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Salivary Gland Fine Needle Aspiration and Introduction of the Milan Reporting System

Pusztaszeri, Marc, MD*; Rossi, Esther D., MD, PhD; Baloch, Zubair W., MD, PhD; Faquin, William C., MD, PhD§

Advances in Anatomic Pathology: March 2019 - Volume 26 - Issue 2 - p 84–92
doi: 10.1097/PAP.0000000000000224
Review Articles
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Fine needle aspiration (FNA) is a well-established procedure for the diagnosis and management of salivary gland lesions despite challenges imposed by their diversity, complexity, and cytomorphologic overlap. Until recently, the reporting of salivary gland FNA specimens was inconsistent among different institutions throughout the world, leading to diagnostic confusion among pathologists and clinicians. In 2015, an international group of pathologists initiated the development of an evidence-based tiered classification system for reporting salivary gland FNA specimens designated the “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC) that culminated with the publication of the MSRSGC Atlas in February 2018. The MSRSGC consists of 6 diagnostic categories, which incorporate the morphologic heterogeneity and overlap among various non-neoplastic, benign, and malignant lesions of the salivary glands. In addition, each diagnostic category is associated with a risk of malignancy and management recommendations. The main goal of the MSRSGC is to improve communication between cytopathologists and treating clinicians, while also facilitating cytologic‐histologic correlation, sharing of data from different laboratories for quality control, and research. Herein, we review the current status of salivary gland cytology and the role of MSRSGC in providing a framework for reporting salivary gland lesions.

*Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada

Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy

Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA

§Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA

The authors have no funding or conflicts of interest to disclose.

All figures can be viewed online in color at www.anatomicpathology.com.

Reprints: Marc Pusztaszeri, MD, Department of Pathology, Jewish General Hospital, McGill University, 3755, Chemin de la Côte Ste Catherine, Montréal, QC, Canada H3T 1E 2 (e-mail: marc.pusztaszeri@mcgill.ca).

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