A pattern-based risk-stratification scheme for salivary gland cytology: A multi-institutional, interobserver...

Area of Science:

• Cytopathology
• Oncology
• Surgical Pathology

Background:

• Salivary gland aspiration cytology aids preoperative management but faces challenges due to overlapping tumor morphology.
• Accurate malignancy determination is limited by morphologic overlap, necessitating improved diagnostic systems.
• A risk-based categorization scheme for salivary gland aspirates is under development.

Purpose of the Study:

• To evaluate the interobserver variability of a specific pattern and risk-based system for salivary gland aspirates.
• To assess the diagnostic accuracy and risk stratification capabilities of the proposed system.
• To identify potential simplifications for improved usability and agreement.

Main Methods:

• Digitally imaged smears and cell blocks from 50 salivary gland aspirates from two academic centers.
• Independent, blinded review by four cytopathologists using a proposed pattern-based categorization scheme.
• Calculation of interobserver agreement and aggregated risks of malignancy with surgical follow-up.

Main Results:

• Of 42 neoplastic samples, interobserver agreement varied: uniform (23.8%), majority (33.3%), divided (11.9%), minimal (21.4%), and none (9.5%).
• Condensing similar categories improved interobserver agreement.
• The system successfully stratified the risk of malignancy.

Conclusions:

• The pattern-based risk-stratification scheme demonstrates good interobserver agreement and effective malignancy risk stratification.
• The system is compatible with the forthcoming Milan System.
• Simplification of the scheme can enhance ease of use and interobserver agreement while preserving risk stratification.