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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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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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.
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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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DOI: https://doi.org/10.1007/s12105-022-01487-w