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Recently, significant advances in the molecular characterization of salivary gland neoplasms have facilitated the classification and diagnosis of specific diagnostic entities. In the highly challenging diagnostic scenario of salivary malignancies, molecular testing is increasingly being adopted in routine practice to refine the cytological diagnosis of salivary lesions. Here, we reviewed the most recent evidence in the field of salivary glands molecular cytopathology. [ABSTRACT FROM AUTHOR]

The use of standardised reporting systems for non‐gynaecologic cytopathology has made enormous gains in popularity during the past decade, including for thyroid fine‐needle aspiration, urine cytology, serous effusions, pancreas, lymph nodes, lung and more. In February 2018, the first edition of the Atlas of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was published. The MSRSGC defines six diagnostic fine‐needle aspiration categories encompassing the spectrum of non‐neoplastic, benign and malignant lesions of the salivary glands. The goal of the MSRSGC is to combine each diagnostic category with a defined risk of malignancy and a specific clinical and/or surgical management algorithm. Since its initial publication in 2018, more than 200 studies and commentaries have been published, confirming the role of the MSRSGC. The second edition of the MSRSGC, published in July 2023, includes refined risks of malignancy based on systematic reviews and meta‐analyses, a new chapter summarising the use of salivary gland imaging, new advances in ancillary testing and updates in nomenclature. The second edition of the Milan System for Reporting Salivary Gland Cytopathology, published in July 2023, includes refined risks of malignancy based on systematic reviews and meta‐analyses, a new chapter summarising the use of salivary gland imaging, new advances in ancillary testing, updates in nomenclature and a guide to the practical application of the latest ancillary markers for the diagnosis of selected salivary gland fine‐needle aspiration cases. [ABSTRACT FROM AUTHOR]

Background: The diverse morphology and varying reporting terminology of salivary gland lesions present several challenges to pathologists and clinicians when making a cytological diagnosis. The Milan system for reporting salivary gland cytopathology was introduced as a solution to address these shortcomings. The objective of this study was to classify cases of salivary gland pathology that were diagnosed through histopathological examination using the Milan system, and to establish a correlation between the Milan system and the histopathological diagnosis. The objective of the study is to evaluate the effectiveness of the Milan system and the likelihood of malignancy in each category. Materials and Methods: This study is a retrospective analysis that spanned a period of eighteen months. The study encompassed all instances of salivary gland pathology with fine-needle aspiration cytology findings recorded between March 2021 and September 2022. These cases were subsequently categorized based on the Milan system. Histopathologyfollow-up was conducted in 58 cases, and the risk of malignancy was assessed. The metrics of sensitivity, specificity, positive predictive value, and negative predictive value were computed by employing histopathological diagnosis as the reference standard. Results: A total of 77 cytology slides were examined, and the Milan system was utilized for evaluation. Follow-up histopathology was obtained in 58 cases. The distribution of cases across different categories was as follows: nondiagnostic (9.27%), nonneoplastic (4.64%), atypia of undetermined significance (3.97%), benign neoplasm (23.84%), neoplasm of uncertain malignant potential (8.61%), suspicious for malignancy (11.92%), and malignant (37.75%). The Milan system demonstrated a sensitivity of 94.20%, specificity of 96.00%, positive predictive value of 98.48%, and negative predictive value of 85.71%. Conclusion: The Milan system demonstrates superior sensitivity and specificity when compared to histopathology. This system is beneficial for both pathologists and clinicians as it ensures consistency in reporting terminology by categorizing salivary gland lesions into subcategories that have prognostic significance. [ABSTRACT FROM AUTHOR]

Background: Fine‐needle aspiration cytology (FNAC) represents an important diagnostic tool for the workup of salivary gland (SG) lesions. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a six‐tiered system for standardizing diagnoses and improvement of communication between pathologists and clinicians, providing risk of malignancy (ROM) rates for every category. The aims of the present study were (i) to validate the use of MSRSGC in a large series of SG FNAC in a tertiary center in Switzerland, (ii) to determine ROM for each category and compare them with data from MSRSGC and similar studies, and (iii) to investigate whether there were relevant differences of non‐diagnostic results between fine‐needle aspirations (FNA) performed by cytopathologists compared to non‐cytopathologists. Methods: The files of the department of Pathology in the University Hospital Zurich (UHZ) were searched for SG FNAC between 2010 and 2019. The MSRSGC guidelines were applied retrospectively. Furthermore, ROM, risk of neoplasia (RON), sensitivity, and specificity were calculated based on the cases with histopathological follow‐up. Results: A total of 2156 SG FNAC including 753 cases with histopathological follow‐up were evaluated. Generally, ROM was within the range of values provided by MSRSGC, with some minor deviations. Sensitivity was 94.6%, and specificity was 99.3%. Conclusions: Our study confirms the usefulness of MSRSGC. In addition, it provides a detailed insight into the wide spectrum of SG FNAC. Finally, we showed that the rate of non‐diagnostic FNA was significantly lower in FNAs performed by cytopathologists compared to non‐cytopathologists. [ABSTRACT FROM AUTHOR]

