Risk stratification and clinical outcome in the atypia of undetermined significance category in the Milan System for Reporting Salivary Gland Cytopathology

2020 ◽  
Author(s):  
Sintawat Wangsiricharoen ◽  
Zahra Maleki
Keyword(s):  
Salivary Gland ◽  
Clinical Outcome ◽  
Risk Stratification ◽  
Undetermined Significance

scholarly journals The risk for malignancy using the Milan salivary gland classification categories: A 5-year retrospective review

CytoJournal ◽  
2019 ◽  
Vol 16 ◽  
pp. 14 ◽  
Author(s):  
Christine A. Liang ◽  
Jing Liu ◽  
Jaiyeola Thomas Ogunniyi ◽  
Hui Zhu ◽  
Songlin Zhang
Keyword(s):  
Salivary Gland ◽  
Positive Predictive Value ◽  
Risk Stratification ◽  
Predictive Value ◽  
Benign Neoplasm ◽  
Malignant Potential ◽  
Uncertain Malignant Potential ◽  
Sensitivity Specificity ◽  
Undetermined Significance

Aims: Since the six-tier Milan salivary gland classification has been introduced, there are very limited studies in literature reporting the risk stratification of the Milan classification. Methods: We retrospectively classified a total of 285 salivary gland cytology cases into Milan reporting categories; there were 23 (8.1%) nondiagnostic, 48 (16.8%) nonneoplastic, 19 (6.7%) atypia of undetermined significance (AUS), 138 (48.4%) benign neoplasm, 13 (4.6%) neoplasm of uncertain malignant potential (NUMP), 8 (2.8%) suspicious for malignancy, and 36 (12.6%) malignant. Almost 110 cases (38.6%) had surgical follow-up resections. Results: The overall risk for malignancy (ROM) was 12.5% for AUS, 3.2% for benign neoplasm, 72.7% for NUMP, and 100% for the suspicious for malignancy and malignant. The ROM for nondiagnostic and nonneoplastic categories was not representative due to limited follow-up resections. The salivary cytology had sensitivity, specificity, positive predictive value, and negative predictive value of 93.0%, 100%, 100%, and 46.2% for neoplasm and 82.3%, 95.8%, 90.3%, and 92.0% for malignant. Conclusion: Our study supports the adaptation of the six-tier Milan classification for reporting salivary gland cytology, as well as emphasizing the utility of the NUMP category.

High expression level of geminin predicts a poor clinical outcome in salivary gland carcinomas

2010 ◽  
Vol 56 (7) ◽  
pp. 883-892 ◽  
Author(s):  
Manabu Yamazaki ◽  
Satoshi Fujii ◽  
Yukinori Murata ◽  
Ryuichi Hayashi ◽  
Atsushi Ochiai
Keyword(s):  
Salivary Gland ◽  
Clinical Outcome ◽  
High Expression ◽  
Expression Level ◽  
Poor Clinical Outcome ◽  
Salivary Gland Carcinomas ◽  
High Expression Level

An Insight into the Utility of Sub-Categorisation of Atypia of Undetermined Significance for Risk Stratification: A Retrospective Study on an Indian Cohort with Histopathological Correlation

2019 ◽  
Vol 63 (3) ◽  
pp. 182-188 ◽  
Author(s):  
Sanjeet Roy ◽  
Anne Jennifer Prabhu ◽  
Deepak Thomas Abraham ◽  
Paul Mazhuvanchary Jacob ◽  
Marie Therese Manipadam
Keyword(s):  
Risk Stratification ◽  
Observer Variation ◽  
Cytological Atypia ◽  
Fine Needle Aspirates ◽  
Histopathological Correlation ◽  
Not Otherwise Specified ◽  
Risk Of Malignancy ◽  
Effective Role ◽  
Insight Into ◽  
Undetermined Significance

Background: Atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) criterion in thyroid fine-needle aspirates (FNAs) has been a heterogeneous entity with much inter-observer variation. Sub-categorisation of AUS/FLUS has been observed to play an effective role in risk stratification. We aimed to validate AUS/FLUS sub-categorisation in correlation with the spectrum of malignancy. Study Design: Subjects included patients with AUS/FLUS diagnosed between January 2015 and December 2016. AUS/FLUS cases were sub-categorised into those exhibiting (1) architectural atypia, (2) cytological atypia, (3) architectural and cytological atypia, (4) AUS with Hürthle cells, and (5) AUS not otherwise specified (AUS-NOS). Each sub-category was correlated with their corresponding incidence of malignancy in surgical resections. Result: The overall incidence of AUS/FLUS in our centre was 13% (132/1,018). On retrospective review of 117 patients with AUS/FLUS, smears with cytological atypia showed a higher incidence of malignancy (78.3%) than those with architectural atypia (75.3%). AUS/FLUS cases with both cytological and architectural atypia had a malignancy rate of 71.4%. Conclusion: AUS/FLUS cases with cytological atypia had a higher risk of malignancy than those with architectural atypia. The sub-categorisation of AUS/FLUS is diagnostically important for the proper risk stratification of patients.

scholarly journals Genomic Classification and Clinical Outcome in Rhabdomyosarcoma: A Report From an International Consortium

2021 ◽  
pp. JCO.20.03060
Author(s):  
Jack F. Shern ◽  
Joanna Selfe ◽  
Elisa Izquierdo ◽  
Rajesh Patidar ◽  
Hsien-Chao Chou ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Risk Stratification ◽  
Survival Data ◽  
Driver Mutations ◽  
International Consortium ◽  
Genomic Markers ◽  
Genetic Features ◽  
Malignant Mesenchymal Tumor ◽  
Clinical Annotation ◽  
Ras Isoforms

