Evaluation of Fine Needle Aspiration Cytopathology in Salivary Gland Tumors under Milan System: Challenges, Misdiagnosis Rates, and Clinical Recommendations

doi:10.3390/biomedicines11071973

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Title:	Evaluation of Fine Needle Aspiration Cytopathology in Salivary Gland Tumors under Milan System: Challenges, Misdiagnosis Rates, and Clinical Recommendations
Authors:	Huang, Yi-Tien Ho, Chen-Yu Ou, Chun-Yen Huang, Cheng-Chih Lee, Wei-Ting Tsai, Shu-Wei Hsu, Heng-Jui Hung, David Shang-Yu Tsai, Chien-Sheng Fang, Sheen-Yie Tsai, Sen-Tien Hsiao, Jenn-Ren Chang, Chan-Chi Chen, Chien-Chin
Contributors:	Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Otolaryngol Chia Yi Christian Hosp, Ditmanson Med Fdn, Dept Pathol Chia Nan Univ Pharm & Sci, Dept Cosmet Sci Natl Chung Hsing Univ, Rong Hsing Res Ctr Translat Med, Ph D Program Translat Med Natl Cheng Kung Univ, Coll Biosci & Biotechnol, Dept Biotechnol & Bioind Sci
Keywords:	benign neoplasm cytopathology fine-needle aspiration FNA Milan system MSRSGC pleomorphic adenoma salivary gland Warthin's tumor
Date:	2023
Issue Date:	2024-12-25 11:03:57 (UTC+8)
Publisher:	MDPI
Abstract:	(1) Background: Salivary gland tumors are rare in the head and neck. To determine the need and extent of surgical intervention, fine needle aspiration (FNA) is a widely accepted tool to approach salivary gland lesions. However, the FNA cytology varies between entities, while the lack of uniform terminology makes diagnosis more challenging. Since establishing the Milan system for reporting salivary gland cytopathology (MSRSGC) has become an increasingly accepted reporting standard, further examination and detailed recommendations were needed. (2) Methods: Between April 2013 and October 2021, 375 cases with FNA and salivary gland resection were retrospectively collected. All FNA specimens were reclassified according to the criteria of MSRSGC. After surgical excision, the FNA data were compared with the histological diagnosis to estimate the risk of malignancy (ROM), the risk of neoplasm (RON), and the diagnostic accuracy for each diagnostic category. (3) Results: Our cohort's distribution of ROM and RON was similar to the MSRSGC's recommendation. Carcinoma ex pleomorphic adenoma (CXPA) has the highest rate (66.7%) of misdiagnosed as a nonneoplastic lesion or benign salivary gland tumor. Pleomorphic adenoma (PA) and Warthin's tumor were the most common benign salivary gland tumors, while the cytology diagnosis of Warthin's tumor seems more challenging than PAs. (4) Conclusions: Despite the convenience and effectiveness of MSRSGC, we suggest close follow-up, re-biopsy, or surgical removal for salivary lesions even in Milan IVA-Benign for possibly missing FNA of malignancy, mixed lesions, or prevention of malignant transformation.
Relation:	Biomedicines, v.11, n.7, Article 1973
Appears in Collections:	[Offices] 456

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