Introduction: Salivary gland neoplasms account for approximately 5% of head and neck tumours. The cytomorphology of fine needle aspiration material helps determine the preoperative assessment and risk stratification. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was developed to improve communication between the laboratory and treatment provider. Aims and objective: In the present study, we stratified all salivary gland lesions according to the MSRSGC and evaluated each category's concordance and risk of malignancy (ROM). Materials and methods: This was a 5 year retrospective study. First, all cases were assigned to one of the six MSRSGC categories. Then, following cytohistological correlation, the concordance rates and ROM were calculated based on the final histopathology report. Results: A total of 354 cases were identified, with ages ranging from 2 to 88 years and the commonest age group was the 3rd to 4th decades. Categories I, II, III, IVA, IVB, V, and VI comprised 5.37% (19/354), 26.84% (95/354), 1.13% (04/354), 51.41% (182/354), 1.98% (07/354), 1.13% (04/354), and 12.15% (43/354) of the cases, respectively. The overall concordance rate between the cytological and histopathological diagnoses was 81.25% (65 out of 80 cases), with the sensitivity, specificity, positive predictive value, and negative predictive value at 43.48%, 96.49%, 83.33%, and 80.88%, respectively. Conclusion: The MSRSGC provides a better objective and structured way to communicate with the health care provider. In our study, the overall concordance rate was observed in 62/80 cases, with maximum concordance seen in categories III, IVB, and V of the MSRSGC. [ABSTRACT FROM AUTHOR]

Context: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standardised six‐tier reporting format aimed at ensuring better communication and improved patient management. Aims: The main objectives of our study were to classify salivary gland fine needle aspirates into six categories of the MSRSGC and assess risk of malignancy (ROM), specificity, sensitivity, positive predictive value, and negative predictive value. Settings and design This retrospective study covered a period of three years from January 2017 to December 2020. Materials and methods: All salivary gland FNAs performed in the above period were retrieved and classified into six categories based on the Milan system. Histopathological diagnosis was also retrieved wherever available. Statistical analysis: Using histopathological diagnosis as the gold standard, ROM was calculated. Specificity, sensitivity, positive and negative predictive values, and diagnostic accuracy were also assessed. Results: Out of the 202 salivary gland FNAs, histopathological diagnosis was available in 102 cases. ROM for the Non‐Diagnostic, Non‐Neoplastic, Atypia of Undetermined Significance (AUS), Benign, Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP), Suspicious for Malignancy (SM), and Malignant categories was 30%, 8.3%, 25%, 3.9%, 33.3%, 71.4%, and 93.3% respectively. Highest specificity and diagnostic accuracy were achieved when only Malignant and SM were considered as positive results. Maximum sensitivity was observed when AUS, SUMP, SM, and Malignant were included in positive test results. Conclusion: The MSRSGC is an excellent system for accurately classifying salivary gland FNAs with better reproducibility of reports and enhanced communication between pathologist and surgeon. [ABSTRACT FROM AUTHOR]

