Effectuation to Cognize malignancy risk and accuracy of fine needle aspiration cytology in salivary gland using “Milan System for Reporting Salivary Gland Cytopathology”: A 2 years retrospective study in academic institution

Background: Milan System for Reporting Salivary Gland Cytology (MSRSGC) was introduced to standardise the terminology and reporting of salivary gland cytology.The purpose of our study was to compare the conventional system and the proposed Milan System to look for concordance rates in cytohistopathologic correlation and any value addition to the conventional system.Methods: This was a retrospective cross sectional observational study. The fine needle aspiration cytology (FNAC) were reported in the conventional manner and were correlated with the surgical specimen. The cyto-histopathological correlation was studied to look for concordance rates. FNAC were retrospectively reviewed and were categorised according to the Milan system. These reports were correlated with surgical specimen category wise and concordance rates, risk of neoplasm (RON), risk of malignancy (ROM) were calculated.Results: Salivary gland FNAC done during the study period was 323 in number and histopathological correlation was available for 153 cases. The concordance rate of type specific diagnosis was 80.3% as per conventional system. With the application of Milan system, the concordance rates rose to 88.07% with an improvement of 6.67%(excluding non-diagnostic). RON and ROM for non-diagnostic (I)-50%, 50%; non-neoplastic (II)-22%,0%; atypia of unknown significance (III)-66%, 11%; benign neoplasm (IVA)-98%, 3%; salivary gland neoplasm of uncertain malignant potential (IVB)-93%,14%; suspicious for malignancy (V)-100%, 60% and malignant (VI) was 100%, 94%.Conclusion: The broad categorisation provided by the Milan system represents the gross rate of malignancy and helps in deciding the management plan and eventual surgical plan. Thus, it adds value to conventional reporting of salivary gland cytology.K E Y W O R D S FNAC, Milan system, salivary gland cytology

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“…This was in accordance with the <5% ROM as quoted by the Milan group Karuna et al—2.44% and Rohilla et al—2.4% …”

Section: Discussionsupporting

confidence: 92%

Incorporation of the Milan system in reporting salivary gland fine needle aspiration cytology—An insight into its value addition to the conventional system

Kaushik

Bhatia

Sarin

et al. 2019

Diagnostic Cytopathology

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“…The highly cellular aspirate and presence of fibroblasts has led to misdiagnosis of benign salivary gland tumor on FNAC. Our present study more or less correlated with the studies of Kala et al, Katta et al and Karuna et al [5][6][7] There were no cases reported in Category 4b and 5. Category 6 is for the smears that are diagnostic for malignant lesion, and histological follow up of 46 cases was available.…”

Section: Discussionsupporting

confidence: 93%

“…Other 36 cases in histopathology showed concordance with cytology. Our present study more or less correlated with the studies of Kala et al, Katta et al and Karuna et al [5][6][7] FNAC is an effective tool to distinguish benign and malignant neoplasm with high specificity 98%. 8 However, sometimes it is very difficult to differentiate between a benign neoplasm and low grade malignant neoplasm.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Cytohistological correlation of salivary gland tumours with emphasis on Milan system for reporting: A novel step towards internal quality assurance

