Application of the Milan System for Reporting Salivary Gland Cytopathology: A Study of Cytohistological Correlation and Risk of Malignancy

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018 to provide a uniform, evidence-based framework for reporting salivary gland FNAC, with each diagnostic category linked to an estimated Risk of Malignancy (ROM) and management.Methods: For each FNAC of salivary gland lesions, whether received in-house or ultrasound-guided, a comprehensive clinical examination of the patient was performed. Descriptive statistical mean and frequency (%) is used to depict the baseline characteristics of demographic data of the study participants. ROM were calculated in each MSRSGC categories and performance analysis with Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Diagnostic accuracy. Result: This study evaluated 104 salivary gland FNAC cases using the MSRSGC and correlated cytological findings with histopathology wherever available. Benign neoplasms constituted the largest diagnostic category, followed by malignant and non-neoplastic lesions. A male predominance was observed (69.2%), with a peak incidence in the 61–70-year age group. Radiology–cytology concordance was noted in 82.5% of evaluated cases. Histopathological correlation was available in 44 of 104 FNAC cases, as only these patients underwent subsequent surgical excision/biopsy at our institution. The risk of malignancy was calculated for each MSRSGC Categories Conclusion: Overall, MSRSGC is a simple, user-friendly, and reliable reporting system that enhances communication between pathologists and clinicians and aids in appropriate patient management.