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Background: The purpose of this study was to determine the pathological and ultrasound (US) features of benign nonpalpable breast lesions (NPBLs) classified as Breast Imaging Reporting and Data System (BI‐RADS) category 4C or 5. Methods: Between 2003 and 2007, 849 consecutive NPBLs detected at US and classified as BI‐RADS category 4C (505) or 5 (344) initially underwent US‐guided fine needle aspiration (FNA) at our institution. Benign diagnoses were established according to surgical excision findings or during a minimal 6‐month imaging follow‐up (mean, 3.7 years [SD, 2.6 years]). US BI‐RADS features were reviewed and compared retrospectively using a chi‐square test for the following pathological categories: epithelial and fibrous proliferation (EFP), cystic and papillary lesion (C&P), inflammatory lesion (IL), benign tumor (BT), intramammary lymph node (ILN), intraepithelial proliferative lesion (IPL), and nonspecific morphological alteration (NMA). The performance of FNA in the diagnosis of benignity was assessed. Results: Of 849 NPBLs, 110 (12.9%) NPBLs were benign: 88 (17.4%) were BI‐RADS category 4C, and 22 (6.4%) were BI‐RADS category 5. Forty‐four (40%) were EFPs, 21 (19%) were C&Ps, 13 (12%) were NMAs, 11 (10%) were ILs, 11 (10%) were BTs, 8 (7%) were IPLs, and 2 (2%) were ILNs. Lesion shape, US pattern distribution, and posterior features showed statistically significant differences between these categories (P <.05): 33 (75%) EFPs exhibited posterior shadowing, 18 (86%) C&Ps were homogenous, 9 (82%) ILs were heterogeneous, 11 (100%) BTs were homogeneous, 9 (82%) BTs were oval, and 6 (75%) IPLs were irregularly shaped. Of the 110 benign NPBLs, FNA diagnosis was falsely positive in 7 (6%), suspicious in 10 (9%), and benign in 90 (82%), and 3 (3%) were inadequate for diagnosis. Conclusion: A diverse array of benign NPBLs can be classified as BI‐RADS category 4C or 5 on US, each showing specific imaging presentations. This article describes the ultrasound, cytological and histological features of benign non‐palpable breast lesions classified as highly suspicious for malignancy on imaging studies (BIRADS categories 4C and 5) and sampled by USFNA. [ABSTRACT FROM AUTHOR]

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) represents a standardized, evidence‐based reporting system for salivary gland fine‐needle aspiration (FNA). The role of FNA is well established for the preoperative evaluation of patients with salivary gland lesions; however, the lack of a uniform system for salivary gland FNA has limited its effectiveness. To address this, an international panel of experienced cytopathologists proposed a uniform reporting system in 2015 under the sponsorship of the American Society of Cytopathology and the International Academy of Cytology. The MSRSGC consists of 6 diagnostic tiers: 1) nondiagnostic, 2) non‐neoplastic, 3) atypia of undetermined significance, 4) neoplasm (subdivided into benign and salivary gland neoplasm of uncertain malignant potential), 5) suspicious for malignancy, and 6) malignant. On the basis of evidence from the literature, each category has a suggested risk of malignancy that ranges from 5% for the neoplasm‐benign category to >90% for the malignant category. The overall goal of the MSRSGC is to improve the effectiveness of salivary FNA by providing a uniform system with the ultimate result of better communication and improved patient care. The role of FNA is well established for the pre‐operative evaluation of patients with salivary gland lesions; however, the lack of a uniform system for salivary gland FNA (SG FNA) has limited its effectiveness. To address this, an international panel of experienced cytopathologists in 2015 proposed a uniform reporting system under the sponsorship of the American Society of Cytopathology (ASC) and the International Academy of Cytology (IAC): the Milan system for reporting salivary gland cytopathology. [ABSTRACT FROM AUTHOR]

Background: An international panel of experts in the field of salivary gland cytology (SGC), supported by the American Society of Cytopathology (ASC) and the International Academy of Cytology, conducted a survey to seek evidence and practice patterns regarding SGC. Results were used to provide focus for the proposed Milan System for Reporting Salivary Gland Cytopathology.Methods: The study group, formed during the 2015 European Congress of Cytology held in Milan, Italy, generated a survey that included 49 specific questions related to the taxonomies, practices, and diagnostic entities of salivary cytology. Qualtrics software was used as the study platform. Software and server support were provided by the division of information technology at the University of Wisconsin. The survey was available online from November 2015 until February 2016. Participants were invited through the Web sites of the ASC, the International Academy of Cytology, and the Papanicolaou Society of Cytopathology as well as by the ASC e-mail "ListServe"; responses were evaluated by the Milan System editors.Results: Responses from a total of 515 participants were collected and reviewed. A total of 347 participants provided demographic data information. Responses revealed variations in diagnostic practice and subsequent management. Participants believed that the acceptable rate for nondiagnostic samples should not be higher than 10%. There were varied opinions regarding the approach to neoplastic lesions of uncertain malignant potential, those that may or may have not local invasion and distant spread.Conclusions: Results of the survey demonstrated strong support for the development of a unified system for reporting SGC. Cancer Cytopathol 2017;125:757-66. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]