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Related Experiment Video

Updated: May 9, 2025

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The Milan System SUMP Category: 5-Year Diagnostic Performance.

Henri Lagerstam1,2, Erkka Tommola1,2, David Kalfert3

  • 1Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Diagnostic Cytopathology
|May 6, 2025
PubMed
Summary

Salivary gland neoplasms of uncertain malignant potential (SUMP) pose diagnostic challenges. Our 5-year study found a lower risk of malignancy than expected, with higher risks in oncocytic/oncocytoid subtypes and males.

Keywords:
Milan system for reporting salivary cytopathologySUMPfine‐needle aspirationsalivary glandsalivary gland neoplasm of uncertain malignant potential

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Area of Science:

  • Cytopathology
  • Surgical Pathology
  • Oncology

Background:

  • Salivary gland neoplasms exhibit significant cytomorphological overlap.
  • The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) includes a category for neoplasms of uncertain malignant potential (SUMP) to address diagnostic challenges.

Purpose of the Study:

  • To evaluate the performance of the SUMP category in salivary gland fine-needle aspirations (SG-FNA).
  • To determine the risk of malignancy (ROM) for SUMP cases and its subtypes.
  • To analyze the impact of patient demographics (age, sex) on ROM.

Main Methods:

  • Retrospective analysis of 100 SUMP cases from SG-FNAs diagnosed between 2018-2022.
  • Histological follow-up data reviewed until May 2024.
  • Classification of SUMP cases into cytomorphological subtypes (oncocytic/oncocytoid, basaloid) and calculation of ROM, risk of neoplasm, and workflow timelines.

Main Results:

  • The overall risk of malignancy (ROM) for SUMP cases was 23.2%, lower than the MSRSGC reference value.
  • The oncocytic/oncocytoid subtype had a higher ROM (35.0%) compared to the basaloid subtype (18.4%).
  • Males showed higher ROMs (26.9% overall, 40.0% for oncocytic/oncocytoid) than females (16.2% overall, 14.3% for oncocytic/oncocytoid).

Conclusions:

  • The SUMP category in our practice demonstrated a lower ROM than anticipated.
  • The oncocytic/oncocytoid subtype is associated with a greater risk of malignancy within the SUMP classification.
  • Higher ROMs were observed in males and individuals aged 30-69 years.