We read with interest the recent article by Klijanienko and Vielh 1 on fine-needle aspiration (FNA) cytology of salivary epithelial-myoepithelial carcinoma (EMC). The authors described cytological findings in three primary and two recurrent EMC and presented a review of 8 additional cases. Of the 13 tumors discussed, 11 had a suspicious or malignant cytological diagnosis. Only one of the EMC included in the review had been misinterpreted as a benign salivary neoplasm.
We previously reported on an additional case of EMC that was misdiagnosed as pleomorphic adenoma on FNA cytology. 2 A similar false-negative diagnosis was also noted in a case reported by Di Palma, although the cytological findings were not presented in detail. 3 We have since reviewed two further EMC in which FNA cytology was performed preoperatively. The cytological diagnosis was pleomorphic adenoma in one case, while a differential diagnosis of pleomorphic adenoma and low-grade malignant neoplasm was made in the second tumor. The case we described above 2 was the only EMC in over 300 consecutive salivary-gland FNA examined in our department over a 5-yr period. Similarly, four large series comprising over 1,500 salivary gland aspirates included only two cases of EMC. [4][5][6][7] Relatively few pathologists will share the extensive experience of Klijanienko and Vielh in the interpretation of rare salivarygland tumors, and we suspect that the cytological falsenegative rate in practice might prove to be higher than that suggested in the authors' report. Unfortunately, none of the large histopathological series of EMC provide information on any preoperative cytological findings, and FNA cytology is not mentioned at all in one recent review article. 8 Perhaps only when such data are available will it be possible to assess the accuracy of FNA cytology in the diagnosis of EMC.