Diagnostic challenges and problem cases in salivary gland cytology: A 20-year experience

Sajad Salehi, Zahra Maleki

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


BACKGROUND: Fine-needle aspiration (FNA) is routinely performed to evaluate salivary gland lesions, and provides valuable information regarding the cytomorphologic features of the lesions. Occasionally, there are overlaps between benign and malignant conditions due to heterogeneity of the cell types, metaplastic changes, and sampling issues. Herein, the authors present a retrospective study of diagnostic pitfalls in salivary gland cytology and the simulating conditions. METHODS: A 20-year retrospective review (1995-2015) of medical records was performed searching for the cytology reports of patients who underwent FNA of the salivary gland with the words “amendment” or “revision.” Medical records of the revised cases were reviewed for the subsequent surgical follow-up. All cases with a diagnostic discrepancy between the primary cytologic diagnosis and the final histology diagnosis were included in the current study. The histologic diagnosis was considered the gold standard. RESULTS: A total of 19 cases were included in the current study. The cases were divided into 7 categories based on their cytologic diagnoses: 1) nondiagnostic (1 case); 2) benign, nonneoplastic lesion (2 cases); 3) benign salivary gland neoplasm (2 cases); 4) salivary gland neoplasm (4 cases); 5) epithelial neoplasm, not otherwise specified (1 case); 6) markedly atypical cells suspicious for a malignant neoplasm (1 case); and 7) malignant neoplasms (8 cases). CONCLUSIONS: The interpretation of salivary gland FNA can be influenced by several factors including prominent metaplasia, focal atypia, cystic changes, variable cellular components within the lesions, scant cellularity, variants of neoplasms, and a prior history of malignancy. Multiple passes representing the entire mass, imaging findings, and familiarity with salivary gland cytomorphology may improve the diagnostic accuracy. Cancer Cytopathol 2018;126:101-11.

Original languageEnglish (US)
Pages (from-to)101-111
Number of pages11
JournalCancer Cytopathology
Issue number2
StatePublished - Feb 2018


  • amendment
  • cytology
  • fine-needle aspiration
  • salivary gland

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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