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| Year:
2026 |
Month:
January
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Volume:
15 |
Issue:
1 |
Page:
PO07 - PO12 |
Application of Milan System for Reporting Salivary Gland Neoplasms to Evaluate the Risk of Malignancy: A Cross-sectional Study from a Tertiary Care Hospital in Southern India
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Correspondence
Gudrun Koul, HK Manjunath, Bhargavi Mohan, Akshatha Basavaraju, KM Priyanka, Hassan Sona Rai, K Vinitra, Hema Rajkumari,
Gudrun Koul,
1101, Tower-2, Alteezea, Tata Promont, Ittamadu, Hosakerehalli, BSK-3rd Stage,
Bangalore-560085, Karnataka, India.
E-mail: drgudrunkaul@gmail.com :
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Introduction: Salivary gland tumours comprise about 3% to 6.5% of all head and neck tumours. Fine needle aspiration is used as a primary investigation to diagnose salivary gland lesions, in addition to ultrasonography and Magnetic Resonance Imaging (MRI). Due to the overlapping cytomorphology of salivary gland lesions and their heterogeneity, it is a challenge for pathologists to interpret these lesions. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced to standardise the reporting of salivary gland cytology and estimate the risk of malignancy across different categories. To achieve uniform categorisation of salivary gland lesions and evaluate risk stratification, the present study was conducted.
Aim: To classify salivary gland lesions according to the Milan System, correlate them with histopathological follow-up wherever possible and evaluate the risk of malignancy for each category.
Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at BGS Global Institute of Medical Sciences and Hospital, Bengaluru, Karnataka, India, over a period of two years, from January 2022 to December 2023. The study included 75 cases. Salivary gland cytology cases were retrieved and categorised according to the MSRSGC into six categories. The results were compared with histopathology where possible. The Risk of Malignancy (ROM) was assessed for each category. Statistical analysis was performed to calculate sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy, with histopathology considered the gold standard.
Results: A total of 75 cases of salivary gland cytology were assessed and classified according to the Milan System. The most common age group affected was between 21 years and 40 years. The male-to-female ratio was 1:1.4, indicating a female preponderance. The parotid gland was the most commonly affected salivary gland. Histopathological correlation was available in 41 cases and ROM was calculated. Two cases were placed in the Non Diagnostic category (Category I), 22 cases in the Non Neoplastic category (Category II), two cases of Atypia of Undetermined Significance (AUS) (Category III), 38 cases of Benign Neoplasm (Category IVA), one case of Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) (Category IVB), one case suspicious of malignancy (Category V) and nine cases of Malignancy (Category VI). The risk of malignancy was calculated for Category II, Category III, Category IVA, Category IVB and Category VI as 0%, 50%, 4.54%, 100% and 100%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy in the present study were 77.7%, 100%, 100%, 94.11% and 95.12%, respectively.
Conclusion: The Milan System for Reporting Salivary Gland Cytopathology is invaluable for the uniform reporting of salivary gland lesions. Risk stratification is helpful for further management and improves patient care.
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