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A 10-Year Review of Intraoral Salivary Gland Tumor Diagnoses: Diagnostic Challenges and Inter-Observer Agreement

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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.

Conclusion

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.

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Data Availability

All data is included in the manuscript.

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References

  1. Moutasim KA, Thomas GJ. Salivary gland tumours: update on molecular diagnostics. Diagn Histopathology. 2020;26(4):159–64. doi:https://doi.org/10.1016/j.mpdhp.2020.01.002.

    Article  Google Scholar 

  2. Speight PM, Barrett AW. Salivary gland tumours: diagnostic challenges and an update on the latest WHO classification. Diagn Histopathology. 2020;26(4):147–58. doi:https://doi.org/10.1016/j.mpdhp.2020.01.001.

    Article  Google Scholar 

  3. El-Naggar AK, Chan JKC, Rubin Grandis J, Takata T, Slootweg PJ, International Agency for Research on C. WHO classification of head and neck tumours. 2022.

  4. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L. Major and minor salivary gland tumors. Crit Rev Oncol Hematol. 2010;74(2):134–48. doi:https://doi.org/10.1016/j.critrevonc.2009.10.004.

    Article  PubMed  Google Scholar 

  5. Pires FR, de Almeida OP, Pringle G, Chen SY. Differences on clinicopathological profile from intraoral minor salivary gland tumors around the world. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. vol2. United States2008. p.136–8.

  6. Khurram SA, Barrett AW, Speight PM. Diagnostic difficulties in lesions of the minor salivary glands. Diagn Histopathology. 2017;23(6):250–9. doi:https://doi.org/10.1016/j.mpdhp.2017.04.008.

    Article  Google Scholar 

  7. Rooper LM. Challenges in Minor Salivary Gland Biopsies: A Practical Approach to Problematic Histologic Patterns. Head Neck Pathol. 2019;13(3):476–84. doi:https://doi.org/10.1007/s12105-019-01010-8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bishop JA, Thompson LDR, Wakely PE Jr, Weinreb I. Tumors of the Salivary Glands. AFIP Atlases of Tumor and Non-Tumor Pathology. Vol.5. Arlington: The American Registry of Pathology; 2021.

    Google Scholar 

  9. Lukšić I, Virag M, Manojlović S, Macan D. Salivary gland tumours: 25 years of experience from a single institution in Croatia. J Craniomaxillofac Surg. 2012;40(3):e75–81. doi:https://doi.org/10.1016/j.jcms.2011.05.002.

    Article  PubMed  Google Scholar 

  10. Todorovic E, Dickson BC, Weinreb I. Salivary Gland Cancer in the Era of Routine Next-Generation Sequencing. Head Neck Pathol. 2020;14(2):311–20. doi:https://doi.org/10.1007/s12105-020-01140-4.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Turk AT, Wenig BM. Pitfalls in the biopsy diagnosis of intraoral minor salivary gland neoplasms: diagnostic considerations and recommended approach. Adv Anat Pathol. 2014;21(1):1–11. doi:https://doi.org/10.1097/pap.0000000000000000.

    Article  PubMed  Google Scholar 

  12. Xu B, Barbieri AL, Bishop JA, Chiosea SI, Dogan S, Di Palma S, et al. Histologic Classification and Molecular Signature of Polymorphous Adenocarcinoma (PAC) and Cribriform Adenocarcinoma of Salivary Gland (CASG): An International Interobserver Study. The American Journal of Surgical Pathology. 2020;44(4).

  13. Colella G, Cannavale R, Flamminio F, Foschini MP. Fine-needle aspiration cytology of salivary gland lesions: a systematic review. J Oral Maxillofac Surg. 2010;68(9):2146–53. doi:https://doi.org/10.1016/j.joms.2009.09.064.

    Article  PubMed  Google Scholar 

  14. Rooper L, Sharma R, Bishop JA. Polymorphous Low Grade Adenocarcinoma has a Consistent p63+/p40 – Immunophenotype that Helps Distinguish it from Adenoid Cystic Carcinoma and Cellular Pleomorphic Adenoma. Head Neck Pathol. 2015;9(1):79–84. doi:https://doi.org/10.1007/s12105-014-0554-4.

    Article  PubMed  Google Scholar 

  15. Seethala RR, Stenman G. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Salivary Gland. Head Neck Pathol. 2017;11(1):55–67. doi:https://doi.org/10.1007/s12105-017-0795-0.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wang D, Li Y, He H, Liu L, Wu L, He Z. Intraoral minor salivary gland tumors in a Chinese population: a retrospective study on 737 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(1):94–100. doi:https://doi.org/10.1016/j.tripleo.2006.07.012.

    Article  PubMed  Google Scholar 

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Acknowledgements

This research was funded by the Oral Pathology Graduate Research Fund, Faculty of Dentistry, University of Toronto.

Funding

This research was funded by the Oral Pathology and Oral Medicine Graduate Student Research Funds to Jessie Fuoco and Marco Magalhaes.

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Authors and Affiliations

Authors

Contributions

JF – Data collection, review, analysis, writing manuscript. MM – Research design, data analysis, writing/editing manuscript, supervision of JF. GB – Research design, review, manuscript editing. ED – Data analysis, statistical analysis. WX – Data analysis, statistical analysis, supervision of ED. IK – Data collection, review. CM – Data collection, review. BO – Data collection, review.

Corresponding author

Correspondence to Marco Magalhaes.

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The authors declare no conflicts to disclose.

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This study was conducted following approval from the Research Ethics Boards of the University of Toronto (Protocol #38153), HHSC and SJHH (HiREB Project #11158), MSH (Protocol #20-0148-C), SHSC (Project #2374), and UHN (CAPCR ID 20-5220).

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Fuoco, J., Dong, M., MacMillan, C. et al. A 10-Year Review of Intraoral Salivary Gland Tumor Diagnoses: Diagnostic Challenges and Inter-Observer Agreement. Head and Neck Pathol 17, 193–203 (2023). https://doi.org/10.1007/s12105-022-01487-w

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