Introduction: The cytopathology and diagnostic accuracy of salivary gland (SG) polymorphous adenocarcinoma (PAC) is the subject of a limited number of reports. We undertook a review of our experience with fine needle aspiration (FNA) biopsy and PAC. Materials and methods: A search was made of our cytopathology files for PAC cases that also had histopathological confirmation. FNA biopsy smears and cell‐blocks were performed and examined using standard techniques. Results: Eight FNA biopsy cases of histologically proven PAC from 7 patients [F:M = 1.3:1, age 39‐75 years, mean = 58] met study inclusion. Metastatic aspirates were most common (4), followed by 3 primary cases and 1 locally recurrent neoplasm. Primary FNA sites included hard palate (1 case), lip (1), and lateral tongue (1); all metastatic sites were in the neck. A precise cytologic diagnosis was made in 38% of cases; however, when applying the Milan classification system, 100% could be categorised as either malignant or of uncertain malignant potential. Ancillary immunohistochemical testing performed in 44% of the cases was non‐specific. Cytologic smears showed cellular uniformity and structural variety of cell groups with tubular, branching, cribriform, and convex patterns as well as variable, but occasionally abundant globular myxoid stroma leading to confusion with adenoid cystic carcinoma. Conclusion: The imitative cytopathology of PAC with other SG neoplasms as well as its infrequency in routine FNA biopsy practice makes specific interpretation difficult, but using a classification system allows for appropriate patient management. Molecular testing in future specimens holds promise for enhancing diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Objective: Rapid on‐site evaluation (ROSE) is a fine needle aspiration (FNA) technique for ensuring sampling adequacy and triaging samples. The Milan system for reporting salivary gland cytopathology (MSRSGC) is a standardised reporting system which aims to improve risk stratification. There is scant literature on the diagnostic value and agreement of MSRSGC on ROSE with final cytological diagnosis in salivary gland FNAs. We aimed to assess the concordance of MSRSCG categorisation and diagnosis on ROSE with final cytological and histological diagnosis. Methods: This prospective study included consecutive salivary gland FNAs for which ROSE was performed over a six‐month period. MSRSGC category and diagnosis on ROSE were compared with the final cytological diagnosis and MSRSGC category, and histopathological diagnosis, where available. Results: Sixty salivary gland aspirates were included. The adequacy rate with ROSE was 100%. Using the MSRSGC classification during ROSE, 26 (43.2%) samples were categorised as benign neoplasm, 21 (35%) as malignant neoplasm, 9 (15%) as non‐neoplastic, and one each (1.7%) belonged to the remaining four categories. MSRSGC categorisation on ROSE concurred with final the cytological diagnosis in 58/60 cases (96.7%). Discrepancies in MSRSGC categories on ROSE included one atypia of undetermined significance with final report as non‐neoplastic, and one non‐diagnostic as suspicious for malignancy. Good correlation of MSRSGC categories on ROSE with final histopathological diagnosis (88.9% concordance) was also noted. Conclusions: MSRSGC on ROSE shows good concordance with final cytology and histopathology diagnosis, indicating that categorisation according to MSRSGC has utility in ensuring that adequate material is obtained and triaged appropriately for the diagnosis of salivary gland aspirates. [ABSTRACT FROM AUTHOR]

Objectives: Multi-institutional studies are required for the validation of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).Methods: A total of 1,560 fine-needle aspirations of the salivary glands were retrieved from two institutions for a 12-year period. The diagnoses were reclassified based on the MSRSGC. Risk of malignancy (ROM) for each category was calculated based on 694 histologic follow-up cases.Results: The ROM for each category was: 18.3% for nondiagnostic, 8.9% for nonneoplastic, 37.5% for atypia of undetermined significance (AUS), 2.9% for benign neoplasm, 40.7% for salivary gland neoplasm of uncertain malignant potential (SUMP), 100% for suspicious for malignancy, and 98.3% for malignant. The sensitivity, specificity, positive predictive rate, and negative predictive rates were 89%, 99%, 98%, and 96%, respectively.Conclusions: The results of the current study are in keeping with the MSRSGC. The indeterminate categories of AUS and SUMP showed intermediate ROMs at 37.5% and 40.7%, respectively. [ABSTRACT FROM AUTHOR]

Context: Fine needle aspiration cytology for salivary gland lesions has shown to be adequately sensitive and specific for diagnosing and treating salivary gland pathologies. The Milan System for Reporting Salivary Gland Cytopathology was developed and introduced to provide enhanced communication and improved overall care. Aims: The present study was taken up to assess the accuracy (sensitivity, specificity, positive and negative predictive values) and risk of malignancy of various diagnostic categories when the Milan system is applied and particular emphasis has been laid on cases that showed varied cytohistopathological correlation to highlight the analytical intricacies. Settings and Design: The present study is a two-year retrospective descriptive study conducted in a tertiary care hospital, Vijayawada. Methods and Material: Fine needle aspiration smears, relevant clinical details, histopathological slides and final reports were retrieved from the Departmental archives. The FNA results of the present study were re-categorized according to the Milan system and number of false positives, false negatives, true positives and true negatives were assessed in comparison with the final histopathological diagnosis and thus the accuracy and risk of malignancy of each diagnostic category were calculated. Results: The overall cytological diagnostic accuracy for differentiating malignant from benign tumors in the present study is 90%, with a sensitivity of 73.34%, specificity of 95.56%, positive and negative predictive values of 84.62% and 91.49% respectively.In the present study the highest risk of malignancy was seen in Atypia of undetermined significance (category III-100%) according to the Milan system. Conclusions: Use of The Milan System of Reporting salivary gland Cytopathology can increase the overall effectiveness and communication with clinicians and between institutions thus improving the overall patient care. [ABSTRACT FROM AUTHOR]