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Acanfora G, Carillo AM, Dello Iacovo F, Salatiello M, Pisapia P, Bellevicine C, Troncone G, Vigliar E. Interobserver variability in cytopathology: How much do we agree? Cytopathology 2024. [PMID: 38534091 DOI: 10.1111/cyt.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
Interobserver variability remains a major challenge for cytopathologists despite the development of standardized reporting and classification systems. Indeed, whereas moderate-to-good interobserver agreement is generally achievable when the differential diagnosis between benign and malignant entities is straightforward, high levels of variability make the diagnostic interpretation of atypical and suspicious samples not consistent. This review explores the landscape of interobserver agreement in cytopathology across different anatomical sites.
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Affiliation(s)
- Gennaro Acanfora
- Department of Public Health, University of Naples, 'Federico II', Naples, Italy
| | - Anna Maria Carillo
- Department of Public Health, University of Naples, 'Federico II', Naples, Italy
| | | | - Maria Salatiello
- Department of Public Health, University of Naples, 'Federico II', Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples, 'Federico II', Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples, 'Federico II', Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples, 'Federico II', Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples, 'Federico II', Naples, Italy
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Yaprak Bayrak B, Ozturk M. Acinic cell carcinoma mimicking Warthin's tumor: A diagnostic challenge on fine-needle cytology. Diagn Cytopathol 2024; 52:E23-E29. [PMID: 37800395 DOI: 10.1002/dc.25233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
The cytologic diagnosis of acinic cell carcinoma (ACC) can be challenging due to its polymorphous appearance and sharing cytomorphologic characteristics with other benign and malignant neoplasms as well as non-neoplastic diseases, even though various histomorphological aspects of ACC have been documented. We presented a 39-year-old female patient applied with right pre-auricular parotid swelling spreading infra-auricular region which was gradually increased in size for 3 months. Ultrasonographic examination revealed hypoechoic well-circumscribed mass with 17 × 22 × 29 mm size. Magnetic resonance imaging revealed intra-parotid solid lesion with cystic areas, slightly hypointense on T1 and hyperintense on T2 weighted images. The mass was pushing the retromandibular vein medially, still lateral to it in the caudal images, but in dumbbell-shape spreading through parapharyngeal space in superiorly cranial images. Fine-needle aspiration cytology was also performed with guidance of ultrasonography. The cytological examination of the lesion was characterized by the predominance of heterogeneous lymphoid cells, clusters of epithelial cells with a variety of cytologic appearances, including granular, transparent, vacuolated, and oncocytic, and the presence of numerous naked nuclei with a protein-like foamy background. Due to intense lymphocytic inflammation, it was considered as benign primary parotid tumor such as Warthin's tumor. The excision material was examined histopathologically. Immunohistochemical analysis showed that this carcinoma was positive for DOG1, SOX10, cytokeratin 7 and negative for mammaglobin. This salivary gland tumor was reported as a rare variant of ACC with lymphoid-rich stroma. To improve the diagnostic accuracy, various morphological aspects of ACC should be considered in the pathological practice.
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Affiliation(s)
- Busra Yaprak Bayrak
- Department of Pathology, Faculty of Medicine Kocaeli University, Kocaeli, Turkey
| | - Murat Ozturk
- Department of Otorhinolaryngology, Faculty of Medicine Kocaeli University, Kocaeli, Turkey
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Anthony ML, Kumari N, Jeladharan R, Gowda VN, Joshi PP, Durgapal P, Kumar A, Singh A. MASC Gets UNMASKED: Visiting a Rare Tumor with Emphasis on Cytomorphological Features. J Cytol 2023; 40:192-199. [PMID: 38058671 PMCID: PMC10697318 DOI: 10.4103/joc.joc_155_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/24/2023] [Accepted: 08/16/2023] [Indexed: 12/08/2023] Open
Abstract
Background Secretory carcinoma (SC) is a newly described entity which has been often misdiagnosed earlier as acinic cell carcinoma on cytology. Diagnosing SC was initially based upon identifying the ETV6:NTRK3 fusion gene with the help of fluorescence in situ hybridization (FISH). Lately, with more knowledge of the reliable histomorphology, cytology, and immunohistochemistry features, definitive diagnosis can be confidently made without the help of FISH in almost every case. Materials and Methods Six histologically confirmed cases of SC were studied. The cytology slides of all the six cases were retrieved and reviewed to identify the characteristic features which could have helped in raising the possibility of SC on fine needle aspiration cytology itself. Cell blocks were also studied, wherever available. Results Patients were all male with average age of 35.2 years. The six cases in the current study demonstrated at least focal cytoplasmic vacuolization of varying sizes, papillae formations, and bland nuclear features on fine needle aspirate smears. It was also seen that S-100 and mammaglobin immunohistochemistry (IHC) are very helpful in confirming the diagnosis. Conclusions The results of the current study highlight the cytomorphological features which may help in clinching the diagnosis SC on cytology itself. They also highlight certain cytological features which help to rule out the other differential diagnoses.
