Milan Sınıflandırma Sistemi’ne Göre Değerlendirilen Tükürük Bezi İnce İğne Aspirasyon Sitolojilerinin Histopatolojik Tanı Uyumu

Abstract

Tükürük bezi ince iğne aspirasyon sitolojisi (İİAS) raporlamasında, lezyonların malignite riskinin gruplandırılması ve standart terminolojinin kullanımı hedeflenerek Milan Sınıflandırma Sistemi ortaya çıkmıştır. Çalışmada, tükürük bezi lezyonlarında İİAS’nin tanı uyumluluğunun değerlendirilmesi ve Milan Sistemi kullanılarak sitolojik değerlendirmenin doğruluk oranının saptanması amaçlanmıştır. Ocak 2011- Şubat 2023 yılları arasında, merkezimizde tükürük bezi İİAS ve eksizyonel biyopsi uygulanmış olup histopatolojik tanısına ulaşılabilen 270 hastadan oluşan çalışma grubu oluşturuldu. İİAS tanıları biyopsi sonuçları ile karşılaştırıldı. Testin neoplaziyi ve maligniteyi saptamadaki duyarlılığı, özgüllüğü, pozitif/negatif belirleyicilik değerleri ve doğruluk oranı hesaplandı. Her tanı kategorisi için malignite riski değerleri yüzde olarak saptandı. 270 olgunun İİAS tanıları %9,6 tanısal olmayan, %21,1 non-neoplastik, %2,2 önemi belirsiz atipi, %48,5 benign, %2,6 malignite potansiyeli belirsiz, %10,4 malignite şüphesi ve %5,6 malign şeklindeydi. Non-neoplastik tanısı alan olguların histopatolojik tanı uyum oranı %40,4’tü. Non-neoplastik tanısı alan olguların en sık karıştığı antite Warthin tümörü olarak belirlendi. Benign olgularda tanı uyumu %87,8, tümör alt tip uyum oranı ise %94,4’tü. Benign grupta en sık saptanan tanı pleomorfik adenomdu. Malignitenin saptanmasında İİAS duyarlılığı %64, özgüllüğü %94,2, pozitif ve negatif belirleyicilik değerleri sırasıyla %74,4 ve %90,8, yöntemin doğruluk oranı ise %87,8 bulundu. Neoplazi saptanmasında ise duyarlılık %83,3, özgüllük %67,6, pozitif ve negatif belirleyicilik değerleri sırasıyla %93,9 ve %40,3, yöntemin doğruluk oranı %81,1 olarak saptandı. Tükürük bezi lezyonlarında İİAS’nin Milan Sistemi kullanılarak raporlanmasının, klasik morfolojik özellikler gösteren lezyonlarda yüksek tanısal doğruluk gösterdiği gösterilmiştir. Bu sınıflama, özellikle ara tanılarda ve şüpheli lezyonlarda, tanı standardizasyonunu sağlamanın yanı sıra her kategori için malignite riskini de belirttiğinden tüm merkezler tarafından kullanılmalıdır.

Keywords

• İnce iğne aspirasyonu
• Histopatoloji
• Milan
• Sitoloji
• Tükürük bezi

Histopathological Diagnostic Correlation of Salivary Gland Fine Needle Aspiration Cytologies Evaluated According to the Milan Classification System

Abstract

The Milan Classification System has emerged with the purpose of using standart terminology and categorizing risk of malignancy for salivary gland lesions, when reporting fine needle aspiration cytology (FNAC). This study aimed to evaluate the diagnostic compatibility of FNAC in salivary gland lesions and to determine the accuracy of cytological evaluation using the Milan System. A study group of 270 patients who underwent salivary gland FNAC and excisional biopsy in our center, between January 2011 and February 2023, was formed. FNAC diagnoses were compared to biopsy results. The sensitivity, specificity, positive/negative predictive values and accuracy of the test in detecting neoplasia and malignancy were calculated. Risk of malignancy was given as percentage for each diagnostic category. FNAC diagnoses of 270 cases were 9.6% non-diagnostic, 21.1% non-neoplastic, 2.2% atypia of undetermined significance, 48.5% benign, 2.6% uncertain malignant potential, 10.4% suspicious for malignancy, and 5.6% malignant. The histopathological diagnostic compatibility rate for non-neoplastic category was 40.4%. Warthin tumor was the most frequently misdiagnosed entity as non-neoplastic. For benign cases, diagnostic compatibility was 87.8% and tumor subtype compatibility was 94.4%. The most common diagnosis in the benign group was pleomorphic adenoma. For detecting malignancy, the sensitivity of FNAC was 64%, specificity was 94.2%, positive and negative predictive values were 74.4% and 90.8%, and the accuracy of the method was 87.8%. For detection of neoplasia, the sensitivity was 83.3%, the specificity was 67.6%, and the positive and negative predictive values were 93.9% and 40.3%, respectively, and the accuracy rate of the method was 81.1%. Reporting of FNAC in salivary gland lesions using the Milan System has been shown to provide high diagnostic accuracy in lesions with classical morphological features. This classification should be in all centers, especially in intermediate diagnoses and suspicious lesions, as it not only provides diagnostic standardization, but also indicates the risk of malignancy for each category.

Keywords

• Cytology
• Fine needle aspiration
• Histopathology
• Milan
• Salivary gland

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