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. 2020 Jan;130(1):80-85.
doi: 10.1002/lary.27905. Epub 2019 Mar 8.

A Call for Universal Acceptance of the Milan System for Reporting Salivary Gland Cytopathology

Eric Barbarite  1 , Sidharth V Puram  2   3 , Adeeb Derakhshan  1 , Esther D Rossi  4 , William C Faquin  5 , Mark A Varvares  1
Affiliations

A Call for Universal Acceptance of the Milan System for Reporting Salivary Gland Cytopathology

Eric Barbarite et al. Laryngoscope. 2020 Jan.

Abstract

Objectives: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) established a standardized, tiered reporting system for salivary gland fine-needle aspiration (FNA) that has gained international acceptance among cytologists. Our goal was to review the key features of the MSRSGC to familiarize the surgical community with this system and its application to the FNA evaluation of salivary gland masses.

Methods: A comprehensive review of the MSRSGC and its application in clinical practice.

Results: The MSRSGC consists of six major diagnostic categories: 1) nondiagnostic, 2) non-neoplastic, 3) atypia of undetermined significance, 4) neoplasm (benign or salivary gland neoplasm of uncertain malignant potential), 5) suspicious for malignancy, and 6) malignant. Each diagnostic category is associated with an implied risk of malignancy with implications for clinical management.

Conclusions: The MSRSGC is similar to the system used for reporting thyroid FNA, which is familiar to most otolaryngologists and head and neck surgeons. As this reporting system continues to gain popularity among pathologists, widespread understanding by surgeons will be important to standardize communication and classification of salivary gland cytopathology to improve clinical care. Laryngoscope, 130:80-85, 2020.

Keywords: Fine-needle aspiration; Milan system; cytopathology; salivary gland.

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Figures

Fig. 1.
Fig. 1.
Non-neoplastic. This salivary gland fine-needle aspiration FNA sample shows features of chronic sialadenitis (Papanicolau stain, 600×).
Fig. 2.
Fig. 2.
Neoplasm: benign. This salivary gland fine-needle aspiration sample shows classical features of pleomorphic adenoma (Papanicolau stain, 400×).
Fig. 3.
Fig. 3.
Neoplasm: salivary gland neoplasm of uncertain malignant potential. This basaloid neoplasm was diagnosed at resection as a basal cell adenoma (Papanicolaou stain, 400×).
Fig. 4.
Fig. 4.
Malignant. These salivary gland fine-needle aspiration samples show characteristic cytologic features of low-grade mucoepidermoid carcinoma (left: Papanicolaou stain, 600×) and salivary duct carcinoma (right: Papanicolau stain, 400×).
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