-grade salivary gland carcinomas (SGC) transform into high-grade, poorly or undifferentiated malignancies with focal or complete loss of their conventional histomorphologic features. Because tumors with HGT are associated with a worse prognosis than their conventional counterparts, preoperative recognition of HGT may be of benefit for optimal patient management. Using a multi-institutional approach, we describe the largest fine needle aspiration (FNA) cohort of salivary gland carcinomas with HGT. The archives of 9 large academic medical centers were searched, and 22 cases of SGC with HGT were identified by surgical excision accompanied by preoperative FNA. Clinical and cytomorphologic features were retrospectively reviewed. The male-to-female ratio was 14:8, and the mean patient age was 60.2 years. The average tumor size was 3.6 cm, and 19 cases were from the parotid gland. Acinic cell carcinoma with HGT was the most common tumor subtype, comprising 12 cases with HGT, followed by adenoid cystic carcinoma, secretory carcinoma, and other subtypes. Eighteen cases were classified as malignant; however, a specific diagnosis of HGT was not made. Sixteen cases contained a high-grade cytologic component, and 7 cases had a mixture of both conventional and high-grade components retrospectively. SGC with HGT should be considered in the differential diagnosis of a salivary gland aspirate exhibiting high-grade cytomorphologic features. The presence of distinct tumor populations, conventional and high-grade, should prompt consideration of HGT, especially when the conventional component is acinic cell carcinoma or adenoid cystic carcinoma.

Moving toward a systematic approach for reporting salivary gland cytopathology: cytohistological correlation with the application of the Milan system for risk stratification at a tertiary care center.

Fine-needle aspiration cytology (FNAC) of salivary glands is a well-established technique that plays a critical role in the preoperative diagnosis of lesions. Despite its clinical utility, it remains one of the most challenging areas in cytopathology. This is because there is no consensus on how to report salivary gland cytopathology, which has resulted in inconsistent terminology and confusion in communication among cytopathologists and clinicians. A risk stratification of FNA diagnostic categories has been recently proposed to be useful in reporting. A retrospective study of FNAC of salivary gland lesions reported from 2014 to 2017 was performed. The performance of the cytology reporting system was evaluated with histological diagnosis serving as the gold standard. The aspirates were then categorized according to the Milan system. Furthermore, the risk of malignancy was calculated for all diagnostic categories. A total of 899 salivary gland aspirates were evaluated: 2.2% were nondiagnostic, 55.8% indicated nonneoplastic lesions, and 40.4% indicated neoplastic lesions. Histopathology was available for 172 cases. FNA had a sensitivity of 72.3% and a specificity of 92.6% with an overall diagnostic accuracy of 91.4% for differentiating malignant from benign tumors. A tiered classification scheme as proposed by the Milan system may prove helpful in effectively guiding clinical management of patients with salivary gland lesions. Our experience with this system helps to pave the way for the adoption of the Milan System for Reporting Salivary Gland Cytopathology.

Practical implication of risk based categorization of salivary gland lesions on FNAC by Milan system: A two year retrospective study

Milan system was introduced in 2018 with an objective to standardize and bring uniformity in the reporting of salivary gland lesion on fine needle aspiration. The present study is conducted retrospectively over a period of two years to reclassify salivary gland lesions according to Milan system and to calculate risk of malignancy in each category. Out of total 106 salivary gland aspiration cases, histologic follow up was available for 57 cases. On re-categorizing these lesions, maximum cases belong to neoplastic benign category. Risk of malignancy in each category were-non diagnostic (0%), non-neoplastic (25%), atypia of undetermined significance AUS (33.3%), neoplastic benign (5.3%), suspicious for malignancy (75%) and malignant (100%). Three false negative and one false positive case was identified in the study. In conclusion, Milan system is very helpful in providing a uniform reporting system for salivary gland lesions, enhancing diagnostic accuracy and providing valuable impact on their management.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Lesions of Oral Cavity and Salivary Glands: A Clinico-Pathological Study.

