Title: The Milan System for Reporting Salivary Gland Cytopathology: Assessment by Recategorization and Predicting Risk of Malignancy: An Experience from a Tertiary Health Care from North India
Authors: Mahendra Singh, Saheeta Sudarsini, Lubna Khan, Prem Singh, Sandip Kumar Barik
DOI: https://dx.doi.org/10.18535/jmscr/v9i6.22
Abstract
Introduction: Fine needle aspiration (FNA) is an essential and most widely practiced procedure in a cytology laboratory.FNA of salivary gland also cannot point out a particular diagnosis exactly with 100% surerity. To bring uniformity to the reporting of salivary gland FNAC, the American Society of Cytopathology and the International Academy of Cytology proposed an international classification scheme, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).
Materials and Methods: In the present study, 255 cases of salivary gland lesions were studied by fine-needle aspiration cytology in pathology department of a Tertiary care hospital of North India, between July 2018 to September 2020. The study is a prospective observational study with the aim to study the incidence of various salivary gland lesions after recategorization by the Milan’s system and to correlate the the FNA findings with histology were ever available and calculate the Risk of Malignancy(ROM).
Results: The distribution of cases according to MSRSGC shows 31(12.15%) patients in Category 1,Non diagnostic .Majority of the cases,107(41.96%), were in Category 2 Non-Neoplastic salivary gland lesion. In Category 3,Atypia of undeterminate significance (AUS) 4 (1.56%)patients were categorized.Category 4 a benign salivary gland tumor had 84 cases (32.94%).Among the benign lesions pleomorphic adenoma accounts for 69patients (84.14%),Warthin tumour accounts for 11(13.41%)cases and 2(2.43%) case was intraparotid schwannoma .While the Category 4b Salivary gland neoplasm of uncertain malignant potential (SUMP) had 2 (2.38%)cases.7 (2.74%) cases were categorized under Category 5. In category 6 malignant lesion were 22 cases (8.62%). The majority of 22 malignancy cases are Carcinoma Ex Pleomorphic Adenoma, which is 8 cases and accounts for36.36%,followed by Mucoepidermoid carcinoma 12 cases(54.54%) and 1 case(4.54%) each of Adenocystic carcinoma and Acinitic cell carcinoma.. The ROM after histopathological correlation for Caterogy I was 14.2%, Category 2 was 13%,Category 3 was 0%,Category 4a was 4%,Category 4b was 0%, Category 5 was 100% and Category 6 was 100%.
Conclusion: Milan system of classification (MSRSCG) of salivary gland can be an effective and reliable tool for reporting. It can effectively predict the risks of Malignancy and help in effective management of the salivary gland tumours.
Keywords: Milan System, Salivary Gland, FNA, Risk of Malignancy.
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