通过形态学检验：一种已确立的分类方案通过观察者间的广泛一致性可靠地区分了唾液腺细胞学的恶性风险。
Putting morphology to the test: An established classification scheme reliably stratifies salivary gland cytology by risk of malignancy with substantial interobserver agreement.
机构信息
Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia.
Department of Pathology, Cleveland Clinic, Cleveland, Ohio.
出版信息
Cancer Cytopathol. 2021 Apr;129(4):291-303. doi: 10.1002/cncy.22382. Epub 2020 Nov 2.
BACKGROUND
The Milan System for Reporting Salivary Gland Cytopathology describes several salivary gland fine-needle aspiration cytology (SGFNAC) morphologies developed by Griffith et al. Basaloid neoplasms are pleomorphic (PB) or monomorphic with fibrillary (MBFib), hyaline (MBHy), or other (MBOther) matrix. Oncocytoid neoplasms can be pleomorphic (PO), demonstrate granular and/or vacuolated cytoplasm (OGV), or be monomorphic with mucinous (MOMuc), cystic (MOCyst), or other (MOOther) background. In the current study, the authors explore interobserver agreement (IOA) and risk of malignancy (ROM) for these subcategories.
METHODS
The study included 169 SGFNAC cases with surgical follow-up. Four reviewers categorized these cases using the criteria of Griffith et al. with consensus determined by majority. For all morphologic categories, IOA (using the Fleiss kappa) and ROM were calculated.
RESULTS
ROMs for basaloid categories were: PB: 100% (1 of 1 case); MBHy: 71.4% (5 of 7 cases); MBFib: 50.0% (3 of 6 cases); and MBOther: 47.4% (9 of 19 cases). ROMs for oncocytoid neoplasms were: OGV: 100% (10 of 10 cases); MOMuc: 92.3% (12 of 13 cases); PO: 88.9% (8 of 9 cases); MOOther: 33.3% (5 of 15 cases); and MOCyst: 0 (0 of 1 case). The system demonstrated substantial agreement overall (κ = 0.69). For basaloid neoplasms, the IOA results were: MBHy: κ = 0.59; MBFib: κ = 0.41; MBOther: κ = 0.41; and PB: κ = 0.11. For oncocytoid neoplasms, the IOA results were: MOMuc: κ = 0.88; OGV: κ = 0.67; PO: κ = 0.63; MOOther: κ = 0.57; and MOCyst: κ = 0.18.
CONCLUSIONS
The SGFNAC scheme proposed by Griffith et al. and incorporated into the Milan System for Reporting Salivary Gland Cytopathology demonstrated substantial agreement overall, with particularly high agreement for the MOMuc, OGV, PO, and MBHy categories. The PB and MOCyst categories demonstrated slight agreement and may be improved by revised criteria. The PB, PO, MOMuc, and OGV categories demonstrated high ROM, and the latter 2 categories might best be classified as suspicious for malignancy.
背景
《米兰唾液腺细胞病理学报告系统》描述了 Griffith 等人提出的几种唾液腺细针抽吸细胞学（SGFNAC）形态学特征。基底细胞肿瘤具有多形性（PB）或单一形态，伴有纤维状（MBFib）、透明样（MBHy）或其他（MBOther）基质。成釉细胞瘤样肿瘤可以是多形性（PO），表现为颗粒状和/或空泡状细胞质（OGV），或单一形态，伴有黏液性（MOMuc）、囊性（MOCyst）或其他（MOOther）背景。在本研究中，作者探讨了这些亚类的观察者间一致性（IOA）和恶性风险（ROM）。
方法
该研究纳入了 169 例有手术随访的 SGFNAC 病例。四名评审员使用 Griffith 等人的标准对这些病例进行分类，并通过多数决定达成共识。对于所有形态学类别，计算 IOA（使用 Fleiss kappa）和 ROM。
结果
基底细胞肿瘤类别的 ROM 为：PB：100%（1/1 例）；MBHy：71.4%（7/7 例）；MBFib：50.0%（6/6 例）；MBOther：47.4%（19/19 例）。成釉细胞瘤样肿瘤的 ROM 为：OGV：100%（10/10 例）；MOMuc：92.3%（12/13 例）；PO：88.9%（8/9 例）；MOOther：33.3%（5/15 例）；MOCyst：0（0/1 例）。该系统总体上显示出高度一致性（κ=0.69）。对于基底细胞肿瘤，IOA 结果为：MBHy：κ=0.59；MBFib：κ=0.41；MBOther：κ=0.41；PB：κ=0.11。对于成釉细胞瘤样肿瘤，IOA 结果为：MOMuc：κ=0.88；OGV：κ=0.67；PO：κ=0.63；MOOther：κ=0.57；MOCyst：κ=0.18。
结论
Griffith 等人提出并纳入《米兰唾液腺细胞病理学报告系统》的 SGFNAC 方案总体上显示出高度一致性，其中 MOMuc、OGV、PO 和 MBHy 类别的一致性尤其高。PB 和 MOCyst 类别的一致性为轻度，可能需要通过修订标准来改进。PB、PO、MOMuc 和 OGV 类别的 ROM 较高，后两个类别可能最好被归类为可疑恶性。
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