The Milan System for Reporting Salivary Gland Cytopathology—Proposed modifications to improve clinical utility

Mazzola, Francesco; Gupta, Ruta; Luk, Peter P.; Clark, Jonathan; Low, Tsu-Hui Hubert

doi:10.1002/hed.25732

Cited by 18 publications

(24 citation statements)

References 13 publications

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“…In the present study, the ROM for each category was lower in the ND (5.1%), NN (0%), AUS (12.9%), BN (0%), and SUMP (32.1%) categories, but higher in the SFM (85.7%) and M (100%) categories compared with values provided by the MSRSGC (Table 1). Stratification of the ROM was performed as well or better in the present study than previous studies (Table 6) [13,[15][16][17][18][19][20][21][22].…”

Section: Discussion/conclusionsupporting

confidence: 67%

Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

et al. 2020

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Objective: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a recently published evidence-based categorization system for salivary gland fine-needle aspiration (FNA). We applied MSRSGC to Japanese cases and evaluated its utility. Study Design: A total of 480 FNA cases were reviewed. We recategorized each case into one of the MSRSGC categories. The risk of neoplasm (RON) and the risk of malignancy (ROM) for each diagnostic category in MSRSGC, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for malignancy and for neoplasms were calculated for cases with histological follow-up. In addition, the overall ROM (O-ROM) was calculated for all FNA cases. Results: RON, ROM, and O-ROM rates were as follows – non-diagnostic: 51.3, 5.1, and 1.0%; non-neoplastic: 0, 0, and 0%; atypia of undetermined significance: 83.9, 12.9, and 7.3%; neoplasm, benign: 100, 0, and 0%; salivary gland neoplasm of uncertain malignant potential: 100, 32.1, and 23.7%; suspicious for malignancy: 100, 85.7, and 60%; and malignant: 100, 100, 81.8%. The sensitivity, specificity, and accuracy with (without) indeterminate cases for malignancy were 65 (100), 99 (99), 92% (99%) and PPV and NPV were 96 and 100%, respectively, and those for neoplasms were 84 (100), 100 (100), 85% (100%), and PPV and NPV were 100 and 100%, respectively. Conclusions: The MSRSGC is useful for stratification of ROM and for promoting the performance of salivary gland FNA. The MSRSGC could be easily introduced in Japan and may improve the Japanese salivary gland FNA status.

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Section: Discussion/conclusionsupporting

confidence: 67%

Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

et al. 2020

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“…Previous studies reporting on the ROMs for MSRSGC categories have shown variation in the distribution of ROMs, especially in the MSRSGC I, II, III, and IVb categories 5‐14 . These studies are summarized in Table 6.…”

Section: Discussionmentioning

confidence: 98%

“…Numerous studies have assessed the accuracy of cytopathological evaluation using the MSRSGC tool; these have concluded that this tool can make a valuable contribution to the management of a parotid gland mass 5‐14 . Unfortunately, most of these studies have lacked large groups and have been mostly single‐institution or bi‐institutional studies.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of parotid gland FNA cytology and reliability of the Milan System for Reporting Salivary Gland Cytopathology in clinical practice

Reerds

Grunsven

Hoogen

et al. 2021

Cancer Cytopathology

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BACKGROUND: Differentiating between malignant and benign salivary gland tumors with fine-needle aspiration cytology (FNAC) can be challenging. This study was aimed at testing the validity of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and at assessing possible differences in the sensitivity and specificity of parotid gland FNAC between dedicated head and neck (H&N) centers, subdivided into head and neck oncology centers (HNOCs) and head and neck oncology affiliated centers (HNOACs), and general hospitals (GHs). METHODS: The Dutch Pathology Registry (PALGA) database was searched for patients who had undergone a salivary gland resection between January 1, 2006, and January 1, 2017, and had a preoperative FNAC result. The FNAC reports were retrospectively assigned to MSRSGC categories. The risk of malignancy (ROM) was calculated for each category. The sensitivity and specificity for diagnosing malignancy were calculated and compared among HNOCs, HNOACs, and GHs. RESULTS: In all, 12,898 FNAC aspirates were evaluated. The ROMs for each category were as follows: 12.5% in MSRSGC I, 10.3% in MSRSGC II, 29% in MSRSGC III, 2.3% in MSRSGC IVa, 28.6% in MSRSGC IVb, 83% in MSRSGC V, and 99.3% in MSRSGC VI. The sensitivity of FNAC was highest in HNOCs (88.1%), HNOACs scored lower (79.7%), and GHs had a sensitivity of 75.0%. CONCLUSIONS: The MSRSGC is a valid tool for reporting parotid gland FNAC; therefore, these results strongly advocate its use. On the basis of the higher sensitivity of FNAC in dedicated H&N centers, the authors recommend that GHs use the presented management strategies to help to minimize the chances of a preoperative misdiagnosis. Cancer Cytopathol 2021;0:1-10.

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“…As most WTs are classified correctly as category 4A—benign neoplasm with ROM less than <5%, the majority of category 4A lesions, as well as WT, can be managed by conservative surgical resection or, in some patients, followed clinically to avoid potential surgical complications …”

Section: Diagnostic Accuracy Of Cytopathology For Salivary Gland Lesimentioning

confidence: 99%

Cytopathology and diagnostics of Warthin's tumour

Sučić

Ljubić²,

Perković³

et al. 2020

Cytopathology

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Warthin's tumour (WT) is a benign epithelial salivary tumour, one type of salivary adenoma. Histologically, WT is structured of two components, epithelial tissue that often lines cystic formations and lymphoid tissue in the tumour stroma. FNA is a reliable diagnostic approach in the diagnosis of salivary gland lesions allowing a highly accurate categorization of benign tumour‐like lesions, benign tumours and malignant tumours. In the proposed Milan reporting system of salivary gland lesions, WT is categorized in the IVA group of benign neoplasms. Accurate cytological diagnosis is straightforward when three characteristic components are present: oncocytes, either isolated or associated in clusters, lymphocytes and lymphoid cells and often an inflammatory/necrotic‐like substance. Also, specific features of scintigraphy and radiological imaging contribute to the diagnosis of WT. WT is categorized according to Seifert G. et al in 4 types, depending on the proportions of the epithelial component and lymphoid stroma. Differential cytopathological and pathohistological diagnosis include other salivary gland lesions with lymphoid, oncocytic epithelial and cystic components. In some cases, such as the metaplastic WT variant, there are additional cytopathological and histological diagnostic difficulties. Moreover, bilateral, multicentric or multiple and infrequently seen extra‐salivary localizations of WT are associated with further cytopathological diagnostic difficulties. Also, a rare possibility of malignant transformation of the epithelial or lymphoid component of WT as well as possible association with other primary tumours remains a challenge in accurate cytopathological and histological diagnosis of WT.

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The Milan System for Reporting Salivary Gland Cytopathology—Proposed modifications to improve clinical utility

Cited by 18 publications

References 13 publications

Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

Accuracy of parotid gland FNA cytology and reliability of the Milan System for Reporting Salivary Gland Cytopathology in clinical practice

Cytopathology and diagnostics of Warthin's tumour

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