title: The impact of FNAC in the management of salivary gland lesions: Institutional experiences leading to a risk-based classification scheme.
abstract: BACKGROUND
  Fine-needle aspiration cytology (FNAC) has proven its value as an essential step in the diagnosis of salivary gland lesions. Although the majority of salivary gland lesions, especially those that are common and benign, can be diagnosed with ease on FNAC, limited cellularity and morphologic lesion heterogeneity can pose diagnostic challenges and lead to false-positive and false-negative diagnoses. This study presents the institutional experience of FNAC of salivary gland lesions from 2 academic centers.
  
  
  METHODS
  A retrospective analysis was conducted on 1729 salivary gland FNAC specimens that were diagnosed over an 8-year period from January 2008 to March 2015. All samples were processed either with liquid-based cytology alone or in combination with air-dried, Diff-Quik-stained or alcohol-fixed, Papanicolaou-stained smears.
  
  
  RESULTS
  Surgical excision was performed in 709 of 1749 FNACs (41%) that were diagnosed as nondiagnostic/inadequate (n = 29), benign (n = 111), neoplasm (n = 453), atypical (n = 15), suspicious for malignancy (n = 28), and malignant (n = 73). The overall concordance between cytologic and histologic diagnoses was 92.2%, with 91.8% concordance in the benign category and 89.5% concordance in cases diagnosed as suspicious for malignancy and malignant. The most frequent benign and malignant lesions were pleomorphic adenoma and squamous cell carcinoma, respectively. There were 46 false-negative and 13 false-positive results, leading to an overall specificity of 97.6% and diagnostic accuracy of 91.3%.
  
  
  CONCLUSIONS
  FNAC is a reliable diagnostic modality for the diagnosis and management of salivary gland lesions based on its high specificity and diagnostic accuracy. Cancer Cytopathol 2016;124:388-96. © 2016 American Cancer Society.
authors.affiliation: Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Esther Diana
authors.initials: ED
authors.lastname: Rossi
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lawrence Q
authors.initials: LQ
authors.lastname: Wong
authors.affiliation: Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bizzarro
authors.affiliation: Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Petrone
authors.affiliation: Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mule
authors.affiliation: Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Fadda
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Zubair M
authors.initials: ZM
authors.lastname: Baloch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis / Q000379:methods*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012468:Salivary Gland Neoplasms / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: fine-needle aspiration cytology; liquid-based cytology; malignancies; salivary gland lesions