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Affiliation(s)
- Michael L. Anthony
- Department of Pathology, Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India
| | - Neha Kumari
- Department of Pathology, Dr. B R Ambedkar State Institute of Medical Sciences S.A.S Nagar Mohali, Punjab, India
| | - Reshma Jeladharan
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Vinay N. Gowda
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
| | | | | | - Arvind Kumar
- Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
| | - Ashok Singh
- Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
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Kumar M, Dwivedi P, Maurya MK, Bhalla S, Chandra M, Babu S. Application of the Milan System for Reporting Salivary Gland Lesions and Its Cytohistological Correlation for Risk Stratification: A Single-Institution Experience. Cureus 2023; 15:e47383. [PMID: 38021816 PMCID: PMC10657607 DOI: 10.7759/cureus.47383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Salivary gland tumors are known to have a heterogeneous profile with variable clinical presentation and a wide variety of histological subgroups of prognostic significance. Immunocytochemical markers that aid in the diagnosis and characterization of the cell type of origin are critical for this heterogeneous group of malignancies. AIMS AND OBJECTIVES To study the application of The 'Milan System' for Reporting Salivary Gland Cytology and the diagnostic utility of a panel of immunocytochemical markers in the diagnosis of salivary gland neoplasms and their cytohistological correlation for their risk stratification. MATERIALS AND METHODS This was a prospective study carried out in which a total of 60 patients were enrolled in the study. Fine-needle aspiration cytology (FNAC) smears and cell blocks were prepared with standard techniques and staining procedures. Immunocytochemistry (ICC) was performed on cell block sections by immunoperoxidase procedure. Immunocytochemical (ICC) stains were used for the differentiation of the lesions in cell blocks. Histopathology was also studied if the patient underwent excision of salivary gland lesions. DISCUSSION AND RESULTS Almost 60 cases were studied under FNAC and cell block evaluation, as well as ICC, among those five (8.33%) samples were inadequate, eight (13.3%) were non-neoplastic, 27 (45%) were benign, one (1.7%) was neoplasm with uncertain malignancy potential, one (1.7%) was suspected of malignancy, and 19 (31.7%) were malignant. The histopathological diagnosis was confirmed in 47 cases. Of these, 24 (51.1%) were benign and 23 (48.9%) were malignant. The malignancy rate for Milan Categories I, II, III, IVa, IVb, V, and VI was 0%, 0%, 100%, 24%, 50%, 80%, and 84.6%, respectively. The study showed that malignancy risk stratification could be further improved by using cell block with immunocytochemistry as a complementary diagnostic modality. CONCLUSIONS The present study was carried out to assess the usefulness of the Milan system to report salivary gland cytology results. Thus, the findings of the present study show that the Milan system is helpful in stratifying the risk of malignancy in salivary gland tumors.
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Affiliation(s)
- Madhu Kumar
- Pathology Department, King George's Medical University, Lucknow, IND
| | - Pooja Dwivedi
- Pathology Department, Sarojini Naidu Medical College, Agra, IND
| | | | - Shalini Bhalla
- Pathology Department, King George's Medical University, Lucknow, IND
| | - Manish Chandra
- Otorhinolaryngology Department, King George's Medical University, Lucknow, IND
| | - Suresh Babu
- Pathology Department, King George's Medical University, Lucknow, IND
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Saoud C, Wangsiricharoen S, Kahler J, Maleki Z. Atypia of undetermined significance in the Milan System for Reporting Salivary Gland Cytopathology: Cystic versus non-cystic masses. Diagn Cytopathol 2022; 50:154-161. [PMID: 34989152 DOI: 10.1002/dc.24913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/31/2022]
Abstract
The term "Atypia" has been employed to describe a wide spectrum of cytomorphologic features associated with reactive/inflammatory processes as well as those suspicious for neoplasms in cytology. Similar to other cytopathology reporting systems, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has reserved the atypical category for cytology specimens lacking quantitative and/or qualitative cytomorphologic features to be diagnosed with confidence as either non-neoplastic or neoplastic. In MSRSGC, the atypical category is associated with a risk of malignancy and recommendation for clinical management. In this review, we discuss the value of atypical diagnostic category of MSRSGC in both cystic and non-cystic salivary gland lesions by evaluating our institutional case cohort.
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Affiliation(s)
- Carla Saoud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Jessica Kahler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mir F, Rohra P, Aakash N, Furlan K, Cheng L, Ghai R, Reddy V, Gattuso P. Acinic cell carcinoma of the salivary gland associated with lymphoid-rich stroma. A diagnostic dilemma on cytology: Study of two cases. Diagn Cytopathol 2020; 49:E55-E59. [PMID: 32761994 DOI: 10.1002/dc.24571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 01/12/2023]
Abstract
A lymphoid-rich stroma is a common finding in salivary gland tumors. Several reports documented this association with acinic cell carcinoma (ACC). However, cytologic studies reporting this phenomenon are rare and mainly confined to sporadic single case reports. We present the cytologic features of two cases of ACCs of the parotid gland displaying a lymphoid-rich background and discuss the cytologic differential diagnoses of this uncommon ACC variant.
