The Milan system in salivary gland cytopathology: Classification and diagnostic utility

Background: Fine-needle aspiration cytology (FNAC) plays a crucial role in the diagnosis of salivary gland lesions. This study was undertaken with an aim to determine the cytopathological spectrum of salivary gland lesions using the MSRSGC in patients attending at a tertiary care hospital in Assam, India. Materials and methods: This study included 36 cases of salivary gland lesions over a period of three and a half years from December 2019 to June 2022 . Patients ranged in age from 3 to 80 years. FNAC was performed on all cases after obtaining informed consent. Diagnoses were classified into the six categories defined by the Milan System. Results: Of the total 36 cases the majority of cases originated from the parotid gland (21 cases, 58.3%), followed by the submandibular gland (15 cases, 44.4%). Pleomorphic adenoma was most common in benign cases and mucoepidermoid carcinoma in malignant cases.18 cases were males and 18 were females According to the Milan System, the distribution of cases was as follows: Category I – 3 cases, Category II – 12 cases, Category III – 0 cases , Category IVA – 15 cases, Category IVB – 0 cases, Category V – 0 cases and Category VI – 6 cases. Conclusion: The Milan System categorizes salivary gland lesions effectively, aiding cytopathologists in accurate diagnosis and minimizing false-positive and false-negative results. This standardized reporting also supports clinicians in making appropriate management decisions based on the lesion category.