Conventional cytology reporting versus revised Milan system reporting (2023) in salivary gland lesions: A cross-sectional study

Background: Fine needle aspiration cytology (FNAC) is a widely accepted first-line diagnostic tool for evaluating salivary gland lesions because it is minimally invasive, rapid, cost-effective, and reliable. However, conventional cytology reporting lacks standardized terminology, resulting in variability in interpretation and communication. The revised Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) 2023 provides uniform diagnostic categories with associated risk of malignancy and management recommendations. This study compared conventional cytology reporting with the revised Milan System (2023) in salivary gland lesions.
Aim: To compare conventional cytology reporting with the revised Milan System reporting (2023) in salivary gland lesions.
Materials and Methods: This cross-sectional observational study was conducted in the Department of Pathology, Rohilkhand Medical College and Hospital, Bareilly. A total of 58 salivary gland FNAC cases were included after applying the inclusion and exclusion criteria. All cases were reported using the conventional cytology reporting system and simultaneously categorized according to the revised Milan System (2023). Histopathological correlation was performed wherever surgical specimens were available. Diagnostic categorization, risk stratification, and cytohistological concordance were evaluated. Statistical analysis was performed using SPSS version 26.0, with a p-value <0.05 considered statistically significant.
Results: Most patients belonged to the 21–40 years age group. Benign lesions predominated on conventional reporting. According to the revised Milan System, most cases were categorized as benign neoplasm and non-neoplastic lesions. Histopathological correlation, available in 15 cases, showed an overall cytohistological concordance of 80%, with the highest concordance observed in benign neoplasm and malignant categories. Diagnostic variability was mainly seen in atypia of undetermined significance and salivary gland neoplasm of uncertain malignant potential categories.
Conclusion: The revised Milan System (2023) provides a standardized and clinically relevant framework for reporting salivary gland cytology, improving diagnostic reproducibility, risk stratification, and communication between cytopathologists and clinicians.