Milan system in action: Bridging cytology, histopathology and risk of malignancy in salivary gland lesions

Introduction Fine-needle aspiration cytology (FNAC) is widely employed in the initial evaluation of salivary gland lesions. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized six-tier diagnostic framework with defined Risk of Malignancy (ROM) and management recommendations. Aim To classify salivary gland FNAC cases according to MSRSGC, correlate cytological findings with histopathology, determine ROM and evaluate diagnostic utility. Materials and methods A retrospective study of Fifty salivary gland FNAC cases was undertaken at a tertiary care hospital in Karnataka, India. All cases were reclassified as per MSRSGC. Histopathological follow-up was available in 22 cases. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and ROM were calculated. Results Patients ranged from 20 to 70 years (median 45 years) with slight male predominance (54%). The parotid gland was most frequently involved (68%). Category IV (Benign neoplasm) constituted 52% of cases. Histopathology identified malignancy in 5 among 22 cases. Sensitivity was 80%, specificity 100%, PPV 100%, NPV 94.4% and overall diagnostic accuracy was 95.45%. ROM for Categories V and VI were 100%. Conclusion MSRSGC demonstrates high diagnostic reliability and strong clinicopathological concordance. Its structured reporting and Risk of Malignancy (ROM) based stratification significantly enhance clinical decision making in salivary gland pathology.