title: Performance Characteristics of Adenoid Cystic Carcinoma of the Salivary Glands in Fine-Needle Aspirates: Results From the College of American Pathologists Nongynecologic Cytology Program.
abstract: BACKGROUND
  Although the cytomorphology of adenoid cystic carcinoma (ACC) has been well described, the accuracy of this diagnosis in fine-needle aspirates (FNAs) of the salivary glands has not been extensively evaluated.
  
  
  OBJECTIVE
  To assess participants' responses in the College of American Pathologists (CAP) Nongynecologic Cytology (NGC) Program to determine the accuracy and false-negative rate of ACC cases in salivary gland FNAs.
  
  
  METHODS
  A retrospective review of the CAP NGC Program's cumulative data from 2000-2010 was performed for the general and the specific reference diagnosis categories for ACC in salivary gland FNAs according to preparation and participant types.
  
  
  RESULTS
  Of 5156 responses, the overall concordance rates for both the general category of malignancy and the specific category of ACC were 63.6% (3279 of 5156) and 38.6% (1966 of 5088), respectively, with a false-negative rate of 36.4% (1877 of 5156). The most frequent false-negative responses were pleomorphic (1080) and monomorphic (526) adenoma (1614 of 5088, 31.5%), while lymphoma was the most frequent malignant misinterpretation. There was a significant statistical difference in concordance to the reference interpretation between the reader types: 39.9% (1006 of 2521) concordance rate for pathologists compared to 33.8% (503 of 1488) for cytotechnologists. However, there was no significant statistical difference for concordance to the general category or reference interpretation, based on preparation type (Papanicolaou versus modified Giemsa stained).
  
  
  CONCLUSIONS
  In this interlaboratory comparison educational program, accurate identification of ACC has shown to be problematic, with ACC representing an important cause of false-negative responses. The most common diagnostic pitfall is distinguishing this entity from pleomorphic and monomorphic adenoma in the benign category and from lymphoma and adenocarcinoma in the malignant one.
authors.affiliation: From the Department of Pathology, University of California San Francisco, San Francisco (Dr Tabatabai); the Department of Pathology, McGill University Health Sciences Center, Montreal, Quebec, Canada (Dr Auger); the Department of Pathology, Wisconsin State Lab of Hygiene, Madison (Dr Kurtycz); the Department of Anatomic Pathology Services, North Shore Long Island Jewish Hospital System, New Hyde Park, New York (Dr Laser); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, Loyola University, Maywood, Illinois (Dr Barkan); the Department of Pathology and Area Lab Services, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Crothers); and the Department of Pathology, University of Pittsburgh Medical Center (UPMC)-Shadyside, Pittsburgh, Pennsylvania (Dr Khalbuss).
authors.forename: Z Laura
authors.initials: ZL
authors.lastname: Tabatabai
authors.forename: Manon
authors.initials: M
authors.lastname: Auger
authors.forename: Daniel F I
authors.initials: DF
authors.lastname: Kurtycz
authors.forename: Alice
authors.initials: A
authors.lastname: Laser
authors.forename: Rhona J
authors.initials: RJ
authors.lastname: Souers
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Laucirica
authors.forename: Guliz A
authors.initials: GA
authors.lastname: Barkan
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Crothers
authors.forename: Walid E
authors.initials: WE
authors.lastname: Khalbuss
mesh_terms: D044963:Biopsy, Fine-Needle; D003528:Carcinoma, Adenoid Cystic / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D006801:Humans; D010338:Pathology, Clinical; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012469:Salivary Glands / Q000473:pathology*; D012955:Societies, Medical; D014481:United States