Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi-institutional study

Zahra Maleki, Zubair Baloch, Ryan Lu, Khurram Shafique, Sharon J. Song, Kartik Viswanathan, Rema A. Rao, Holly Lefler, Aisha Fatima, Austin Wiles, Vickie Y. Jo, He Wang, Guido Fadda, Celeste N. Powers, Syed Z. Ali, Liron Pantanowitz, Momin T. Siddiqui, Ritu Nayar, Jerzy Klijanienko, Guliz A. BarkanJeffrey F. Krane, Esther D. Rossi, Fabiano Callegari, Ivana Kholová, Massimo Bongiovanni, William C. Faquin, Marc P. Pusztaszeri

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)306-315
Number of pages10
JournalCancer Cytopathology
Volume127
Issue number5
DOIs
StatePublished - May 2019

Keywords

  • Milan System for Reporting Salivary Gland Cytopathology (MRSSGC)
  • atypia of undetermined significance (AUS)
  • benign neoplasm
  • fine-needle aspiration (FNA)
  • malignant
  • nondiagnostic
  • nonneoplastic
  • risk of malignancy (ROM)
  • salivary gland neoplasm of uncertain malignant potential (SUMP)
  • submandibular gland
  • suspicious for malignancy (SM)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi-institutional study'. Together they form a unique fingerprint.

Cite this