Objective:Fine Needle Aspiration Cytology (FNAC) is a rapid, reliable and safe diagnostic tool used for various lesions of the oral cavity and salivary glands. The present study was undertaken to categorize the cytomorphology of the oral cavity and salivary gland lesions on FNAC and to assess the accuracy of FNAC in arriving at a diagnosis.Materials and Methods:A prospective study on oral cavity swellings and salivary gland aspirates was done during a 2 year period from August 2015 to July 2017 in which a total of 70 FNAC’s were performed. There were 12 aspirates obtained from oral cavity swellings and 58 aspirates were obtained from salivary glands. Histopathological evaluation of 65 lesions was done and was considered as gold standard. Only the lesions undergoing histopathological confirmation were included in the study. The sensitivity, specificity, diagnostic accuracy and clinical utility index were evaluated for accuracy of FNAC.Results:Hard palate (33.33%) was the predominantly aspirated site in the oral cavity. Parotid gland was the predominant gland aspirated (60.32%) among the involved salivary glands. Non-neoplastic lesions constituted 18.47% cases whereas neoplastic lesions were 81.53% (60.00% benign and 21.53% malignant). Pleomorphic adenoma (28.65%) was the most common benign lesion in the oral cavity involving hard palate and as salivary gland neoplasm (70.54%). Squamous cell carcinoma (60%) was the most common malignant lesion of oral cavity involving the tongue and buccal mucosa and adenoid cystic carcinoma (44.45%) was the commonest malignancy in salivary gland malignant neoplasms. The overall sensitivity, specificity and accuracy of FNAC in the present study were 89.5%, 100% and 85% respectively.Conclusion:FNAC is a safe, cost-effective and reliable technique effective in diagnosing the spectrum of different lesions in the oral and maxillofacial region.

A pattern‐based risk‐stratification scheme for salivary gland cytology: A multi‐institutional, interobserver variability study to determine applicability

Salivary gland aspiration cytology is useful in the preoperative management of patients but remains challenging, because of the extensive morphologic overlap of some tumors limits the ability to always determine the presence of malignancy. In response to this challenge, there has been increasing drive to develop a risk-based categorization scheme for salivary gland aspirates. Herein, the authors examine the interobserver variability of 1 such pattern and risk-based system. Select smears and cell-block sections of 50 salivary gland aspirates from 2 large academic centers were digitally imaged. These scanned slides were independently and blindly reviewed by 4 cytopathologists, and each aspirate was assigned to 1 of the proposed pattern-based categories if it was considered neoplastic by the observer. Interobserver agreement was scored and aggregated risks of malignancy were calculated for cases with available surgical follow-up. In total, 42 samples (84%) were considered neoplastic by at least 2 observers and were scored for interobserver agreement: 10 of 42 (23.8%) had uniform agreement, 14 of 42 (33.3%) had majority agreement, and 5 of 42 (11.9%) had divided agreement. Only 9 of 42 samples (21.4%) had minimal agreement, and 4 of 42 (9.5%) had no agreement. Condensation of similar categories was able to improve interobserver agreement and still maintain stratified risk of malignancy. The proposed pattern-based risk-stratification scheme, which could be implemented with the forthcoming Milan System, has good overall interobserver agreement and successfully stratifies the risk of malignancy. Some simplification is possible to make the system easier to use and improve interobserver agreement while maintaining stratification of risk. Cancer Cytopathol 2017;125:776-85. © 2017 American Cancer Society.

Squamous cells and keratin pearls in fine-needle aspiration and frozen section: A pitfall in the diagnosis of ameloblastic carcinoma

Intraosseous involvement of jaw bones are commonly seen with squamous cell carcinoma (SCC) of the oral cavity. Ameloblastic carcinoma (AC) is a rare malignant odontogenic neoplasm that tends to occur in mandible with or without intraosseous involvement. We present one such rare case of, 60-year-old female with gray white growth in the left lower buccal cavity with enlarged lymph nodes. The computed tomography scan showed a mass from the left submandibular salivary gland and fine-needle aspiration was suggestive of malignant salivary gland tumor. The patient was posted for frozen section and mandibulectomy. Frozen section showed squamous cells with keratin pearl formation suggestive of metastatic SCC. The routine histopathology proved it as AC with keratin pearl formation. With this case, we would like to highlight the pitfalls, difficulties, and importance in the diagnosis of AC.

Salivary gland tumor fine-needle aspiration cytology: a proposal for a risk stratification classification.

