Factors that can affect the diagnostic accuracy and specificity of an SG FNA include the technical experience of the individual performing the FNA, the quality of the cytologic preparations, the diagnostic experience of the cytopathologist, the cytomorphologic complexity and overlap of various salivary gland lesions, and the cystic nature of some salivary gland aspirates. A recent analysis by the College of Pathologists CAP highlighted the diagnostic challenges of basaloid tumors, in which the differential diagnosis can range from PA and basal cell adenoma to adenoid cystic carcinoma AdCC and basal cell adenocarcinoma.
To endorse the MSRSGC as an international effort and to foster collaboration, the Milan system task force included participation by 47 experts in the fields of salivary gland cytology, pathology, and head and neck surgery from 15 countries as coauthors of the atlas. Two online surveys related to the practice of salivary gland cytology were conducted, 5 and the results of these surveys assisted in formulating the initial framework for the MSRSGC. The frequency with which each diagnostic category is used will vary, depending on individual institutions and patient populations.
Salivary Gland Cytopathology: 5 (Essentials in Cytopathology)
For each diagnostic category, the corresponding atlas chapter includes definitions, morphologic criteria, explanations with pitfalls and differential diagnostic considerations, and reporting examples. The following is an overview of each diagnostic category. Although the diagnostic categories are numbered from I to VI, the authors strongly encourage including the full diagnostic category name in the official SG FNA report.
The ROM associated with each diagnostic category is based on calculations from the available literature Table 1. Actual values for ROM are likely to vary, depending on the characteristics of the patient population at any given institution as well as the anatomic site, radiologic features, and other characteristics of the individual tumor. The nondiagnostic category includes SG FNAs with significant limitations, often caused by scant cellularity or preservation artifacts. Adequate cellularity from a target lesion is essential for an accurate FNA interpretation.
Both qualitative and quantitative aspects of the sample can influence the ability to interpret the FNA.
This somewhat high ROM most likely reflects sampling limitations at the preanalytic level. In addition, future studies may better define the ROM for this category, possibly at a lower level. Examples of SG FNAs classified as nondiagnostic include nonmucinous cyst contents, normal salivary gland elements in the setting of a clinically and radiologically defined mass, and samples with very scant or absent cellularity and lacking atypia Fig.
Diagnostic Pathology: Cytopathology
Exceptions to these nondiagnostic cytologic criteria include mucinous cyst contents, aspirates with atypia, and specimens that contain abundant acellular matrix material or abundant inflammatory cells without an epithelial component. FNAs classified as AUS often will have preanalytic issues eg, preparation artifact or sampling limitations. It is divided into 2 diagnostic subcategories 1 benign and 2 salivary gland neoplasm of uncertain malignant potential SUMP.
The most common entities included in the benign neoplasm category are PA and Warthin tumor as well as lipoma, schwannoma, lymphangioma, and hemangioma Fig. To maintain the low ROM associated with this category, stringent cytomorphologic criteria need to be used. The neoplasm subcategory of SUMP is adopted for SG FNAs in which the morphologic features are compatible with a neoplastic process, but a specific diagnosis cannot be made. To assist in formulating a differential diagnosis, the SUMP category can be further divided based on the presence of basaloid, oncocytic, or clear cell features.
The presence of a cystic or matrix component or of significant atypia can further influence the differential diagnosis. Clinical management in most cases of SUMP will be conservative surgical resection. The suspicious for malignancy SM category is similar to the corresponding conventional diagnostic category used in other nongynecologic reporting systems Fig.
The cytomorphologic features of SM are characterized by a sample that is highly suggestive of a malignant neoplasm, but the cytomorphologic features are not definitive. Scenarios in which a diagnosis of SM might be made include a limited sample containing few markedly atypical cells or a specimen suggestive of lymphoma but without material for immunophenotyping. Many specimens diagnosed as SM potentially could benefit from the application of ancillary studies.
The diagnostic category malignant includes a broad range of different primary malignant neoplasms from both the major and minor salivary glands Fig.
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A majority of neoplasms in this category will be carcinomas, and they also include secondary metastatic carcinomas to the salivary gland lymph nodes. Other less common entities included in the malignant category are lymphomas and sarcomas. Once an FNA is diagnosed as malignant, an attempt to make a specific classification based on the edition of the World Health Organization Classification of Head and Neck Tumors should be made. The past decade has witnessed the identification of significant numbers of immunohistochemical markers and molecular features, mostly gene rearrangements, for many of the more common salivary gland tumors 10 , 13 , 25 - 28 Table 2.
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With regard to clinical management, and informed by an international team of 3 head and neck surgeons, each diagnostic category of the MSRSGC is linked with a set of clinical management options. The MSRSGC diagnosis is used in conjunction with clinical and radiologic findings to assist in formulating a management plan.
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By linking each diagnostic category with an ROM, the information provided is more useful and can lead to better patient care. Studies published before formal publication of the MSRSGC were limited by knowledge of the diagnostic category stratification and detailed criteria. The ROM can vary slightly, depending on various factors, some of which may be related to individual institutional diagnostic trends and histologic correlations, as demonstrated in Table 3.
Liu and colleagues estimated a ROM of Furthermore, for a particular case of a salivary gland mass, the true ROM is influenced by the size and anatomic location of the mass. Participants were recruited through national and international cytopathology societies. The images were selected from the respective diagnostic categories of the atlas and included typical and borderline cytomorphology.
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Given the complexity of salivary gland cytology in general as well as the novelty of a new and unfamiliar reporting system, there will be a need for educational efforts aimed at cytologists and treating clinicians. In conclusion, as in this quote by Leonardo da Vinci, the MSRSGC connects principles of conventional diagnostic cytology with a standardized international reporting system rooted in the same nomenclature used for reporting cytology results from other anatomic sites. Volume , Issue 9. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.
If the address matches an existing account you will receive an email with instructions to retrieve your username. Cancer Cytopathology Volume , Issue 9. Commentary Free Access. William C.
Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Introduction It had long since come to my attention that people of accomplishment rarely sat back and let things happen to them.
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Knowing is not enough; we must apply. Being willing is not enough; we must do. The journey into the history of the msrsgc Science is the captain, and practice the soldiers. View Larger Image. Ask Seller a Question. Title: Salivary Gland Cytopathology Essentials in Salivary gland cytopathology is one of the most challenging areas of diagnostic cytology. Salivary Gland Cytopathology will use a simplified algorithmic approach based upon differential diagnostic groups to cover practical aspects of diagnosing common as well as challenging salivary gland lesions. These guide books fit into the lab coat pocket, ideal for portability and quick reference.
Each volume is heavily illustrated with a full color art program, while the text follows a user-friendly outline format.
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Faquin, M. This volume, part of the Essentials in Cytopathology book series, fits into the lab coat pocket and is ideal for portability and quick reference. Each volume in the series is heavily illustrated with a full color art program, while the text follows a user-friendly outline format. William C. Celeste N. Visit Seller's Storefront. For assistance with billing questions, please refer to our help page in abebooks.
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