“Suspicious” salivary gland FNA: Risk of malignancy and interinstitutional variability

Zahra Maleki, James Adam Miller, Seyedeh Elham Arab, Guido Fadda, Ping Bo, Olga Wise, Esther Diana Rossi, Nirag Jhala, Chandra Ashish, Syed Z. Ali, He Wang

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


BACKGROUND: Fine-needle aspiration (FNA) cytology is well accepted as a safe, reliable, minimally invasive, and cost-effective method for the diagnosis of salivary gland lesions. Salivary gland neoplasms are often difficult to diagnose because of morphologic heterogeneity and a variety of epithelial metaplastic changes. Hence, a number of salivary gland FNA specimens yield indeterminate results. For indeterminate FNA specimens, the suspicious-for-malignancy (SFM) category is used when a specific neoplasm falls short in quantity or quality for the criteria for malignancy. Therefore, the findings are not sufficient for a conclusive diagnosis of malignancy. METHODS: This study was designed to evaluate the risk of malignancy (ROM) for the SFM group at 5 tertiary medical centers worldwide with the aforementioned criteria. Among 12,606 salivary gland FNA cases between 1997 and 2014, 276 (2.2%) were reported to be SFN. Specifically, 114 suspicious cases (41%) had histological follow-up. RESULTS: Histological follow-up of the 114 suspicious cases showed 95 malignant tumors indicating a risk of malignancy (ROM) of 83.3%. The ROM varied between 74% and 88% for the 5 participating institutions, and a Fisher's exact test with significance set to p<.05 showed no significant difference in ROM among the institutions (p =.78). CONCLUSIONS: Overall, 83.3% of SFM salivary gland FNA specimens turned out to be malignant; there was no significant interinstitutional variability in the ROMs. The SFM category for salivary gland FNA is very homogeneous, and the ROMs are quite similar worldwide. Cancer Cytopathol 2018;126:94-100.

Original languageEnglish (US)
Pages (from-to)94-100
Number of pages7
JournalCancer Cytopathology
Issue number2
StatePublished - Feb 2018


  • cytology
  • fine-needle aspiration (FNA)
  • interinstitutional variability
  • risk of malignancy
  • salivary gland
  • suspicious

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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