Fine-needle aspiration (FNA) is useful in the evaluation of salivary gland tumors, but currently no standard terminology or risk stratification model exists. FNA smears were reviewed and categorized based on cytonuclear features, stromal characteristics, and background characteristics. Risk of malignancy was calculated for each category. Classifications as benign, neoplasm of uncertain malignant potential (NUMP), suspicious for malignancy, and positive for malignancy were used to aggregate categories into similar risk groups. Categorization of salivary gland aspirates into morphologic categories resulted in the expected risk stratification. Grouping of categories maintained risk stratification, providing classes with malignancy risk as follows: benign, 2%; NUMP, 18%; suspicious for malignancy, 76%; and positive for malignancy, 100%. Salivary gland FNA categorization into commonly encountered morphologic categories provides risk stratification, which translates to a simplified classification scheme of benign, NUMP, suspicious, and positive for malignancy similar to the paradigm in other organ systems.

唾液腺穿刺吸引細胞診に関するアンケート結果の報告

目的 : われわれは日本における唾液腺穿刺吸引細胞診の実施状況を把握するためアンケート調査を実施した. その結果について考察を加えて報告する.方法 : 唾液腺腫瘍病理研究会員の病院を含む計 55 病院に対して 2011 年 3 月に 9 個の質問よりなるアンケートを実施した.結果 : 対象病院のベッド数は 300 床以上が 79%を占めた. 年間唾液腺腫瘍手術件数は 20 件以上が 32%, 49%の施設では 10 件以下であった. 唾液腺腫瘍疑い症例の穿刺吸引細胞診実施状況は “全例実施” が 60%, “症例を選択する” が 23%, “穿刺しない” が 17%みられた. 穿刺回数は 48%が複数回, 41%が 1 回のみであった. また, 84%の施設では穿刺時に細胞検査士がベッドサイドに出向し, 染色法はパパニコロウ染色とギムザ染色の併用を 91%の施設が実施していた. 唾液腺腫瘍の細胞診断については 55%の施設が苦手意識を持っており, “唾液腺細胞診の新報告様式” は 71%の施設で使用されていなかった.結論 : 唾液腺穿刺吸引細胞診は広く実施されているが, さらなる精度向上のためには複数回穿刺の奨励, 唾液腺細胞診講習会などの開催, 唾液腺新報告様式の普及活動が必要と考えられた.

Fine needle aspiration of salivary gland masses in HIV‐infected patients

Salivary gland disease is an important manifestation of HIV-infection. The aim of this study was to evaluate the cytologic findings of salivary gland fine needle aspiration (FNA) in South African human immunodeficiency virus (HIV)-infected patients. A retrospective review was performed on confirmed HIV-positive patients who underwent FNA of various body sites, including salivary glands, over a 5-year period. There were 495 (14.1%) salivary gland FNAs out of a total of 3,501 HIV-positive patients. This included 260 (52.5%) parotid, 226 (45.7%) submandibular, 2 (0.4%) sublingual, and 7 (1.4%) specimens labeled as a salivary gland aspirate, exact site not provided. Patients were of average age 34 years (range 9 months to 63 years) with a female: male ratio of 1:0.6. There were 37 (7.5%) inadequate FNAs and 22 (4.4%) that contained normal gland constituents only. Most diagnoses were benign and comprised 168 (33.9%) reactive lymphadenopathy, 115 (23.2%) benign lymphoepithelial cysts, 62 (12.5%) mycobacterial infections, and 52 (10.5%) abscesses, of which 10 had associated mycobacterial infections. Neoplasms accounted for 31 (6.7%) diagnoses including 11 pleomorphic adenomas, 13 lymphoma, 3 Kaposi sarcoma, 1 squamous cell carcinoma, 1 metastatic carcinoma, and 1 rhabdomyosarcoma. There were four epidermoid inclusion cysts, three non-specific sialadenitis, one mucocele, and one spindle cell lesion not able to be further characterized. FNA is a useful procedure to evaluate salivary gland lesions in an HIV-infected population, allowing prompt management to be undertaken and obviating the need for surgery in many instances, an important consideration in an underfunded public health care system.

Fine-needle aspiration cytology of salivary glands: Diagnostic pitfalls—revisited

Fine needle aspiration cytology (FNAC) of salivary gland lesions is a safe, effective diagnostic technique. Several amply illustrated reviews are available in the English literature. The reported diagnostic accuracy varies between 86% to 98%. The sensitivity ranges from 62% to 97.6% and specificity is higher from 94.3% to 100%. In this present study, we have analyzed 172 cases of salivary gland aspirates and the histopathological diagnosis was available in 45 cases. There was discordance in cytological and histopathological diagnosis in nine cases. Five cases had discrepancies in benign versus malignant diagnosis with four cases being false negative. The errors in these FNA diagnoses were due to sampling error, observational error and interpretational error. Therefore, this study illustrates high diagnostic accuracy of FNAC in salivary gland lesions and shows that FNAC offers valuable information that allows the planning of subsequent patient management.

