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. 2015 Jun;143(6):839-53.
doi: 10.1309/AJCPMII6OSD2HSJA.

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

Christopher C Griffith  1 , Reetesh K Pai  2 , Frank Schneider  2 , Umamaheswar Duvvuri  3 , Robert L Ferris  3 , Jonas T Johnson  3 , Raja R Seethala  2
Affiliations

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

Christopher C Griffith et al. Am J Clin Pathol. 2015 Jun.

Abstract

Objectives: Fine-needle aspiration (FNA) is useful in the evaluation of salivary gland tumors, but currently no standard terminology or risk stratification model exists.

Methods: 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.

Results: 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%.

Conclusions: 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.

Keywords: Cytology; Fine-needle aspiration; Risk stratification; Salivary gland.

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Figures

Figure 1
Figure 1
Diagram of proposed salivary gland aspiration categories. Possible categories are laid out in an algorithmic approach with the major division among neoplastic aspirates being the distinction of basaloid from oncocytoid neoplasms. Photomicrographs demonstrate typical areas of aspirate for each of the proposed categories with the surgical follow-up being designated. The number and percentage of aspirates in each category are listed.
Figure 2
Figure 2
Receiver operator characteristic (ROC) curve analysis. A, ROC curve with malignancy on surgical follow-up as end point gives an area under the curve of 0.932. All but nonneoplastic = malignant (A), neoplasm of uncertain malignant potential (NUMP) + suspicious + malignant = malignant (B), suspicious + malignant = malignant (C), and malignant only = malignant (D). B, ROC curve with high-grade (HG) malignancy on surgical follow-up as the end point gives an area under the curve of 0.929. All but nonneoplastic = HG malignant (A), NUMP + suspicious + malignant = HG malignant (B), suspicious + malignant = HG malignant (C), and malignant only = HG malignant (D).
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