Application of the Milan System for Reporting Salivary Gland Cytopathology: A Tertiary Care Experience

Jheel Sureshbhai Anjaria; Purvi Sharad Patel; Shital P. Vaghasiya; Dipal Kantibhai Hadavani; Sree Pooja Rajmohan; Hansa Goswami

doi:10.21276/apalm.3474

Authors

Jheel Sureshbhai Anjaria Department of Pathology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
Purvi Sharad Patel Department of Pathology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
Shital P. Vaghasiya Department of Pathology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
Dipal Kantibhai Hadavani Department of Pathology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
Sree Pooja Rajmohan Department of Pathology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
Hansa Goswami Department of Pathology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.21276/apalm.3474

Keywords:

The Milan system, Salivary Glands, Fine needle aspiration cytology, malignant.

Abstract

Background: Fine-needle aspiration cytology (FNAC) of salivary gland lesions poses diagnostic challenges due to diverse features and overlapping characteristics. To address this, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was established to promote standardized reporting and improve clinico-pathologic correlation. The aim of the present study was to assess the application of the MSRSGC on FNAC specimens of salivary gland lesions at B.J. Medical College and Hospital.

Materials and Methods: A retrospective study was conducted, retrieving clinical information and cytology smear slides from salivary gland lesions diagnosed between January 2022 and July 2024. The cytological features were evaluated and the cases were classified according to the MSRSGC.

Results: A total of 118 cases were evaluated cytologically. The distribution of cases into different categories was as follows: Non-diagnostic (12.71%), Non-neoplastic (38.99%), Atypia of Undetermined Significance (5.08%), Neoplasm: Benign (33.05%), Salivary Gland Neoplasm of Uncertain Malignant Potential (3.39%), Suspicious for Malignancy (1.69%), and Malignancy (5.08%). The Risk of Malignancy (ROM) for non-diagnostic, non-neoplastic, benign neoplasms, AUS, SUMP, SFM, and malignant were 0%, 0%, 50%, 2.7%, 100%, 100%, and 100%, respectively.

Conclusion: The MSRSGC is an essential tool for standardizing reporting and preoperatively stratifying cases. The findings of this study reinforce the value of MSRSGC in enhancing diagnostic accuracy, stratifying malignancy risk, and facilitating collaborative patient management between cytopathologists and clinicians, highlighting the need for ongoing refinement and widespread adoption.

References

1. Naz S, Hashmi AA, Khurshid A, et al. Diagnostic role of fine needle aspiration cytology (FNAC) in the evaluation of salivary gland swelling: an institutional experience. BMC Res Notes. 2015;8:101.

2. Tochtermann G, Nowack M, Hagen C, Rupp NJ, Ikenberg K, Broglie MA, et al. The Milan system for reporting salivary gland cytopathology—a single-center study of 2156 cases. Cancer Med. 2023;12(11):12198–207.

3. Singh G, Jahan A, Yadav SK, Gupta R, Sarin N, Singh S. The Milan System for Reporting Salivary Gland Cytopathology: an outcome of retrospective application to three years' cytology data of a tertiary care hospital. Cytojournal. 2021;18:12.

4. Baloch Z, Lubin D, Katabi N, Wenig BM, Wojcik EM. Chapter 1. In: The Milan System for Reporting Salivary Gland Cytopathology. 2nd ed. Springer; 2023. p. 1–3.

5. Eneroth C, Frazén S, Zajicek J. Cytologic diagnosis on aspirate from 1000 salivary-gland tumours. Acta Otolaryngol Suppl. 1967;63(Suppl 224):168–72.

6. Mairembam P, Jay A, Beale T, Morley S, Vaz F, Kalavrezos N, et al. Salivary gland FNA cytology: role as a triage tool and an approach to pitfalls in cytomorphology. Cytopathology. 2016;27(2).

7. Kala C, Kala S, Khan L. Milan System for Reporting Salivary Gland Cytopathology: an experience with the implication for risk of malignancy. J Cytol. 2019;36(3):160–4.

8. Rohilla M, Singh P, Rajwanshi A, Gupta N, Srinivasan R, Dey P, et al. Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification. Cancer Cytopathol. 2017;125(10).

9. Datta B, Daimary M, Bordoloi K, Thakuria C. Cytopathological spectrum of salivary gland lesions according to the Milan system for reporting salivary gland cytopathology: a retrospective study. Asian Pac J Cancer Care. 2023;8(3).

10. Jha S, Mitra S, Purkait S, Adhya AK. The Milan system for reporting salivary gland cytopathology: assessment of cytohistological concordance and risk of malignancy. Acta Cytol. 2021;65(1).

11. Karuna V, Gupta P, Rathi M, Grover K, Nigam JS, Verma N. Effectuation to cognize malignancy risk and accuracy of fine needle aspiration cytology in salivary gland using the "Milan System for Reporting Salivary Gland Cytopathology": a 2-year retrospective study in an academic institution. Indian J Pathol Microbiol. 2019;62(1).

12. Viswanathan K, Sung S, Scognamiglio T, Yang GCH, Siddiqui MT, Rao RA. The role of the Milan System for Reporting Salivary Gland Cytopathology: a 5-year institutional experience. Cancer Cytopathol. 2018;126(8):589–90.

13. Song SJ, Shafique K, Wong LQ, LiVolsi VA, Montone KT, Baloch Z. The utility of the Milan System as a risk stratification tool for salivary gland fine needle aspiration cytology specimens. Cytopathology. 2019;30(1).

14. Leite AA, Vargas PA, Dos Santos Silva AR, Galvis MM, Sá RS, Lopes Pinto CA, et al. Retrospective application of the Milan System for reporting salivary gland cytopathology: a cancer center experience. Diagn Cytopathol. 2020;48(9):788–94.