K¹,

Raghavan²,

Sri³

et al. 2020

ACHR

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Background: Fine needle aspiration cytology (FNAC) is a cost-effective diagnostic technique for evaluation of salivary gland lesions. But, then, cytological evaluation of salivary gland lesions also has lot of challenges. To overcome the difficulties, "The Milan system for reporting salivary gland cytopathology" (MSRSGC) was introduced for diagnosis and management and establishing the risk of malignancy (ROM) in different categories. The present study was conducted to grade the salivary gland lesions according to Milan system of reporting and to correlate with their histopathological findings. Material and Methods : The current study was conducted in the department of Pathology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry for a period of 5 years. Around 153 salivary gland lesions were aspirated. Salivary gland swellings were examined clinically, correlated with the details on the request forms and ultrasound findings, palpated and aspirated. The cytological features were evaluated and categorized according to Milan System for Reporting Salivary Gland Cytopathology": Category 1: Nondiagnostic (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). They were further correlated with histopathological findings. All data were entered in MS excel sheet. Results : Total 153 cases were evaluated cytologically, and histological followup was available in 134 cases. The distribution of cases into different categories were as follows Non-Diagnsotic (2.6%), Non-Neoplastic (20.9%), Atypia of Undetermined Significance (1.9%), Neoplastic-Benign (41.1%),Salivary gland neoplasm of Uncertain Malignant Potential (0%), Suspicious of Maligancy (0%) and Malignancy (33.3 %). Risk of malignancy were observed in categories 2 and 6 and were 3.84 % and 78.2 %. Sensitivity of FNAC in diagnosing salivary gland lesions was 84.2 %, specificity was 98.21%,positive predictive value was 94.64%, and negative predictive value was 91.70% with an accuracy of 93.60%. Conclusion: MSRSGC is a novel reporting system in cytological diagnosis of salivary gland lesions. Implementation of this reporting system in cytological diagnosis has enabled establishment of adequate diagnosis, assessment of risk stratification and facilitating clinicians to take further step in management plan.

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“…Among all FNAs with histological follow-up, 22 out of 90 cases (24.4%) were non-neoplastic lesions, whereas 68 lesions (75.6%) were neoplastic and 16 lesions (17.8%) were malignant. The risk of neoplasm, the risk of malignancy, and the overall risk of malignancy were calculated for each MSRSGC category (Table 3) and compared with other MSRSGC studies [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26] and MSRSGC estimated ROMs (Table 4).…”

Section: Resultsmentioning

confidence: 99%

Salivary Gland FNA Diagnostics in a Real-Life Setting: One-Year-Experiences of the Implementation of the Milan System in a Tertiary Care Center

Tommola

Porre

et al. 2019

Cancers

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The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018 following other organ specific cytopathological reporting systems and it aimed at bringing a practical, evidence-based, user-friendly classification system with characterization and management algorithms. At the Department of Pathology, Fimlab Laboratories, Tampere, Finland all salivary fine needle aspirations (FNAs) have been given cytopathological diagnoses according to the MSRSGC since January 2018. Analyses of a one-year-period (January 2018–December 2018) consisted of 183 salivary FNA samples from 138 patients with correlation to histopathology in 90 cases with surgical follow-up. The MSRSGC performance in patient based analysis was as follows: accuracy was 90.9%, sensitivity was 61.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89.4%, respectively. Risks of malignancy (ROMs) in MSRSGC categories were: 0.0% (0/15) in non-diagnostic category, 100.0% (1/1) in non-neoplastic category biased by only one falsely-negative lymphoma case, 14.3% (1/7) in atypia of undetermined significance category, 0.0% (0/28) in benign neoplasm category, 27.3% (3/11) in neoplasm of uncertain malignant potential category, and 100% for both suspicious for malignancy (4/4) and malignancy (4/4) categories, respectively. The MSRSGC has been proven as a reliable classification system in salivary gland FNA routine diagnostics in a tertiary care center.

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Effectuation to Cognize malignancy risk and accuracy of fine needle aspiration cytology in salivary gland using “Milan System for Reporting Salivary Gland Cytopathology”: A 2 years retrospective study in academic institution

Cited by 34 publications

References 3 publications

Incorporation of the Milan system in reporting salivary gland fine needle aspiration cytology—An insight into its value addition to the conventional system

Incorporation of the Milan system in reporting salivary gland fine needle aspiration cytology—An insight into its value addition to the conventional system

Cytohistological correlation of salivary gland tumours with emphasis on Milan system for reporting: A novel step towards internal quality assurance

Salivary Gland FNA Diagnostics in a Real-Life Setting: One-Year-Experiences of the Implementation of the Milan System in a Tertiary Care Center

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