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Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi‐institutional study
Author(s) -
Maleki Zahra,
Baloch Zubair,
Lu Ryan,
Shafique Khurram,
Song Sharon J.,
Viswanathan Kartik,
Rao Rema A.,
Lefler Holly,
Fatima Aisha,
Wiles Austin,
Jo Vickie Y.,
Wang He,
Fadda Guido,
Powers Celeste N.,
Ali Syed Z.,
Pantanowitz Liron,
Siddiqui Momin T.,
Nayar Ritu,
Klijanienko Jerzy,
Barkan Guliz A.,
Krane Jeffrey F.,
Rossi Esther D.,
Callegari Fabiano,
Kholová Ivana,
Bongiovanni Massimo,
Faquin William C.,
Pusztaszeri Marc P.
Publication year - 2019
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.29
H-Index - 57
eISSN - 1934-6638
pISSN - 1934-662X
DOI - 10.1002/cncy.22135
Subject(s) - medicine , cytopathology , atypia , malignancy , submandibular gland , salivary gland , fine needle aspiration , pathology , cytology , radiology , biopsy
Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6‐tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fine‐needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs. Methods Submandibular gland FNA cytology specimens from 15 international institutions (2013‐2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow‐up was performed, and the ROM was calculated for each MSRSGC diagnostic category. Results The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%‐50%); nonneoplastic, 24.2% (9.1%‐53.6%); AUS, 6.7% (0%‐14.3%); benign neoplasm, 18.3% (0%‐52.5%); SUMP, 12% (0%‐37.7%); SM, 3.5% (0%‐12.5%); and malignant, 13.9% (2%‐31.3%). The histopathologic follow‐up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. Conclusions This multi‐institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA.