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Milan Interobserver Reproducibility Study (MIRST): Milan System 2018.

Daniel F I Kurtycz1, Ester Diana Rossi2, Zubair Baloch3

  • 1Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin.

Journal of the American Society of Cytopathology
|March 16, 2020
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Summary

This study evaluated the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) categories. Diagnostic agreement varied by category and pathologist certification, highlighting the need for clear guidelines in salivary gland pathology.

Keywords:
Fine-needle aspirationInterobserver reproducibilitySalivary gland cancerSalivary gland cytologySalivary gland neoplasmThe Milan SystemWeb-based image study

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Area of Science:

  • Cytopathology
  • Surgical Pathology
  • Oncology

Background:

  • The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018.
  • Prior to its publication, an interobserver study assessed MSRSGC categories and identified areas of low agreement.
  • This established a baseline for future research in salivary gland cytopathology reproducibility.

Purpose of the Study:

  • To evaluate the reporting categories of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).
  • To identify specific cytomorphologic features contributing to poor interobserver agreement.
  • To establish a baseline for future studies on salivary gland cytopathology reproducibility.

Main Methods:

  • A web-based survey was distributed to collect participant demographics, including training level, practice patterns, and experience.
  • Participants evaluated 75 images from the MSRSGC image set, covering all diagnostic categories and borderline cytomorphology.
  • Image difficulty was a priori classified to assess its impact on diagnostic reproducibility.

Main Results:

  • Out of 555 participants, 42% agreed with reference interpretations of salivary gland lesions.
  • Cytopathology-certified pathologists showed the highest agreement rates.
  • Agreement was highest for Neoplasm-Benign and Non-Diagnostic categories, and lowest for Salivary Gland Lesion of Uncertain Malignant Potential (SUMP) and Suspicious For Malignancy (SFM) categories.

Conclusions:

  • Diagnostic reproducibility in salivary gland cytopathology is influenced by image difficulty and pathologist expertise.
  • Higher certifications correlated with better diagnostic performance.
  • Findings underscore the importance of standardized criteria and training for accurate salivary gland lesion classification.