Application of the Milan System for Reporting Salivary Gland Cytopathology in pediatric patients: An international, multi-institutional study

Zahra Maleki, Carla Saoud, Kartik Viswanathan, Irem Kilic, Erkka Tommola, Daniel T. Griffin, Amer Heider, Gianluigi Petrone, Vickie Y. Jo, Barbara A. Centeno, Mauro Saieg, Panagiota Mikou, Guido Fadda, Syed Z. Ali, Ivana Kholová, Eva M. Wojcik, Güliz A. Barkan, David W. Eisele, Claudio Bellevicine, Elena VigliarAustin B. Wiles, Alyaa Al-Ibraheemi, Derek B. Allison, Glen R. Dixon, Ashish Chandra, Jonathan M. Walsh, Zubair W. Baloch, William C. Faquin, Jeffrey F. Krane, Esther Diana Rossi, Liron Pantanowitz, Giancarlo Troncone, Fabiano M. Callegari, Jerzy Klijanienko

Research output: Contribution to journalArticleScientificpeer-review


BACKGROUND: Pediatric salivary gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a small proportion of malignancies. This international, multi-institutional cohort evaluated the application of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and the risk of malignancy (ROM) for each diagnostic category. METHODS: Pediatric (0- to 21-year-old) salivary gland FNA specimens from 22 international institutions of 7 countries, including the United States, England, Italy, Greece, Finland, Brazil, and France, were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. Cytology-histology correlation was performed where available, and the ROM was calculated for each MSRSGC diagnostic category. RESULTS: The cohort of 477 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 10.3%; nonneoplastic, 34.6%; AUS, 5.2%; benign neoplasm, 27.5%; SUMP, 7.5%; SM, 2.5%; and malignant, 12.4%. Histopathologic follow-up was available for 237 cases (49.7%). The ROMs were as follows: nondiagnostic, 5.9%; nonneoplastic, 9.1%; AUS, 35.7%; benign neoplasm, 3.3%; SUMP, 31.8%; SM, 100%; and malignant, 100%. Mucoepidermoid carcinoma was the most common malignancy (18 of 237; 7.6%), and it was followed by acinic cell carcinoma (16 of 237; 6.8%). Pleomorphic adenoma was the most common benign neoplasm (95 of 237; 40.1%). CONCLUSIONS: The MSRSGC can be reliably applied to pediatric salivary gland FNA. The ROM of each MSRSGC category in pediatric salivary gland FNA is relatively similar to the ROM of each category in adult salivary gland FNA, although the reported rates for the different MSRSGC categories are variable across institutions.

Original languageEnglish
Number of pages11
Publication statusE-pub ahead of print - Jan 2022
Publication typeA1 Journal article-refereed

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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