Cytopathological Study of Salivary Gland Lesions Using Milan System

Introduction:Salivary gland neoplasms comprise 2-6.5% of all tumors of the head and neck. Fine Needle Aspiration (FNA) is the first line of investigation for swelling of salivary glands.Milan system provides a uniform reporting system for various morphologically heterogeneous lesions of salivary glands.Aim:To study various cytomorphological lesions of salivary gland and categorize them according to the MILAN system of reporting.Materials and Methods:This is a retrospective 3 year observational study of 146 salivary gland FNA samples received at the department of pathology of GCS Medical College, Hospital & Research Centre, Ahmedabad,Gujarat, from January 2017 to December 2019.Salivary gland cytopathologies were categorized based on Milan system of reporting; sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were assessed in comparison with histopathological diagnosis. Clinical data were retrieved from case notes prepared during history taking and clinical examination of patients.Results and Discussion:Mean age of patients was 40.1 years with male to female ratio of 1.14:1.As per Milan system, maximum cases were non-neoplastic (47.94%) followed by benign (17.12%), non-diagnostic (10.95%),malignant (8.9%), neoplasm of uncertain malignant potential(7.6%), atypia of undetermined significance(6.16%) and suspicious for malignancy(1.37%). In non-neoplastic and benign categories, the most common lesion was sialadenitis (34.4%) and pleomorphicadenoma (15.5%).Histopathological correlation was available in 42 cases. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Milan system came out to be 87.5%, 96.2%, 93.3%,92.5% and 92.8% respectively.Conclusion:Milan system provides different categories with risk of malignancy of various salivary gland lesions. It helps to maintain international standards and creates easy and clear communication between cytologist and the physician for further management of the condition.