Mucoepidermoid carcinoma, acinic cell carcinoma, and adenoid cystic carcinoma on fine-needle aspiration biopsy and The Milan System: an international multi-institutional study

James A. Miller, Daniel An, Khurram Shafique, Sharon Song, Rema A. Rao, Kartik Viswanathan, Elizabeth Eykman, Austin Wiles, Syed Z. Ali, Andrew Field, Guido Fadda, Guliz A. Barkan, Lester J. Layfield, Esther D. Rossi, Celeste N. Powers, Momin T. Siddiqui, Ivana Kholova, Zubair Baloch, Zahra Maleki

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: We evaluated the diagnostic accuracy (DA), risk of neoplasm (RON), and risk of malignancy (ROM) for the commonly encountered malignant salivary gland tumors mucoepidermoid carcinoma (MECa), acinic cell carcinoma (ACCa), and adenoid cystic carcinoma (ADCa) applying The Milan System for Reporting Salivary Gland Cytology (MSRSGC). Materials and methods: The cytology archives from 2007 to 2017 of 9 academic institutions were searched for salivary gland FNAs for the following key words mentioned either in the principal and/or differential diagnosis: MEC, ACCa, and ADCa. The original cytology diagnosis was retrospectively classified according to the MSRSGC. Patient demographics, biopsy site, and available surgical follow-up were recorded. The final analysis included only cases with surgical follow-up. Results: A total of 212 salivary gland FNAs were included. Based on retrospective reclassification according to MSRSGC, 97 of 212 (46%) FNA cases carried a diagnosis of malignancy specific for either MECa, ACCa, or ADCa. In the remaining 115 cases, 24 of 212 (11%) were reclassified as suspicious for malignancy (SM) and 91 of 212 (43%) as salivary gland neoplasm of uncertain malignant potential (SUMP). The DA for MECa, ACCa, and ADCa was 78.7%, 75% and 89%, respectively. The RON was 100% for all 3 tumors and the ROM was 93.6% for MECa, 96.8% for ACCa, and 94.4% for ADCa. Conclusions: The DA of 78.7% for MECa, 75% for ACCa, and 89% for ADCa is reasonable in FNA specimens. Although the management of definitive cases of malignancy remains unchanged, the MSRSGC provides a ROM for SM and SUMP categories, which can improve patient management.

Original languageEnglish (US)
Pages (from-to)270-277
Number of pages8
JournalJournal of the American Society of Cytopathology
Volume8
Issue number5
DOIs
StatePublished - Sep 1 2019
Externally publishedYes

Keywords

  • Acinic cell carcinoma
  • Adenoid cystic carcinoma
  • Fine-needle aspiration
  • Mucoepidermoid carcinoma
  • Risk of malignancy
  • Risk of neoplasm
  • Salivary gland
  • The Milan System for Reporting Salivary Gland Cytology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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