背景:在细针穿刺标本中诊断唾液腺分泌癌(SC)具有挑战性,因为它的低级性质使得它很难与各种良性或恶性唾液腺肿瘤区分开来。目前,金标准是证明ETV6-NTRK3融合基因。然而,通过正确识别其细胞形态特征,可以促进订购这种昂贵的分子测试的决定。
目的:主要目的是确定细针穿刺细胞学(FNAC)诊断唾液腺SC的准确性。次要目标是识别各种细胞形态学模式,SC的特征并将其与其他肿瘤区分开。
方法:PubMed/MEDLINE,科学直接,Embase,在Cochrane综述和PROSPERO数据库中搜索了具有以下所有关键搜索词的研究:(\“唾液腺分泌性癌\”或\“唾液腺乳腺类似物分泌性癌\”)和(\“细胞学\”或\“细胞学特征\”或\“抽吸物\”或\“细胞诊断\”)在2010年至2023年6月的时间框架内发表。报告唾液腺肿瘤细胞学特征的研究,这些肿瘤在分子研究中被证实/诊断为分泌性癌,包括在系统审查中。最后,共有17项报告45例病例的研究被纳入meta分析.
结果:FNAC诊断唾液腺SC的敏感性为27.7%(95%CI16.6-42.5%)。LR+(正似然比)为0.654(0.344-1.245),LR-(阴性似然比)为1.023(0.538-1.946),诊断比值比为0.421(0.129-1.374)。对细胞块进行的分子测试和/或免疫组织化学提高了诊断的准确性。
结论:识别细微的细胞形态学模式,即,乳头状形成,在大多数情况下,簇和单个分散的细胞以及细胞浆内空泡的存在是特征性的发现,通过诊断分子谱分析证实。这可能有助于通过有限的公开文献鉴定这种稀有实体,并有助于提高诊断准确性。
BACKGROUND: The diagnosis of salivary gland secretory carcinoma (SC) in fine-needle aspiration specimens is challenging because its low-grade nature makes it difficult to differentiate it from various benign or malignant salivary gland neoplasms. Currently, the gold standard is demonstration of ETV6-NTRK3 fusion gene. However, the decision for ordering this costly molecular testing can be facilitated by the correct recognition of its cytomorphological features. The aim of the
review was to determine the accuracy of fine-needle aspiration cytology (FNAC) in diagnosis of salivary gland SC. The secondary objective was to recognize varied cytomorphological patterns, characteristic features of SC and differentiate it from other neoplasms.
METHODS: PubMed/MEDLINE, Science Direct, Embase, Cochrane
review, and PROSPERO databases were searched for studies having the following key search terms: (\"secretory carcinoma of salivary gland\" OR \"mammary analogue secretory carcinoma of salivary gland\") AND (\"Cytology\" OR \"Cytological features\" OR \"aspirate\" OR \"cytodiagnosis\") published in the time frame of 2010 to June 2023. Studies reporting cytological features of the salivary gland tumors which were confirmed/diagnosed as SC on molecular investigation, were included in the systematic
review. Finally, seventeen studies reporting a total of 45 cases were included in the metanalysis.
RESULTS: The sensitivity of the FNAC in diagnosing SC in salivary gland is 27.7% (95% CI: 16.6-42.5%). The LR+ (positive likelihood ratio) was 0.654 (0.344-1.245), LR- (negative likelihood ratio) was 1.023 (0.538-1.946), and diagnostic odds ratio was 0.421 (0.129-1.374). The molecular testing and/or immunohistochemistry performed on cell block increased the diagnostic accuracy.
CONCLUSIONS: Recognition of subtle cytomorphological patterns, i.e., papillary formation, clusters, and singly dispersed cells along with presence of fine intracytoplasmic vacuolations were the characteristic findings in majority of cases, confirmed with diagnostic molecular profiling. This may be helpful in identification of this rare entity with limited published literature and help in increasing diagnostic accuracy.