The Milan system for reporting salivary gland cytopathology: A study of inter‐observer reproducibility

Layfield, Lester J.; Esebua, Magda; Yang, Zhongbo; Vatzmitsel, Maryna; Giorgadze, Tamara; Schmidt, Robert L.

doi:10.1002/dc.24187

Cited by 21 publications

(39 citation statements)

References 23 publications

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“…However, it is well‐known that using the same diagnostic classification scheme does not eliminate observer bias. Several studies have examined the inter‐observer bias related to MSRSGC 13,45,46 . According to these studies, the overall Cohen's kappa score ranged from 0.4 to 0.8.…”

Section: Discussionmentioning

confidence: 99%

“…Only the studies which separated the NN from the benign neoplastic diagnoses upon histopathological follow‐up were included in calculating the FNA accuracy in detecting neoplasm 11,12,15,17,19,20,22,23,25,26,28,30‐38,40,45 . The studies which solely reported the cytologic‐histopathological correlation among the AUS, SUMP, and/or SM were excluded from the accuracy analyses.…”

Section: Methodsmentioning

confidence: 99%

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The Milan system for reporting salivary gland cytopathology: A comprehensive review of the literature

Jalaly

Farahani

Baloch

2020

Diagnostic Cytopathology

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Background The Milan system for Reporting Salivary Gland Cytopathology (MSRSGC) was published in 2018. Since then, many authors have published their institutional experience by retrospectively assigning salivary gland fine‐needle aspiration cases to each of the MSRSGC categories and calculated their risk of malignancy (ROM) accordingly. Methods We reviewed all published articles available online in English that used the MSRSGC since or near its publication. We calculated the risk of neoplasm and ROM for each diagnostic category. In addition, the false‐negative and false‐positive rates from all studies were examined. Results Thirty‐seven articles were identified in the English literature; 2 were published in 2017, 14 in 2018, 18 in 2019, and 3 in 2020. The total number of cases was 16 394, and 8 468 had surgical follow‐up. The mean ROM was 16.9% for category I, 10.5% for category II, 39.3% for category III, 2.9% for category IVa, 39.4% for category IVb, 84.2% for category V, and 97.5% for category VI. The mean false‐negative rate for MSRSGC categories II and IVa was 4.5%. Similarly, the mean false‐positive rate for MSRSGC categories V and VI was 5.1%. Conclusion A tiered classification scheme of MSRSGC is helpful in effectively guiding clinical management of patients with salivary gland lesions. The reported mean ROM for each category in most studies is within the recommended range published by the MSRSGC.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Milan system for reporting salivary gland cytopathology: A comprehensive review of the literature

Jalaly

Farahani

Baloch

2020

Diagnostic Cytopathology

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“…Only with a significant level of interobserver agreement for each of the diagnostic categories can the system succeed in clarifying the meaning of diagnostic terms such as “atypical” and “suspicious for malignancy.” Diagnostic accuracy depends on a variety of factors including clinical features [9, 10] and the skill of the individual obtaining the cytologic material [11, 12]. The impact of the cytopathological interpretation is also of great importance and studies of other categorization systems at other body sites have shown variability in interobserver agreement [13-15]. While the ROM and predictive values for the IAC YSRB have been reported [7, 8, 16], little information is available on the interobserver reproducibility of the 5 categories.…”

Section: Introductionmentioning

confidence: 99%

Interobserver Agreement for the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

