Northern Italy in the American South: Assessing interobserver reliability within the Milan System for Reporting Salivary Gland Cytopathology

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized reporting system for salivary gland fine-needle aspiration (SGFNA). We review the clinical utility of the MSRSGC at a tertiary care cancer center by assessing the rates of malignancy (ROM) among different categories.Methods: A retrospective search was performed to retrieve all SGFNA cases performed at our institution between 1/1/07 and 12/31/18. The initial primary diagnoses were recorded and cases were then assigned to appropriate MSRSGC categories. ROM was then calculated for all categories.Results: A total of 976 cases were identified, and 373 with follow-up. The ROM was 19.7% (192/976) for all-comers and 51.3% (192/374) among cases with follow-up.Using MSRSGC, SGFNA showed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 65.6%, 87.4%, 100%, and 72.6%, respectively. ROM for MSRSGC categories I, II, III, IVa, IVb, V, and VI were 20.7%, 30.0%, 45.8%, 3.3%, 50.7%, 100%, and 100%, respectively. Utilizing MSRSGC resulted in a nondiagnostic rate of 14.4%. The nondiagnostic rate was lower when the procedure was performed by pathologists vs nonpathologists (12.9% vs 15.8%) but was comparable when rapid on site evaluation (ROSE) was performed (12.9% vs 11.6%).Conclusion: In our patient population, MSRSGC resulted in a perfect PPV and moderate NPV. Utilizing MSRSGC results in a higher nondiagnostic rate due to the inclusion of cases with benign elements or cyst contents only in this category. Performing ROSE is more important in attaining an adequate sample than the specialty of the person performing SGFNA. K E Y W O R D Sfine-needle aspiration, Milan system for reporting salivary gland cytopathology, salivary gland

Section: Discussioncontrasting

confidence: 85%

The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in‐house salivary gland fine‐needle aspiration cytology at a comprehensive cancer center

Lubin

Buonocore

Wei

et al. 2019

“…This rate was higher than that of the Milan system . However, the ROM for this category was reported as 16% and 17% in the two studies, respectively …”

Section: Discussionmentioning

confidence: 47%

The risk of malignancy according to Milan reporting system of salivary gland fine‐needle aspiration with Becton Dickinson SurePath liquid‐based processing

Sadullahoğlu¹,

Yıldırım²,

Çekiç³

et al. 2019

Background Fine‐needle aspiration cytology (FNAC) is a noninvasive, safe, cost‐effective, diagnostic procedure for the evaluation of salivary gland lesions and the selection of patients for surgery. The aim of this study was to analyze the risk of malignancy (ROM) according to the Milan reporting system of salivary gland FNA specimens using a liquid‐based cytology (LBC) technique. Methods The cytological diagnosis of 459 cases between 2014 and 2017 was revised according to the Milan reporting system. The FNAC results of 129 cases with a histological diagnosis were compared with respect to the final diagnosis. The ROM for each category calculated. Results The ROM was high in the indeterminate and malignant categories, while the ROM in the benign neoplasm category was low. Sensitivity and specificity analyzed in two different ways were 95.1% and 88.8%, 81%, and 77.7%, respectively. Conclusions When salivary gland lesions are evaluated together with clinical and radiological data, the LBC technique can be applied to salivary gland specimens based on the high diagnostic sensitivity and specificity in liquid‐based samples reported according to the Milan system.

“…The rate of neoplasia (RON) in the AUS and SUMP categories were 58% and 90.9%. Hollyfield et al reported similar findings with RON of 56% and 100% in the AUS and SUMP categories respectively. Within the AUS category the histologic diagnoses were variable with an approximate distribution of 25% between lymphomas, carcinomas, benign neoplasms and reactive conditions.…”

Section: Discussionmentioning

confidence: 59%

Risk stratification of salivary gland cytology utilizing the Milan system of classification

Savant

Cao

Chau

et al. 2018

Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is based on risk stratification. Our study is a retrospective review of salivary gland fine needle aspiration cytology (FNAC) with the goal of determining the risk of malignancy (ROM) in each of the categories proposed by the MSRSGC. Methods FNAC of salivary gland lesions with corresponding surgical resection specimens were retrieved over a 5‐year period. Metastatic tumors were excluded. BothFNAC and corresponding surgical resections were reviewed blindly and classified as per criteria published by the MSRSGC. The ROM for each of the diagnostic categories was determined and compared with the ROM published by the MSRSGC. Results The total number of entities and ROM in 199 reviewed cases were as follows: Nondiagnostic 18 (9.2%) (ROM 0%), non‐neoplastic 4(2%) (ROM 0%), atypia of undetermined significance (AUS) 12(6%) (ROM 33%), benign neoplasm 118(59.2%) (ROM 0.8%), salivary gland neoplasm of uncertain malignant potential (SUMP) 22(11%) (ROM 40.9%), suspicious for malignancy 3(1.5%) (ROM 100%), malignant 22(11%) (ROM 100%). Conclusion The ROM reported in our study was mostly concordant with ROM published by the MSRSGC. This classification is helpful for the management of categories; nondiagnostic, non‐neoplastic, benign neoplasm, suspicious for malignancy and malignant. The management is not standardized for the category, salivary gland neoplasm of uncertain malignant potential, as clinical information plays an important role in planning surgical procedures at an individual basis. Further studies will need to be performed using this new classification to help define appropriate management and predict ROM more accurately.