The Role of Mitotic Count and Ki-67 Index in Identifying Likely Benign Salivary Gland Tumors to Avoid Overtreatment Mitotic Count and Ki-67 in Salivary Gland Tumors
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Abstract
Objective: This study evaluated and compared the utility of mitotic count and Ki-67 index in distinguishing benign and malignant salivary gland tumors. The primary objective was to identify optimal cut-off points for these proliferative indices to help guide diagnosis and avoid overtreatment in cases where definitive histomorphology is challenging, especially in small biopsy specimens.
Materials and Methods: A total of 88 salivary gland tumor specimens were evaluated, including 56 benign and 32 malignant cases. Mitotic count and Ki-67 index were quantified for all cases. The diagnostic performance of each marker was assessed by determining sensitivity, specificity, and the area under the receiver operating characteristic curve the Area Under the Curve (AUC).
Results: Benign tumors exhibited consistently low mitotic counts (average < 1) and Ki-67 indices (average < 2.00%). In contrast, malignant tumors showed significantly higher values. A mitotic count ≥ 2 and a Ki-67 index ≥ 5.00% were determined as optimal cut-off points. The Ki-67 index (AUC = 0.76) demonstrated a higher sensitivity (68.80%) than the mitotic count (50.00%), performing slightly better than the mitotic count (AUC = 0.73).
Conclusion: Diagnosing benign and malignant salivary gland tumors based on morphology alone in small biopsies can be challenging. A mitotic count ≥ 2 and a Ki-67 index ≥ 5.00% are linked with malignancy, and these proliferation markers serve as valuable adjuncts to improve diagnostic accuracy and guide appropriate patient management. This approach is particularly useful in preventing overtreatment.
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