Putting morphology to the test: An established classification scheme reliably stratifies salivary gland cytology by risk of malignancy with substantial interobserver agreement Journal Article


Authors: Lubin, D. J.; Griffith, C. C.; Buonocore, D. J.; Wei, X. J.; Lin, O.
Article Title: Putting morphology to the test: An established classification scheme reliably stratifies salivary gland cytology by risk of malignancy with substantial interobserver agreement
Abstract: 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. © 2020 American Cancer Society
Keywords: clinical article; cancer surgery; cancer risk; follow up; reproducibility; consensus; salivary gland; cytopathology; interrater reliability; fine needle aspiration biopsy; fine-needle aspiration; risk of malignancy; interobserver agreement; human; article; basaloid; milan system for reporting salivary gland cytopathology (milan system); oncocytoid; salivary gland cytopathology
Journal Title: Cancer Cytopathology
Volume: 129
Issue: 4
ISSN: 1934-662X
Publisher: John Wiley & Sons  
Date Published: 2021-04-01
Start Page: 291
End Page: 303
Language: English
DOI: 10.1002/cncy.22382
PUBMED: 33136345
PROVIDER: scopus
PMCID: PMC8491145
DOI/URL:
Notes: Article -- Export Date: 3 May 2021 -- Source: Scopus
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MSK Authors
  1. Xiao-Jun Wei
    9 Wei
  2. Oscar Lin
    278 Lin