INTRODUCTION: Warthin's tumour (WT) is the second most common salivary gland neoplasm. With classic cytomorphological features of WT, the diagnostic accuracy is over 95%. WT is usually categorized as benign neoplasm according to the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). METHODS: Database search at the Department of Pathology, Fimlab Laboratories, Tampere, Finland, revealed 146 WTs during a 10-year period (January 1, 2013-December 31, 2022). Diagnostic accuracy was calculated for the entire study period, and the study period divided in half to pre-MSRSGC years (2013-2017) and MSRSGC years (2018-2022). In addition, a separate cytomorphology analysis of false-negative cases that were classified according to the MSRSGC was performed. RESULTS: Diagnostic accuracy was 96.4%, sensitivity was 68.5%, and specificity was 99.8%. Sensitivities and specificities were almost equal during the pre-MSRSGC years and the MSRSGC years. The number of true-positive cases was 113. Fifty-five cases (52 false-negative and 3 false-positive cases) were not accurately diagnosed. Risk of malignancy and risk of neoplasm were 0.0% and 98.3% of cases that were cytologically diagnosed as WT. Cytomorphological analysis showed that lack of papillae, the presence of small groups, and cystic degeneration led to false diagnoses. In addition, necrosis and diffuse hypercellularity increased the suspicion of malignancy and led to classification of fine-needle aspirations as salivary gland neoplasm of uncertain malignant potential. CONCLUSION: The MSRSGC is useful in WT diagnostics, and it improves communication between cytopathologists and clinicians. In this study, the most useful cytomorphological feature that led to accurate WT diagnoses was papillary architecture in cell block specimens and the most significant pitfall was necrosis followed by diffuse hypercellularity.

Department of Clinical Pathology Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland

Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine University Hospital Motol Charles University Prague Czechia

Fimlab Laboratories Pathology Tampere Finland

Institute of Clinical Medicine Pathology and Forensic Medicine University of Eastern Finland Kuopio Finland

Tampere University Faculty of Medicine and Health Technology Tampere Finland

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