A comparison study of the reporting systems for salivary gland fine needle aspirations: Are they really different?

Montezuma, Diana; Canberk, Şule; Aydın, Özlem; Dermirhas, Mehmet Polat; Vieira, André Filipe; Göksel, Süha; İnce, Ümit; Schmitt, Fernando

doi:10.1002/dc.24037

Cited by 23 publications

(26 citation statements)

References 16 publications

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“…The RON and the ROM were 93.5% and 41.9%, respectively. The ROM for the SUMP category of submandibular FNA cases was similar to the ROM of 42% in a meta‐analysis review and slightly higher than the 35% target rate of the MSRSGC and the 37.5% rate in a comprehensive literature review, even though significant variation is expected for this indeterminate category as well (ROM, 37.5% ± 24.7%) . Although the ROMs of AUS (28%) and SUMP (42%) overlapped or were close in our study and others, the RONs of AUS (48%) and SUMP (94%) were very different (Table ), and this was in keeping with the definitions of AUS (indefinite for a neoplasm) and SUMP (diagnostic of a neoplasm but an uncertain type) and supported different approaches for the management of these categories (eg, repeat FNA vs upfront surgery).…”

Section: Discussionsupporting

confidence: 73%

“…In this study, 21.4% of submandibular FNA cases (157 of 734) were diagnosed as nondiagnostic, and this was much higher than the maximum target rate of 10% suggested by the MSRSGC and the 13.5% reported for this category by Song et al Moreover, in 2 separate comprehensive reviews of the literature on salivary gland FNA conducted by Wei et al and Farahani and Baloch, the nondiagnostic rates ranged from 1.1% to 7.8% and from <1% to 44%, respectively . In addition, our study showed that there was high variability in the nondiagnostic rates between institutions, which ranged from 0% to 50%, with 7 of the 15 institutions having nondiagnostic rates ≤ 10%.…”

Section: Discussioncontrasting

confidence: 52%

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Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi‐institutional study

Maleki

Baloch

et al. 2019

Cancer Cytopathology

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BACKGROUND:The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6-tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fineneedle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs. METHODS: Submandibular gland FNA cytology specimens from 15 international institutions (2013-2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow-up was performed, and the ROM was calculated for each MSRSGC diagnostic category. RESULTS: The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%-50%); nonneoplastic, 24.2% (9.1%-53.6%); AUS, 6.7% (0%-14.3%); benign neoplasm, 18.3% (0%-52.5%); SUMP, 12% (0%-37.7%); SM, 3.5% (0%-12.5%); and malignant, 13.9% (2%-31.3%). The histopathologic follow-up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. CONCLUSIONS: This multi-institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA.

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Section: Discussionsupporting

confidence: 73%

Section: Discussioncontrasting

confidence: 52%

Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi‐institutional study

Maleki

Baloch

et al. 2019

Cancer Cytopathology

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“…Three studies formally compared the MSRSGC to previous reporting schemes 21,29,40 . Two of these showed that implementation of the MSRSGC increases the rate of unsatisfactory or ND FNA cases 21,40 .…”

Section: Discussionmentioning

confidence: 99%

“…The most notable difference between the MSRSGC and previous classification schemes for reporting salivary gland FNA specimens is the introduction of “SUMP” category; this significantly lowers the ROM of cases classified as either benign or negative for malignancy 29,40 . Both benign and malignant salivary gland neoplasms have significant morphological overlap and can be difficult to classify even after resection.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the uniform terminology allows cross communication between pathologists and institutions. Since the print publication of the MSRSGC in 2018, many institutions across the world retrospectively applied this tired diagnostic scheme to their institutional cohort of cases or those collected from multiple institutions and reported their findings with and without surgical follow‐up 6‐43 …”

Section: Introductionmentioning

confidence: 99%

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The Milan system for reporting salivary gland cytopathology: A comprehensive review of the literature

Jalaly

Farahani

Baloch

2020

Diagnostic Cytopathology

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Background The Milan system for Reporting Salivary Gland Cytopathology (MSRSGC) was published in 2018. Since then, many authors have published their institutional experience by retrospectively assigning salivary gland fine‐needle aspiration cases to each of the MSRSGC categories and calculated their risk of malignancy (ROM) accordingly. Methods We reviewed all published articles available online in English that used the MSRSGC since or near its publication. We calculated the risk of neoplasm and ROM for each diagnostic category. In addition, the false‐negative and false‐positive rates from all studies were examined. Results Thirty‐seven articles were identified in the English literature; 2 were published in 2017, 14 in 2018, 18 in 2019, and 3 in 2020. The total number of cases was 16 394, and 8 468 had surgical follow‐up. The mean ROM was 16.9% for category I, 10.5% for category II, 39.3% for category III, 2.9% for category IVa, 39.4% for category IVb, 84.2% for category V, and 97.5% for category VI. The mean false‐negative rate for MSRSGC categories II and IVa was 4.5%. Similarly, the mean false‐positive rate for MSRSGC categories V and VI was 5.1%. Conclusion A tiered classification scheme of MSRSGC is helpful in effectively guiding clinical management of patients with salivary gland lesions. The reported mean ROM for each category in most studies is within the recommended range published by the MSRSGC.

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The Milan system for reporting salivary gland cytology: A retrospective analysis of 1384 cases in a tertiary Southeast Asian institution

Lee

Tan

Chua

et al. 2020

Cancer Cytopathology

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BackgroundThe Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) aims to provide a common language for risk stratification and management. We examine the incidence of MSRSGC categories and the corresponding risk of malignancy (ROM) within a tertiary referral centre in Southeast Asia.MethodsSalivary gland fine needle aspirations (FNAs) performed within a 10‐year period were classified retrospectively according to the MSRSGC. Cytohistologic correlation was performed. The results were compared with the existing literature, including Asian and Western studies.ResultsA total of 1384 salivary gland FNAs were evaluated, 421 with corresponding histology. The category distribution was: nondiagnostic, 28.9%; nonneoplastic, 18.0%; atypia of undetermined significance (AUS), 9.8%; benign neoplasm, 32.9%; salivary gland neoplasm of uncertain malignant potential (SUMP), 5.7%; suspicious for malignancy, 1.6%; and malignant, 3.2%. The ROMs were: nondiagnostic, 10.0%; nonneoplastic, 17.5%; AUS, 29.5%; benign neoplasm, 0.5%; SUMP, 17.1%; suspicious for malignancy, 83.3%; and malignant, 100.0%. Our relatively high nondiagnostic rate likely reflects preanalytical factors, whereas our low malignancy rate may be related to population and health care accessibility. Our nonneoplastic ROM was 17.5% compared with 5% to 10% in the literature, likely due to the relatively small number of excised cases; the ROM for SUMP was 17.1% versus 21% to 44% in the literature, possibly reflecting a significant proportion of benign basaloid neoplasms on histology. Interestingly, all false‐negative cases in the nonneoplastic category were lymphoid‐rich lesions.ConclusionThis is one of the largest single‐institution studies in the existing literature documenting both the incidence and ROMs of MSRSGC categories. We also highlight specific challenges surrounding lymphoid‐rich lesions.

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A comparison study of the reporting systems for salivary gland fine needle aspirations: Are they really different?

Cited by 23 publications

References 16 publications

Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi‐institutional study

Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi‐institutional study

The Milan system for reporting salivary gland cytopathology: A comprehensive review of the literature

The Milan system for reporting salivary gland cytology: A retrospective analysis of 1384 cases in a tertiary Southeast Asian institution

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