Introduction: Salivary gland tumours represent 3% of head and neck neoplasms. Fine needle aspiration cytology (FNAC) is widely used for pre-operative diagnosis, but its accuracy varies due to the diverse morphology of these tumours. The revised 2023 Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides updated risk of malignancy (ROM) estimates and guidelines for standardized reporting. This study reclassifies salivary gland FNAs using the revised MSRSGC and evaluates the ROM and diagnostic accuracy of each category. Methods: We retrospectively analysed 184 FNAC samples of salivary gland lesions collected from January 2023 to June 2024. Each case was reclassified according to the 2023 Milan System. Histopathological follow-up was available for 46 cases. ROM was calculated for each category, and sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were computed for two diagnostic groups: group A (SM and malignant) and group B (malignant only). Results: Of the 184 cases, 47.3% were benign and 14.1% were malignant. The ROM for non-diagnostic, non-neoplastic, atypia of undetermined significance, benign, salivary gland neoplasm of undetermined significance, SM, and malignant categories were 33%, 0%, 50%, 7.1%, 0%, 66.6%, and 100%, respectively. Group B had higher specificity and PPV, while group A showed improved sensitivity and diagnostic accuracy. Conclusion: The revised Milan System improves diagnostic accuracy in salivary gland FNAs. However, variations in ROM highlight the need for further studies to refine diagnostic challenges in certain categories.

1.
Tochtermann
G
,
Nowack
M
,
Hagen
C
,
Rupp
NJ
,
Ikenberg
K
,
Broglie
MA
, et al
.
The Milan system for reporting salivary gland cytopathology: a single-center study of 2156 cases
.
Cancer Med
.
2023
;
12
(
11
):
12198
207
.
2.
Hafez
NH
,
Abusinna
ES
.
Risk assessment of salivary gland cytological categories of the Milan system: a retrospective cytomorphological and immunocytochemical institutional study
.
Turk Patoloji Derg
.
2020
;
36
(
2
):
142
53
.
3.
Liang
CA
,
Liu
J
,
Ogunniyi
JT
,
Zhu
H
,
Zhang
S
.
The risk for malignancy using the Milan salivary gland classification categories: a 5-year retrospective review
.
CytoJournal
.
2019
;
16
:
14
.
4.
Kala
C
,
Kala
S
,
Khan
L
.
Milan system for reporting salivary gland cytopathology: an experience with the implication for risk of malignancy
.
J Cytol
.
2019
;
36
(
3
):
160
4
.
5.
Pusztaszeri
M
,
Rossi
ED
,
Faquin
WC
.
Update on salivary gland fine-needle aspiration and the Milan system for reporting salivary gland cytopathology
.
Arch Pathol Lab Med
.
2024
;
148
(
10
):
1092
104
.
6.
Rossi
ED
,
Baloch
Z
,
Barkan
G
,
Foschini
MP
,
Kurtycz
D
,
Pusztaszeri
M
, et al
.
Second edition of the milan system for reporting salivary gland cytopathology: refining the role of salivary gland FNA
.
Cytopathology
.
2024
;
35
(
2
):
188
98
.
7.
Alsanie
I
,
Rajab
S
,
Cottom
H
,
Adegun
O
,
Agarwal
R
,
Jay
A
, et al
.
Distribution and frequency of salivary gland tumours: an international multicenter study
.
Head Neck Pathol
.
2022
;
16
(
4
):
1043
54
.
8.
Kambale
T
,
Iqbal
B
,
Patil
A
,
Kumar
H
.
Diagnostic role of FNAC in Salivary gland lesions and its histopathological correlation
.
Ind J Pathol Oncol
.
2016
;
3
:
372
.
9.
Wang
X
,
Wang
H
.
The milan system for reporting salivary gland cytopathology and updates
.
J Clin Transl Pathol
.
2023
;
3
:
126
33
.
10.
Datta
B
,
Daimary
M
,
Bordoloi
K
,
Thakuria
C
.
Cytopathological spectrum of salivary gland lesions according to Milan reporting system: a retrospective study
.
Asian Pac J Cancer Care
.
2023
;
8
(
3
):
465
70
.
11.
Jha
S
,
Mitra
S
,
Purkait
S
,
Adhya
AK
.
The milan system for reporting salivary gland cytopathology: assessment of cytohistological concordance and risk of malignancy
.
Acta Cytol
.
2021
;
65
(
1
):
27
39
.
12.
Grandhi
B
,
Rao
BS
,
Rao
NM
,
Sunandha
GV
.
Milan scoring system in the diagnosis of salivary gland lesions for assessment of risk of malignancy
.
Indian J Pathol Oncol
.
2021
;
8
(
4
):
443
6
.
13.
Lee
JJL
,
Tan
HM
,
Chua
DYS
,
Chung
JGK
,
Nga
ME
.
The Milan system for reporting salivary gland cytology: a retrospective analysis of 1384 cases in a tertiary Southeast Asian institution
.
Cancer Cytopathol
.
2020
;
128
(
5
):
348
58
.
14.
Rivera Rolon
M
,
Schnadig
VJ
,
Faiz
S
,
Nawgiri
R
,
Clement
CG
.
Salivary gland fine-needle aspiration cytology with the application of the Milan system for risk stratification and histological correlation: a retrospective 6-year study
.
Diagn Cytopathol
.
2020
;
48
(
11
):
1067
74
.
15.
Mullen
D
,
Gibbons
D
.
A retrospective comparison of salivary gland fine needle aspiration reporting with the Milan system for reporting salivary gland cytology
.
Cytopathology
.
2020
;
31
(
3
):
208
14
.
16.
Ahuja
S
,
Malviya
A
.
Evaluation of accuracy of salivary gland fine needle aspirates using the Milan System for Reporting Salivary Gland Cytopathology
.
Cytopathology
.
2022
;
33
(
4
):
463
71
.
17.
Savant
D
,
Jin
C
,
Chau
K
,
Hagan
T
,
Chowdhury
M
,
Koppenhafer
J
, et al
.
Risk stratification of salivary gland cytology utilizing the Milan system of classification
.
Diagn Cytopathol
.
2019
;
47
(
3
):
172
80
.
18.
Rohilla
M
,
Singh
P
,
Rajwanshi
A
,
Gupta
N
,
Srinivasan
R
,
Dey
P
, et al
.
Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification
.
Cancer Cytopathol
.
2017
;
125
(
10
):
767
75
.
19.
Griffith
CC
,
Pai
RK
,
Schneider
F
,
Duvvuri
U
,
Ferris
RL
,
Johnson
JT
, et al
.
Salivary gland tumor fine-needle aspiration cytology: a proposal for a risk stratification classification
.
Am J Clin Pathol
.
2015
;
143
(
6
):
839
53
.
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