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Performance Characteristics of Milan System for Reporting Salivary Gland Cytopathology: An Experience From Western
Samah Saharti1, Reem Aljohani2
1Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Introduction:
Salivary gland tumors are rare but diverse, with a higher prevalence of benign tumors in the parotid gland and a greater incidence of malignancy in other glands. Fine needle aspiration (FNA), enhanced by the Milan Reporting System, is widely used to evaluate these tumors. This study aimed to assess the diagnostic accuracy of the Milan Reporting System in a Saudi Arabian setting.
Methods:
This retrospective study included 117 patients from the western region of Saudi Arabia who underwent salivary gland FNA cytology with histological confirmation. Data were analyzed to evaluate demographic variables, Milan system category distribution, and diagnostic accuracy using SPSS Version 25.
Results:
The study cohort had a slight male predominance, with most patients being middle-aged or older. Tumors were most commonly found in the parotid glands. Pleomorphic adenoma and squamous cell carcinoma were the most frequent benign and malignant tumors, respectively, in this study. The Milan Reporting System demonstrated excellent diagnostic performance, with high sensitivity (87.9%), specificity (99.5%), Positive Predictive Value (98.1%), and Negative Predictive Value (96.4%). The system correctly classified all benign tumors, indicating high diagnostic concordance and showed high sensitivity for malignant tumors. Statistical analysis revealed a significant correlation between the Milan Reporting System and histological diagnosis (p = 0.000).
Conclusion:
Our study evaluated the Milan Reporting System for salivary gland cytopathology in the western region of Saudi Arabia, revealing it to be a highly reliable screening tool for salivary gland tumors. The system demonstrated exceptional performance, particularly for common entities, such as pleomorphic adenoma and squamous cell carcinoma. This promotes early and accurate detection. However, when malignancy is suspected but the Milan Reporting System results are negative, it is crucial to perform additional confirmatory tests (such as repeating the FNA or performing a core biopsy) to avoid missing a diagnosis of cancer.