et al. 2020

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Background: A number of guidelines have been developed to improve standardization of the terminology and criteria for cytologic specimens obtained from the thyroid, pancreas, lung, and salivary glands. A major goal of these guidelines is to improve reproducibility and understanding of the reporting of diagnostic results among cytopathologists and between cytopathologists and clinicians. The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology (IAC YSRB) is the most recent of these guidelines. The value of this system is, in part, dependent upon interobserver reproducibility. Design: Ninety consecutive fine-needle aspiration biopsies (FNAB) of the breast, performed over a 6-year period, were independently evaluated by 4 board-certified pathologists blinded to the original diagnoses. The 5 diagnostic categories used were those of the IAC YSRB according to published criteria for these categories. Observed agreement and chance corrected agreement (Fliess κ) were calculated. Differences in κ values were evaluated using the T statistic of Gwent. Statistical calculations were performed using STATA v16.0 (STATA Corp., College Station, TX, USA). Results: Overall agreement between observers was good. Observed unweighted agreement was 69% and weighted agreement was 91%. The majority of diagnoses were concordant (68.6%). Conclusions: Interobserver agreement of 4 cytopathologists was good using the 5 categories of the IAC YRSB (69%). Agreement was greater among pathologists with more years of experience. The IAC YSRB system appears to provide greater agreement among viewers than guidelines for cytologic specimens obtained from some other body sites (salivary gland and lung). Most discrepancies were only by a single category, with only 22/113 (19%) differing by more than one category.

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“…11 et al observed moderate overall agreement with a κ score of 0.42 on 408 salivary gland FNAs. The highest interobserver agreement was noted with the BN category (κ score, 0.71) and the high‐grade M category (κ score, 0.72), whereas the indeterminate categories AUS, SUMP, and SFM had the lowest interobserver agreement with κ scores of 0.15, 0.17, and 0.17, respectively 22 . Finally, before publication of the MSRSGC, the MIRST, a recently published, web‐based interobserver study using a 75‐image study set, was initiated to explore potential cytomorphologic sources of IOV.…”

Section: Discussionmentioning

confidence: 95%

Interobserver variability between cytopathologists and cytotechnologists upon application and characterization of the indeterminate category in the Milan System for Reporting Salivary Gland Cytopathology

Viswanathan

Patel

Abdelsayed

et al. 2020

Cancer Cytopathology

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Background The indeterminate categories in the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) are diagnostically challenging because of inherent heterogeneity and complexity, with wide interobserver variability (IOV). Herein, the authors explore the concordance rate (CR) between cytopathologists (CPs) and cytotechnologists (CTs) in interpreting indeterminate salivary gland lesions using the MSRSGC. Methods Between 2011 and 2016, 86 indeterminate fine‐needle aspirations had slides available for review, of which 48 had follow‐up. Four CPs and 2 CTs performed an independent, blinded review of these slides and categorized them according to the MSRSGC. The CRs between CTs and CPs with the final sign‐out cytopathologist (FCP) were assessed, and interobserver agreement was categorized into uniform, majority, divided, minimal, or no agreement. Results The overall CR with the FCP ranged from 48.8% to 60.5% for CPs and from 22.1% to 36% for CTs. IOV κ scores for the entire group were 0.314 and, with the FCP as the reference, ranged from 0.403 to 0.539 for CPs and from 0.091 to 0.254 for CTs. Uniform, majority, divided, minimal, and no agreement was noted in 12.8%, 31.4%, 38.4%, 10.5%, and 6.9%, respectively, of all cases and in 16.7%, 35.4%, 31.3%, 8.3%, and 6.3%, respectively, of the cases with follow‐up. Diagnostic challenges included distinguishing lymphoma from a reactive process and distinguishing mucin from mucin‐like material. Conclusions CPs had modestly higher CRs compared with CTs; and, although the variable CRs highlight indeterminate IOV, the MSRSGC enables reproducibility. Characterizing larger cohorts in the indeterminate categories will further improve MSRSGC criteria. Moreover, education on the MSRSGC should include CTs and CPs to improve overall diagnostic accuracy.

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The Milan system for reporting salivary gland cytopathology: A study of inter‐observer reproducibility

Cited by 21 publications

References 23 publications

The Milan system for reporting salivary gland cytopathology: A comprehensive review of the literature

The Milan system for reporting salivary gland cytopathology: A comprehensive review of the literature

Interobserver Agreement for the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

Interobserver variability between cytopathologists and cytotechnologists upon application and characterization of the indeterminate category in the Milan System for Reporting Salivary Gland Cytopathology

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