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Affiliation(s)
- Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Nfn Aakash
- Department of Pathology, University of Texas Health Science Center, Houston, Texas, USA
| | - Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Vijaya Reddy
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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Savant D, Jin C, Chau K, Hagan T, Chowdhury M, Koppenhafer J, Kercy M, Laser A, Gimenez C, Das K. Risk stratification of salivary gland cytology utilizing the Milan system of classification. Diagn Cytopathol 2018; 47:172-180. [PMID: 30479006 DOI: 10.1002/dc.24063] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/12/2018] [Accepted: 08/06/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is based on risk stratification. Our study is a retrospective review of salivary gland fine needle aspiration cytology (FNAC) with the goal of determining the risk of malignancy (ROM) in each of the categories proposed by the MSRSGC. METHODS FNAC of salivary gland lesions with corresponding surgical resection specimens were retrieved over a 5-year period. Metastatic tumors were excluded. BothFNAC and corresponding surgical resections were reviewed blindly and classified as per criteria published by the MSRSGC. The ROM for each of the diagnostic categories was determined and compared with the ROM published by the MSRSGC. RESULTS The total number of entities and ROM in 199 reviewed cases were as follows: Nondiagnostic 18 (9.2%) (ROM 0%), non-neoplastic 4(2%) (ROM 0%), atypia of undetermined significance (AUS) 12(6%) (ROM 33%), benign neoplasm 118(59.2%) (ROM 0.8%), salivary gland neoplasm of uncertain malignant potential (SUMP) 22(11%) (ROM 40.9%), suspicious for malignancy 3(1.5%) (ROM 100%), malignant 22(11%) (ROM 100%). CONCLUSION The ROM reported in our study was mostly concordant with ROM published by the MSRSGC. This classification is helpful for the management of categories; nondiagnostic, non-neoplastic, benign neoplasm, suspicious for malignancy and malignant. The management is not standardized for the category, salivary gland neoplasm of uncertain malignant potential, as clinical information plays an important role in planning surgical procedures at an individual basis. Further studies will need to be performed using this new classification to help define appropriate management and predict ROM more accurately.
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Affiliation(s)
- Deepika Savant
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Cao Jin
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Karen Chau
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Tamla Hagan
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Maruf Chowdhury
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Joshua Koppenhafer
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Mercedes Kercy
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Alice Laser
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Cecilia Gimenez
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
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Bajwa MS, Rose SJ, Mairembam P, Nash R, Hotchen D, Godden D, Alam P, Daborn L, Spedding AV, Brennan PA. Feasibility of a novel classification for parotid gland cytology: A retrospective review of 512 cytology reports taken from 4 United Kingdom general hospitals. Head Neck 2016; 38:1596-1603. [PMID: 27098831 DOI: 10.1002/hed.24482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/12/2016] [Accepted: 03/16/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A novel classification for parotid cytology has been previously proposed. The purpose of this study was to assess the feasibility and clinical relevance of this classification. METHOD Between 2010 and 2013, cytology reports from 4 United Kingdom general hospitals were retrospectively classified and compared to histological and clinical outcomes. RESULTS Based on the cytology reports of 512 patients, we revised our previous "P" system to a "Sal" (salivary) classification to encompass all cytologic outcomes. The percentage of patients with a final diagnosis of malignancy according to each category heading were: Sal 1 (inadequate) 7.9%; Sal 2I (nonneoplastic) 10%; Sal 2N (benign neoplastic) 1.4%; Sal 3 (atypical) 20.4%; Sal 4 (suspicious) 52.6%; Sal 5P (primary salivary gland malignancy) 71.4%; Sal 5NOS (malignancy not otherwise specified) 100%; and Sal 5M (metastasis) 91.7%. CONCLUSION By stratifying the probability of encountering a malignant neoplasm, the classification could guide clinical management decisions. A future prospective study is warranted. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
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Affiliation(s)
- Mandeep S Bajwa
- Maxillofacial Department, Royal Surrey County Hospital, Guildford, UK.
| | - Samantha J Rose
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Robert Nash
- Department of ENT, Charing Cross Hospital, London, UK
| | - David Hotchen
- Maxillofacial Surgery, Gloucestershire Royal Hospital, Gloucester, UK
| | - Daryl Godden
- Maxillofacial Surgery, Gloucestershire Royal Hospital, Gloucester, UK
| | - Peyman Alam
- Maxillofacial Unit, St Richard's Hospital, Chichester, UK
| | - Louise Daborn
- Cytology Department, Royal Surrey County Hospital, Guildford, UK
| | - Anne V Spedding
- Pathology Department, Queen Alexandra Hospital, Portsmouth, UK
| | - Peter A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, UK
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