A retrospective 3-year study of salivary gland FNAC with categorisation using the Milan reporting system

To assess our practice using the recently developed standardised classification system designated The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and to ascertain the rates of malignancy for each category by means of a retrospective study.

All salivary gland FNAC samples received between 1 January 2013 and 31 December 2015 were retrospectively assigned a diagnostic category code from the MSRSGC. Cytology results were correlated with subsequent histology (where available), and clinical and radiological follow up.

A total of 287 salivary gland FNA samples were received from 272 patients. The specimens were classified as non-diagnostic (21.3%), non-neoplastic (22%), atypia of undetermined significance (2.4%), neoplasm benign (36.9%), neoplasm of uncertain malignant potential (5.2%), suspicious for malignancy (1.7%) and malignant (10.5%; low grade 1.4% and high grade 9.1%). Histological and clinical/radiological follow up was available for 138 (48.1%) specimens, clinical/radiological follow up only for 145 (50.5%) and no follow up for the remaining four (1.4%) samples. The risk of malignancy for each category was non-diagnostic (8.5%), non-neoplastic (1.6%), atypia of undetermined significance (0%), neoplasm benign (1.9%), neoplasm of uncertain malignant potential (26.7%), suspicious for malignancy (100%) and malignant (100%).

The MSRSGC appears to be a useful tool to guide clinical management and provide an indication of possible risk of malignancy. We favour implementing use of these categories in our reporting practice with a future re-evaluation to assess maintenance of service quality as well as the clinical utility of this reporting system.