Milan scoring system in the diagnosis of salivary gland lesions for assessment of risk of malignancy

Abstract

Salivary gland lesions are one of the most common encounters in clinical practice for the evaluation of which Fine needle aspiration cytology is a well-established technique nowadays. Owing to the heterogenecity and morphological overlap between the various categories of these salivary gland lesions, there was a need for a standardised procedure. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardised evidence based reporting system to assess the risk of malignancy and thus helpful for the management of these lesions. We have undertaken this study for evaluation of salivary gland lesions by this newly introduced grading system for predicting the malignant potential of these lesions.: We have done a prospective study of all the salivary gland lesions received in our department for a period of 3 years from 2016 to 2019. The clinical history, aspiration cytology and histopathological examination was done for all the cases.: We have received 225 salivary gland lesions for aspiration, but histological follow up was done in only 105 lesions, which were thus included in our study. Case distribution into different categories was done in the following way:ND (5.71%), NN (38.01%), AUS (2.57%), NB (33.34%), SUMP (1.9%), SM (2.85%), and M (15%). Overall, ROM reported were 25%, 5%, 20%, 4.4%, 33.3%, 85.7%, and 97.5%, respectively for each category. Overall, sensitivity was 83.34%, specificity was 98.01%, positive predictive value was 94.87%, and negative predictive value was 91.89%. MSRSGC is a six category scheme that was recently proposed that separates the salivary gland FNAC into distinct categories, thus increasing the specificity by limiting the number of false negative and false positive cases.