PURPOSE Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood. Despite aggressive therapy, the 5-year survival rate for patients with metastatic or recurrent disease remains poor, and beyond PAX-FOXO1 fusion status, no genomic markers are available for risk stratification. We present an international consortium study designed to determine the incidence of driver mutations and their association with clinical outcome. PATIENTS AND METHODS Tumor samples collected from patients enrolled on Children's Oncology Group trials (1998-2017) and UK patients enrolled on malignant mesenchymal tumor and RMS2005 (1995-2016) trials were subjected to custom-capture sequencing. Mutations, indels, gene deletions, and amplifications were identified, and survival analysis was performed. RESULTS DNA from 641 patients was suitable for analyses. A median of one mutation was found per tumor. In FOXO1 fusion-negative cases, mutation of any RAS pathway member was found in > 50% of cases, and 21% had no putative driver mutation identified. BCOR (15%), NF1 (15%), and TP53 (13%) mutations were found at a higher incidence than previously reported and TP53 mutations were associated with worse outcomes in both fusion-negative and FOXO1 fusion-positive cases. Interestingly, mutations in RAS isoforms predominated in infants < 1 year (64% of cases). Mutation of MYOD1 was associated with histologic patterns beyond those previously described, older age, head and neck primary site, and a dismal survival. Finally, we provide a searchable companion database ( ClinOmics ), containing all genomic variants, and clinical annotation including survival data. CONCLUSION This is the largest genomic characterization of clinically annotated rhabdomyosarcoma tumors to date and provides prognostic genetic features that refine risk stratification and will be incorporated into prospective trials.

scholarly journals Development and evaluation of a machine learning-based in-hospital COvid-19 Disease Outcome Predictor (CODOP): a multicontinental retrospective study

2021 ◽  
Author(s):  
Riku Klen ◽  
Disha Purohit ◽  
Ricardo Gomez-Huelgas ◽  
Jose Manuel Casas-Rojo ◽  
Juan Miguel Anton Santos ◽  
...  
Keyword(s):  
Machine Learning ◽  
Clinical Outcome ◽  
Risk Stratification ◽  
Latin American ◽  
Clinical Utility ◽  
Predictive Performance ◽  
Discriminative Ability ◽  
Resource Limited ◽  
Kaplan Meier ◽  
The Usa

Summary: Background More contagious SARS-CoV-2 virus variants, breakthrough infections, waning immunity, and differential access to COVID-19 vaccines account for the worst yet numbers of hospitalization and deaths during the COVID-19 pandemic, particularly in resource-limited countries. There is an urgent need for clinically valuable, generalizable, and parsimonious triage tools assisting the appropriate allocation of hospital resources during the pandemic. We aimed to develop and extensively validate a machine learning-based tool for accurately predicting the clinical outcome of hospitalized COVID-19 patients. Methods: CODOP was built using modified stable iterative variable selection and linear regression with lasso regularisation. To avoid generalization problems, CODOP was trained and tested with three time-sliced and geographically distinct cohorts encompassing 40 511 blood-based analyses of COVID-19 patients from more than 110 hospitals in Spain and the USA during 2020-21. We assessed the discriminative ability of the model using the Area Under the Receiving Operative Curve (AUROC) as well as horizon and Kaplan-Meier risk stratification analyses. To reckon the fluctuating pressure levels in hospitals through the pandemic, we offer two online CODOP calculators suited for undertriage or overtriage scenarios. We challenged their generalizability and clinical utility throughout an evaluation with datasets gathered in five hospitals from three Latin American countries. Findings: CODOP uses 12 clinical parameters commonly measured at hospital admission and associated with the pathophysiology of COVID-19. CODOP reaches high discriminative ability up to nine days before clinical resolution (AUROC: 0.90-0.96, 95% CI 0.879-0.970), it is well calibrated, and it enables an effective dynamic risk stratification during hospitalization. The two CODOP online calculators predicted the clinical outcome of the majority of patients (73-100% sensitivity and 84-100% specificity) from the distinctive Latin American evaluation cohort. Interpretation: The high predictive performance of CODOP in geographically disperse patient cohorts and the easiness-of-use, strongly suggest its clinical utility as a global triage tool, particularly in resource-limited countries.

scholarly journals Application of the Milan System for Reporting Salivary Gland Cytopathology: A Retrospective 12-Year Bi-institutional Study

2019 ◽  
Vol 151 (6) ◽  
pp. 613-621 ◽  
Author(s):  
Howard H Wu ◽  
Fatimah Alruwaii ◽  
Bao-Rung Zeng ◽  
Harvey M Cramer ◽  
Chiung-Ru Lai ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Benign Neoplasm ◽  
Malignant Potential ◽  
Salivary Gland Neoplasm ◽  
Uncertain Malignant Potential ◽  
Risk Of Malignancy ◽  
Predictive Rate ◽  
Sensitivity Specificity ◽  
Undetermined Significance

Abstract Objectives Multi-institutional studies are required for the validation of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Methods A total of 1,560 fine-needle aspirations of the salivary glands were retrieved from two institutions for a 12-year period. The diagnoses were reclassified based on the MSRSGC. Risk of malignancy (ROM) for each category was calculated based on 694 histologic follow-up cases. Results The ROM for each category was: 18.3% for nondiagnostic, 8.9% for nonneoplastic, 37.5% for atypia of undetermined significance (AUS), 2.9% for benign neoplasm, 40.7% for salivary gland neoplasm of uncertain malignant potential (SUMP), 100% for suspicious for malignancy, and 98.3% for malignant. The sensitivity, specificity, positive predictive rate, and negative predictive rates were 89%, 99%, 98%, and 96%, respectively. Conclusions The results of the current study are in keeping with the MSRSGC. The indeterminate categories of AUS and SUMP showed intermediate ROMs at 37.5% and 40.7%, respectively.

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