The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in-house salivary gland fine-needle aspiration cytology at a comprehensive cancer center Journal Article


Authors: Lubin, D.; Buonocore, D.; Wei, X. J.; Cohen, J. M.; Lin, O.
Article Title: The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in-house salivary gland fine-needle aspiration cytology at a comprehensive cancer center
Abstract: Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized reporting system for salivary gland fine-needle aspiration (SGFNA). We review the clinical utility of the MSRSGC at a tertiary care cancer center by assessing the rates of malignancy (ROM) among different categories. Methods: A retrospective search was performed to retrieve all SGFNA cases performed at our institution between 1/1/07 and 12/31/18. The initial primary diagnoses were recorded and cases were then assigned to appropriate MSRSGC categories. ROM was then calculated for all categories. Results: A total of 976 cases were identified, and 373 with follow-up. The ROM was 19.7% (192/976) for all-comers and 51.3% (192/374) among cases with follow-up. Using MSRSGC, SGFNA showed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 65.6%, 87.4%, 100%, and 72.6%, respectively. ROM for MSRSGC categories I, II, III, IVa, IVb, V, and VI were 20.7%, 30.0%, 45.8%, 3.3%, 50.7%, 100%, and 100%, respectively. Utilizing MSRSGC resulted in a nondiagnostic rate of 14.4%. The nondiagnostic rate was lower when the procedure was performed by pathologists vs nonpathologists (12.9% vs 15.8%) but was comparable when rapid on site evaluation (ROSE) was performed (12.9% vs 11.6%). Conclusion: In our patient population, MSRSGC resulted in a perfect PPV and moderate NPV. Utilizing MSRSGC results in a higher nondiagnostic rate due to the inclusion of cases with benign elements or cyst contents only in this category. Performing ROSE is more important in attaining an adequate sample than the specialty of the person performing SGFNA. © 2019 Wiley Periodicals, Inc.
Keywords: human tissue; major clinical study; comparative study; sensitivity and specificity; adenocarcinoma; diagnostic procedure; multiple myeloma; cystadenoma; angiosarcoma; retrospective study; oncocytoma; ewing sarcoma; health care utilization; scoring system; salivary gland disease; salivary gland; clear cell carcinoma; adenoid cystic carcinoma; acinar cell carcinoma; salivary gland carcinoma; predictive value; myoepithelial carcinoma; pleomorphic adenoma; salivary duct carcinoma; fine needle aspiration biopsy; fine-needle aspiration; benign neoplasm; mucoepidermoid tumor; human; priority journal; article; warthin tumor; milan system for reporting salivary gland cytopathology; epithelial myoepithelial carcinoma
Journal Title: Diagnostic Cytopathology
Volume: 48
Issue: 3
ISSN: 8755-1039
Publisher: Wiley Liss  
Date Published: 2020-03-01
Start Page: 183
End Page: 190
Language: English
DOI: 10.1002/dc.24350
PUBMED: 31809004
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 2 March 2020 -- Source: Scopus
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MSK Authors
  1. Xiao-Jun Wei
    4 Wei
  2. Oscar Lin
    243 Lin
  3. Jean-Marc Cohen
    12 Cohen