Retrospective assessment of the effectiveness of the Milan system for reporting salivary gland cytology: A systematic review and meta‐analysis of published literature

Abstract

Introduction: Fine needle aspiration (FNA) has been widely utilized in establishing the nature of salivary gland lesions and guiding the clinical management. This study aimed to determine the accuracy of FNA in detecting salivary gland neoplasms and malignancies, employing the "Milan System for Reporting Salivary Gland Cytopathology" (MSRSGC).Method: A systematic search was conducted. The data on FNA and histologic diagnosis were extracted and categorized based on the MSRSGC and risk of malignancy (ROM) was calculated.The risk of publication bias and level of heterogeneity were evaluated. A mixed-effects model was used to estimate FNA accuracy. Meta-regression was conducted to assess the potential effect of different variables on FNA accuracy.Results: Ninety-two studies with a total of 16 456 FNA with surgical follow-up were included.ROM was estimated as 17%, 8%, 34%, 4%, 42%, 58%, and 91%, in nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant groups, respectively. High level of heterogeneity was detected (P-value <.001). Including cases with definite FNA diagnosis of neoplasm or malignancy, summary estimates of FNA sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratio in detecting neoplasms and malignancies were 96.9%, 95.3%, 636.8, 20.5, and 0.03, and 80.5%, 97.9%, 189.5, 37.8, and 0.2, respectively. Metaregression showed several variables significantly impacting FNA accuracy; however, subgroup analysis did not reduce the level of heterogeneity.Conclusion: FNA can be used as a reliable diagnostic tool in the preoperative evaluation and management of salivary glands lesions. Concise of abstract is using Milan system for reporting salivary gland FNA could increase FNA reliability, facilitate communication, and improve patient care. K E Y W O R D Sdiagnostic accuracy, FNA, meta-analysis, Milan system for reporting salivary gland cytology, salivary gland malignancy, salivary gland neoplasm

A retrospective comparison of salivary gland fine needle aspiration reporting with the Milan system for reporting salivary gland cytology

“…Our ROM findings are largely comparable to other such studies recently published in the literature, which report similar findings (Table including that of a large meta‐analysis of 92 studies. The calculated ROMs in our cohort appear to be on a par with those found in similar salivary gland studies in the current literature.…”

A 4-Year Retrospective Analysis of Salivary Gland Cytopathology Using the Milan System for Reporting Salivary Gland Cytology and Ancillary Studies

“…The three other cases which were suspicious for epithelial malignancy were finally diagnosed as non-neoplastic (myofibroblastic granuloma) or benign neoplasm (two PA). Though, the ROM for SM is consistent with the MSRSGC (68.8% vs. 60%) and with the literature (68,8% vs. 79%, 59%, 58%) [9,11,16].…”

The Milan system for reporting salivary gland cytopathology: The clinical impact so far. Considerations from theory to practice

“…The publication of papers analysing the role of the Milan System has further defined the ROM . In a recent study by Tommola et al, the non‐diagnostic category had a 0% ROM; however, a recent meta‐analytic study by Farahani analysed 92 studies including 16,456 SG‐FNA with surgical follow‐up The data from this study revealed a 7% ROM for the non‐diagnostic category based on 44 cases with histological follow‐up. The series also supported the statement that the non‐diagnostic rate should be <10%.…”

“…The series also supported the statement that the non‐diagnostic rate should be <10%. Nevertheless, the rate of non‐diagnostic FNA in the studies conducted at general hospitals was 21.28% ± 17.47% as compared to 4.38% ± 2.32% performed at referral or tertiary centres demonstrating an advantage for the latter group . The most common clinical management is represented by a repeat FNA with the use of ultrasound guidance and/or rapid on‐site evaluation in order to prevent a second non‐diagnostic result .…”

“…The current commentary describes the diagnostic categories of the Milan System and the main features of them. Furthermore, we provide data from the most recent salivary series adopting the Milan System for reporting their salivary cases …”