UTILITY OF MILAN SYSTEM FOR SALIVARY GLAND CYTOPATHOLOGY IN A TERTIARY CARE HOSPITAL IN WESTERN INDIA: AN INSTITUTIONAL EXPERIENCE

Abstract

Introduction: Fine-needle aspiration cytology (FNAC) can be challenging to provide a precise diagnosis in salivary gland cytopathology due to diversity of lesions and cytomorphological convergence between the tumors and within the same tumor of salivary gland. The recently proposed Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a risk stratication-based classication system with an intrinsic risk of malignancy (ROM) for each diagnostic category, which aims to furnish useful information to the clinicians. This study was undertaken to evaluate the diagnostic utility and validity of MSRSGC. A 4-year retrospective Materials and Methods: study was conducted at a tertiary care hospital in Central Gujarat in Western India. A total of 90 cases of FNAC of salivary gland lesions for the period of January 2018 to March 2021 were reviewed. Patient clinical details, FNAC smears and histological slides where available were retrieved from the departmental records. Results: The cases belong to following categories: non-diagnostic (4.4%), non-neoplastic (10%), atypia of undetermined signicance (1.1%), benign neoplasm (68.9%), salivary gland neoplasm of uncertain malignant potential (8.9%), suspicious for malignancy (2.2%), and malignant (4.4%). Out of 90 cases, 62 cases (68.8%) had follow-up. The ROM were 7.6% for category IV—A and 50% for category IV-B. The sensitivity, specicity, positive predictive value, negative predictive value, and likelihood ratio for differentiating between benign and malignant lesions were recorded as 98.1%, 42.9%, 92.8%, 75.0%, and 1.750, respectively. Conclusion: Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC. The Milan system of reporting is a risk stratication system which can improve the overall effectiveness of reporting and care of patients.