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. Barkan & 7 others Jeffrey F. Krane, Esther D. Rossi, Fabiano Callegari, Ivana Kholová, Massimo Bongiovanni, William C. Faquin, Marc P. Pusztaszeri

Research output: Contribution to journalArticle

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 1 2019

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Submandibular Gland
Salivary Glands
Neoplasms
Fine Needle Biopsy
Salivary Gland Neoplasms
Parotid Gland
Risk Management
Cell Biology

Keywords

  • atypia of undetermined significance (AUS)
  • benign neoplasm
  • fine-needle aspiration (FNA)
  • malignant
  • Milan System for Reporting Salivary Gland Cytopathology (MRSSGC)
  • 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

Cite this

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

In: Cancer Cytopathology, Vol. 127, No. 5, 01.05.2019, p. 306-315.

Research output: Contribution to journalArticle

Maleki, Z, Baloch, Z, Lu, R, Shafique, K, Song, SJ, Viswanathan, K, Rao, RA, Lefler, H, Fatima, A, Wiles, A, Jo, VY, Wang, H, Fadda, G, Powers, CN, Ali, SZ, Pantanowitz, L, Siddiqui, MT, Nayar, R, Klijanienko, J, Barkan, GA, Krane, JF, Rossi, ED, Callegari, F, Kholová, I, Bongiovanni, M, Faquin, WC & Pusztaszeri, MP 2019, 'Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi-institutional study', Cancer Cytopathology, vol. 127, no. 5, pp. 306-315. https://doi.org/10.1002/cncy.22135
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. / Application of the Milan System for Reporting Submandibular Gland Cytopathology : An international, multi-institutional study. In: Cancer Cytopathology. 2019 ; Vol. 127, No. 5. pp. 306-315.
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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.",
keywords = "atypia of undetermined significance (AUS), benign neoplasm, fine-needle aspiration (FNA), malignant, Milan System for Reporting Salivary Gland Cytopathology (MRSSGC), nondiagnostic, nonneoplastic, risk of malignancy (ROM), salivary gland neoplasm of uncertain malignant potential (SUMP), submandibular gland, suspicious for malignancy (SM)",
author = "Zahra Maleki and Zubair Baloch and Ryan Lu and Khurram Shafique and Song, {Sharon J.} and Kartik Viswanathan and Rao, {Rema A.} and Holly Lefler and Aisha Fatima and Austin Wiles and Jo, {Vickie Y.} and He Wang and Guido Fadda and Powers, {Celeste N.} and Ali, {Syed Z} and Liron Pantanowitz and Siddiqui, {Momin T.} and Ritu Nayar and Jerzy Klijanienko and Barkan, {Guliz A.} and Krane, {Jeffrey F.} and Rossi, {Esther D.} and Fabiano Callegari and Ivana Kholov{\'a} and Massimo Bongiovanni and Faquin, {William C.} and Pusztaszeri, {Marc P.}",
year = "2019",
month = "5",
day = "1",
doi = "10.1002/cncy.22135",
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volume = "127",
pages = "306--315",
journal = "Cancer cytopathology",
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TY - JOUR

T1 - Application of the Milan System for Reporting Submandibular Gland Cytopathology

T2 - An international, multi-institutional study

AU - Maleki, Zahra

AU - Baloch, Zubair

AU - Lu, Ryan

AU - Shafique, Khurram

AU - Song, Sharon J.

AU - Viswanathan, Kartik

AU - Rao, Rema A.

AU - Lefler, Holly

AU - Fatima, Aisha

AU - Wiles, Austin

AU - Jo, Vickie Y.

AU - Wang, He

AU - Fadda, Guido

AU - Powers, Celeste N.

AU - Ali, Syed Z

AU - Pantanowitz, Liron

AU - Siddiqui, Momin T.

AU - Nayar, Ritu

AU - Klijanienko, Jerzy

AU - Barkan, Guliz A.

AU - Krane, Jeffrey F.

AU - Rossi, Esther D.

AU - Callegari, Fabiano

AU - Kholová, Ivana

AU - Bongiovanni, Massimo

AU - Faquin, William C.

AU - Pusztaszeri, Marc P.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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.

AB - 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.

KW - atypia of undetermined significance (AUS)

KW - benign neoplasm

KW - fine-needle aspiration (FNA)

KW - malignant

KW - Milan System for Reporting Salivary Gland Cytopathology (MRSSGC)

KW - nondiagnostic

KW - nonneoplastic

KW - risk of malignancy (ROM)

KW - salivary gland neoplasm of uncertain malignant potential (SUMP)

KW - submandibular gland

KW - suspicious for malignancy (SM)

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