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. 2019 Jul-Sep;36(3):160-164.
doi: 10.4103/JOC.JOC_165_18.

Milan System for Reporting Salivary Gland Cytopathology: An Experience with the Implication for Risk of Malignancy

Chayanika Kala  1 , Sanjay Kala  2 , Lubna Khan  3
Affiliations

Milan System for Reporting Salivary Gland Cytopathology: An Experience with the Implication for Risk of Malignancy

Chayanika Kala et al. J Cytol. 2019 Jul-Sep.

Abstract

Introduction: Fine-needle aspiration cytology (FNAC) is a well-established technique for evaluation of salivary gland lesions, but because of the heterogenicity and morphological overlap between spectrum of lesion, there are a few challenges in its wide use. Recently, "The Milan system for reporting salivary gland cytopathology" (MSRSGC) was introduced, providing guide for diagnosis and management according to the risk of malignancy (ROM) in different categories. The current study was conducted retrospectively to reclassify the salivary gland lesions from previous diagnosis and to evaluate the ROM in different categories.

Material and methods: Clinical data, FNAC specimen, histological, and clinical follow-up of cases were retrieved, cytological features were re-evaluated, and cases were reclassified as follows: Category 1: Non-diagnostic (ND); Category 2: Non-neoplastic (NN); Category 3: Atypia of undetermined significance (AUS); Category 4a: Neoplasm: benign (NB), Category 4b: Neoplasm: salivary gland neoplasm of uncertain malignant potential (SUMP); Category 5: suspicious of malignancy (SM); and Category 6: Malignant (M).

Result: Total 293 cases were evaluated cytologically, and histological follow-up was available in 172 cases. The distribution of cases into different categories was as follows ND (6.1%), NN (38.2%), AUS (2.7%), NB (33.4%), SUMP (2.0%), SM (2.4%), and M (15%). Overall, ROM reported were 25%, 5%, 20%, 4.4%, 33.3%, 85.7%, and 97.5%, respectively for each category. Overall, sensitivity was 83.33%, specificity was 98.31%, positive predictive value was 95.74%, and negative predictive value was 92.80%.

Conclusion: MSRSGC is a recently proposed six category scheme, which places salivary gland FNAC into well-defined categories that limit the possibilities of false negative and false positive cases.

Keywords: Fine-needle aspiration cytology; risk of malignancy; salivary gland lesions; the Milan system.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Abundant hyaline matrix with cells arranged around hyaline globules (Haematoxylin and eosin × 100). (b) Basaloid cells forming micro-acini around hyaline material. (Haematoxylin and eosin × 200)
Figure 2
Figure 2
Bland epithelial cells with minimal pleomorphism embedded in myxoid matrix. (Haematoxylin and eosin ×100)
See this image and copyright information in PMC

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