Iranian Journal of Pathology

Effectiveness of The Milan System for Reporting Salivary Gland Cytology: A 5-Year Retrospective Review

Document Type : Original Research

Authors

Afrooz Arashloo 1
Hana Saffar 2
Maryam Lotfi 2
Fereshteh Ameli 3

1 Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran

2 Department Pathology, School of Medicine Amir Alam Hospital Tehran University of Medical Sciences, Tehran, Iran

3 Department of Pathology, School of Medicine, Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

https://doi.org/10.30699/ijp.2024.2021304.3249
Abstract
Background & Objective: Use of fine needle aspiration cytology (FNAC) in the diagnosis of salivary gland neoplasms is controversial due to the diverse morphologic patterns and overlapping features between benign and malignant lesions. The Milan system has been introduced to report salivary gland cytopathology. The present study aimed to reclassify salivary gland lesions according to the Milan system for reporting salivary gland cytopathology (MSRSGC) to determine the risk of malignancy (ROM) and estimate the diagnostic accuracy of the Milan system.
Methods: In this retrospective cohort study, 136 salivary gland fine needle aspiration cytology samples taken from patients referred to Imam Khomeini and Amir-Aalam Hospital, Tehran, Iran, from 2016 to 2021, were retrieved along with the histopathological follow-up.  Cytology smears were reviewed and reclassified based on MSRSGC. In addition, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. 
Results: ROM for each category was 26.7% for non-diagnostic, 12.5% for non-neoplastic, 40% for atypia of undetermined significance (AUS), 0 for benign neoplasm, 0 for salivary gland neoplasm with uncertain malignant potential (SUMP), 100% for suspicious for malignancy, and 100% for malignant group. Sensitivity, specificity, PPV, and NPV in differentiating benign from malignant neoplasms based on MSRSGC were 75.9%, 100%, 100%, and 93.8%, respectively. Diagnostic accuracy was calculated as 94.8%.
Conclusion: MSRSGC may be associated with  a high accuracy in differentiation of  benign and malignant salivary gland neoplasms, indicating its potential value as an effective classification system for reporting salivary gland cytology. The ROM for cytological categories except SUMP can be almost similar to that suggested by MSRSGC.

Keywords

Milan System for Reporting Salivary Gland Cytopathology
Fine needle aspiration
Risk of malignancy
Salivary gland

Subjects

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Iranian Journal of Pathology
Volume 20, Issue 1
Winter 2025
Pages 76-83

  • Receive Date 24 January 2024
  • Revise Date 08 February 2024
  • Accept Date 16 March 2025

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