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Abstract：
BACKGROUND: Salivary gland tumors (SGT) are a diverse group of neoplasms arising from the major and minor glands. The oral cavity is the most common site for minor SGT (IMSGT), and these lesions frequently pose a challenge to the pathologist due to overlapping histopathological features and limited material for analysis. Our objective was to determine specific clinical and histopathological features associated with challenges in IMSGT diagnoses and pathologists\' agreement.
METHODS: We conducted a retrospective analysis of 248 IMSGT received between 2010 and 2019. We evaluated the diagnostic challenge of the cases by stratifying according to whether a definitive, favored, or indeterminate (challenging) diagnosis was provided. Inter-observer agreement and concordance of biopsy diagnoses with the final diagnoses after tumor resection were evaluated.
RESULTS: Of the 248 biopsies, 191 had a definitive diagnosis, 38 favored diagnoses, and 19 were indeterminate. The predominant diagnoses considered for the indeterminate category were pleomorphic adenoma/myoepithelioma (PA), polymorphous adenocarcinoma (PAC), adenoid cystic carcinoma (AdCC), and low-grade adenocarcinoma. Using multivariate analysis of clinical features, younger patient age, smaller tumor size, and larger biopsy size increased the likelihood of a definitive diagnosis (p = 0.014, p = 0.037, p = 0.012). The inter-observer agreement for 68 representative cases was moderate overall (Fleiss\'s Kappa 0.575) and good for the 40 cases with a definitive diagnosis (Fleiss\'s Kappa 0.66). Sixty-five biopsy diagnoses were matched with corresponding tumor resection diagnoses and found to show a good concordance (Cramer\'s V test 0.76). The discordant diagnoses predominantly involved PA, carcinoma exPA, PAC, AdCC, and adenocarcinoma NOS.
CONCLUSIONS: Diagnostic challenges in IMSGT incisional biopsies were infrequent, especially if multiple pathologists were consulted. PA, PAC, AdCC, and adenocarcinoma NOS were the histologic types more commonly posing diagnostic challenges. Younger patient age, smaller tumor size, and larger biopsy are associated with a definitive diagnosis. This data highlights the importance of appropriate sampling in IMSGT.
METHODS: We conducted a retrospective analysis of 248 IMSGT received between 2010 and 2019. We evaluated the diagnostic challenge of the cases by stratifying according to whether a definitive, favored, or indeterminate (challenging) diagnosis was provided. Inter-observer agreement and concordance of biopsy diagnoses with the final diagnoses after tumor resection were evaluated.
RESULTS: Of the 248 biopsies, 191 had a definitive diagnosis, 38 favored diagnoses, and 19 were indeterminate. The predominant diagnoses considered for the indeterminate category were pleomorphic adenoma/myoepithelioma (PA), polymorphous adenocarcinoma (PAC), adenoid cystic carcinoma (AdCC), and low-grade adenocarcinoma. Using multivariate analysis of clinical features, younger patient age, smaller tumor size, and larger biopsy size increased the likelihood of a definitive diagnosis (p = 0.014, p = 0.037, p = 0.012). The inter-observer agreement for 68 representative cases was moderate overall (Fleiss\'s Kappa 0.575) and good for the 40 cases with a definitive diagnosis (Fleiss\'s Kappa 0.66). Sixty-five biopsy diagnoses were matched with corresponding tumor resection diagnoses and found to show a good concordance (Cramer\'s V test 0.76). The discordant diagnoses predominantly involved PA, carcinoma exPA, PAC, AdCC, and adenocarcinoma NOS.
CONCLUSIONS: Diagnostic challenges in IMSGT incisional biopsies were infrequent, especially if multiple pathologists were consulted. PA, PAC, AdCC, and adenocarcinoma NOS were the histologic types more commonly posing diagnostic challenges. Younger patient age, smaller tumor size, and larger biopsy are associated with a definitive diagnosis. This data highlights the importance of appropriate sampling in IMSGT.
摘要：
背景：唾液腺肿瘤（SGT）是由主要和次要腺体引起的一组不同的肿瘤。口腔是次要SGT（IMSGT）最常见的部位，由于重叠的组织病理学特征和有限的分析材料，这些病变经常对病理学家构成挑战。我们的目标是确定与IMSGT诊断和病理学家同意的挑战相关的特定临床和组织病理学特征。
方法：我们对2010年至2019年收到的248例IMSGT进行了回顾性分析。我们通过分层评估病例的诊断挑战，根据是否确定，青睐，或提供了不确定的（挑战性的）诊断。评估了观察者之间的一致性以及活检诊断与肿瘤切除后最终诊断的一致性。
结果：在248例活检中，191有明确的诊断，38个有利的诊断，19个是不确定的。不确定类别的主要诊断为多形性腺瘤/肌上皮瘤（PA），多形性腺癌(PAC),腺样囊性癌（AdCC），和低度腺癌。使用临床特征的多变量分析，患者年龄较小，较小的肿瘤大小，较大的活检大小增加了明确诊断的可能性(p=0.014,p=0.037,p=0.012).68例代表性病例的观察者间共识总体中等（FleissKappa0.575），对于40例确诊病例（FleissKappa0.66）良好。65例活检诊断与相应的肿瘤切除诊断相匹配，并显示出良好的一致性（CramerV检验0.76）。不一致的诊断主要涉及PA，癌EXPA，PAC,AdCC,和腺癌NOS。
结论：IMSGT切开活检的诊断挑战很少见，特别是如果咨询了多个病理学家。PA,PAC,AdCC,和腺癌NOS是更常见的诊断挑战的组织学类型。患者年龄较小，较小的肿瘤大小，和更大的活检与明确的诊断有关。该数据突出了在IMSGT中适当采样的重要性。
方法：我们对2010年至2019年收到的248例IMSGT进行了回顾性分析。我们通过分层评估病例的诊断挑战，根据是否确定，青睐，或提供了不确定的（挑战性的）诊断。评估了观察者之间的一致性以及活检诊断与肿瘤切除后最终诊断的一致性。
结果：在248例活检中，191有明确的诊断，38个有利的诊断，19个是不确定的。不确定类别的主要诊断为多形性腺瘤/肌上皮瘤（PA），多形性腺癌(PAC),腺样囊性癌（AdCC），和低度腺癌。使用临床特征的多变量分析，患者年龄较小，较小的肿瘤大小，较大的活检大小增加了明确诊断的可能性(p=0.014,p=0.037,p=0.012).68例代表性病例的观察者间共识总体中等（FleissKappa0.575），对于40例确诊病例（FleissKappa0.66）良好。65例活检诊断与相应的肿瘤切除诊断相匹配，并显示出良好的一致性（CramerV检验0.76）。不一致的诊断主要涉及PA，癌EXPA，PAC,AdCC,和腺癌NOS。
结论：IMSGT切开活检的诊断挑战很少见，特别是如果咨询了多个病理学家。PA,PAC,AdCC,和腺癌NOS是更常见的诊断挑战的组织学类型。患者年龄较小，较小的肿瘤大小，和更大的活检与明确的诊断有关。该数据突出了在IMSGT中适当采样的重要性。
