Application of the Milan System for Reporting Salivary Gland Cytopathology: A systematic review and meta‐analysis

Abstract

BACKGROUND:The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standard, evidence-based classification system for salivary gland fine-needle aspiration (SG-FNA). Since it was published in 2018, many researchers across the world have applied this uniform reporting system to their cohorts. METHODS: The authors comprehensively reviewed cohort studies conducted since publication of the MSRSGC and performed a meta-analysis. The risk of neoplasm and the risk of malignancy (ROM) were calculated for each diagnostic category, and their diagnostic efficacy was evaluated. RESULTS:Thirty-five studies were included in the meta-analysis. The total number of SG-FNAs was 10,706, and 7168 of those had histopathologic follow-up. The ROM for each category was: nondiagnostic, 11.4%; nonneoplastic, 10.9%; atypia of undetermined significance, 30.5%; neoplasm-benign, 2.8%; neoplasm-salivary gland neoplasm of uncertain malignant potential, 37.7%; suspicious for malignancy, 83.8%; and malignant, 97.7%. Low-level heterogeneity was observed in ROM estimation. The sensitivity, specificity, and diagnostic odds ratio for differentiating malignant and benign lesions were 88.0%, 98.5% and 520.3, respectively. CONCLUSIONS: The reporting of SG-FNA using the MSRSGC demonstrated high diagnostic accuracy. The ROM for each category was generally concordant with the recommendations, except for the suspicious for malignancy category, which was significantly higher than the reference value. The tiered, standardized classification system would benefit the clinical management of salivary gland lesions. Cancer Cytopathol 2022;

The Use of the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy

“…To our knowledge, this is the first systematic review and meta-analysis regarding the use of the IAC Yokohama system for reporting breast FNAs. Similar works have been published about other cytopathology reporting systems, such as the Bethesda System for Reporting Thyroid Cytopathology, 33 the Milan System for Reporting Salivary Gland Cytopathology, 34 the Paris System for Reporting Urinary Cytopathology, 35 and the Papanicolaou System for Reporting Pancreatobiliary Cytopathology. 36 First, we calculated the pooled ROM of each reporting category, using the extracted data from 18 studies published between 2019 and 2021.…”

Rapid on‐site evaluation improves diagnostic performance of fine‐needle aspiration cytology for salivary lesions: Comparison of data from two cancer centers in southern China

“…Subsequent reports verified its value in the preoperative evaluation of salivary lesions. 2,5 However, ND category, defined as the aspirate provides insufficient diagnostic material to provide an informative interpretation due to qualitative and/or quantitative reasons, is one of the factors that handicaps the diagnostic efficacy of FNAC for salivary lesions. This may result from rare or absent cells less than 60 lesional cells, poorly prepared slides with artifacts (e.g., air-drying, obscuring blood, and poor staining) that preclude the evaluation of the cellular component, non-neoplastic (normal) salivary gland elements in the setting of a clinically or radiologically defined mass.…”

“…1 It has been reported that the FNAC of the salivary glands is highly specific for the detection of neoplasia (up to 98%) and malignancy (up to 96%). 2 However, it is less sensitive for the detection of neoplasia (up to 96%) and malignancy (up to 79%). 2 The primary purpose of salivary FNAC is to assess the nature of the lesions, namely nonneoplastic versus neoplastic and benign versus malignant.…”

“…2 However, it is less sensitive for the detection of neoplasia (up to 96%) and malignancy (up to 79%). 2 The primary purpose of salivary FNAC is to assess the nature of the lesions, namely nonneoplastic versus neoplastic and benign versus malignant. However, salivary gland cytopathology possesses its challenges because of the presence of a wide variety of both benign and malignant neoplasms, tumor heterogeneity, metaplastic changes, and cytomorphologic overlap between benign and malignant neoplasms.…”

“…3,4 A relative number of reports have been published to evaluate its diagnostic accuracy and value in guiding management decision-making. 2,5 Most of these reports came to a consensus that MSRSGC provides a good tool to evaluate salivary lesions and facilitates easier communication between clinicians and patients. However, there was moderate overall agreement among cytopathologists and low interobserver agreement regarding the indeterminate categories, particularly the subcategory of atypia of undetermined significance (AUS) and salivary gland neoplasm of uncertain malignant potential (SUMP).…”