Acinic-cell carcinoma, papillary-cystic variant: a diagnostic dilemma in salivary gland aspiration.

Fine-needle aspiration (FNA) plays a pivotal role as the initial diagnostic modality of choice when dealing with salivary gland (SG) lesions. Due to the heterogeneous nature of most SG neoplasms, cytologic interpretation on FNA can be quite challenging. This is particularly valid when dealing with rare tumor types, such as the papillary-cystic variant of acinic-cell carcinoma (ACC-PCV), resulting in a high rate of false-negative cytologic diagnoses. Seven cases of ACC-PCV diagnosed on tissue resection with a prior FNA performed in cytology were studied. Material consisted of Diff-Quik and Papanicolaou stained cytologic smears, as well as hematoxylin-eosin stained cell block and histopathologic sections. In no case did the FNA performed prior to the surgical resection eventuate in a cytopathologic diagnosis of cancer. A retrospective morphologic review of the smears disclosed several characteristics common to all 7 cases, i.e., mostly tightly cohesive fragments of neoplastic epithelium seen as monolayered sheets or with a prominent papillary architecture, high nuclear:cytoplasmic ratio ductal-type epithelium, cystic material and degenerated cellular debris, histiocytes, cells with squamoid and metaplastic oncocytic changes, vacuolated and pigmented histiocyte-like tumor cells, and lack of a predominant single-cell component or naked neoplastic cell nuclei. ACC-PCV represents a rare yet significant cause of false-negative results for cancer on SG aspirations. An erroneous interpretation may occur due to lack of experience in dealing with this tumor type, the rarity of published literature on ACC-PCV, and a predominantly cystic, somewhat variegated appearance of the tumor mimicking other benign and malignant SG lesions.

Selected Problems in Fine Needle Aspiration of Head and Neck Masses

A wide variety of masses in the head and neck, including those in the major salivary glands, can be approached by fine needle aspiration. In many instances, a correct definitive diagnosis con be rendered after examination of smears or cell block material. However, several significant but uncommon areas can lead to diagnostic difficulties, with the potential for clinically important diagnostic errors. Many of these occur in salivary gland lesions. The most frequent problems involve variations in the expected cytology of pleomorphic adenoma. Then, there are several benign–malignant “look-alike” pairs of lesions. The first of these is related to small-cell epithelial neoplasms of low nuclear grade; the most frequent problem is between basal cell adenomas and adenoid cystic carcinoma, particularly the solid (anaplastic) type. The next area contrasts mucoepidermoid carcinoma with its cytologic mimic, benign salivary gland duct obstruction. The final difficulty in salivary gland aspiration contrasts large-cell epithelial lesions of low nuclear grade: oncocytic proliferations and acinic cell carcinoma. The clinical implications of cytologically benign squamous cell–containing cyst aspirates from the lateral neck will be discussed. Finally, a brief consideration of methodological optimization for thyroid aspirations will be offered.

Association of Mast Cells with Warthin’s Tumor in Fine Needle Aspirates of the Salivary Gland

To determine the significance of the presence of mast cells in Warthin's tumor by evaluating the occurrence of these cells in cellular and immunohistochemical preparations. Specimens derived from five cases of FNAC were examined. A total of four slides from five cases were prepared from each: two air-dried smears were stained with May-Grünwald-Giemsa (MGG) stain and two with Hansel's stain. The other two were alcohol fixed and stained using the Papanicolaou method. The smears were evaluated for the presence of mast cells, especially associated with oxyphilic cells. In order to investigate the location of mast cells, we also counted those cells by means of immunohistochemistry using anti-mast cell monoclonal antibody AA1. The Hanselstained cellular sample from Warthin's tumor contained numerous mast cells, associated mainly with large, oxyphilic cell sheets. The number of AA1-positive cells (mast cells) stained with immunohistochemistry was greater in epithelial component than in lymphoid stroma. Mast cells in a salivary gland aspirate might be indicative of Warthin's tumor; therefore, MGG-stained slides offer the advantage of ease of preparation, particularly when the typical cytologic features are not present.