Some simplification is possible to make the system easier to use and improve interobserver agreement while maintaining stratification of risk. Cytotechnologists with Licenses in Florida and California This program is approved for 2 continuing education credits in the State of Florida and 1 in the State of California. Methods: The study group, formed during the 2015 European Congress of Cytology held in Milan, Italy, generated a survey that included 49 specific questions related to the taxonomies, practices, and diagnostic entities of salivary cytology. Song, Khurram Shafique, Lawrence Q. This is quite similar to findings of Viswanathan et al.
This void motivated a group of experienced cytopathologists to spearhead the development of a uniform reporting system. This effort sparked the interest of many and brought forth an agreement to develop an evidence-based tiered classification consisting of 6 diagnostic categories. The survey was available online from November 2015 until February 2016. Pitfalls in salivary gland fine-needle aspiration cytology author reply. Cytotechnologists find themselves uniquely poised to take on these new responsibilities, using their morphologic and analytical skills. A total of 347 participants provided demographic data information. The Milan System for Reporting Salivary Gland Cytopathology: analysis and suggestions of initial survey.
While searching the literature and amassing scientific evidence, pathologists and cytopathologists from all over the world were invited to add their opinions and expertise. Several respondents indicated that they prefer to ensure that what was observed on the slide was consistent with what the radiologist described. Use of Ancillary Tests Several opinions emerged from this survey regarding the role of ancillary techniques in the field of malignant and indeterminate lesions. Results were used to provide focus for the proposed Milan System for Reporting Salivary Gland Cytopathology. Each diagnostic category of this novel salivary gland reporting system includes detailed descriptions of the cytologic criteria as well as a comprehensive set of photomicrographs demonstrating all of the key microscopic features along with annotated descriptions for each image. The survey participants indicated a preference for the division of benign diagnoses into nonneoplastic and neoplastic subgroups. The percentage of patients with a final diagnosis of malignancy according to each category heading were: Sal 1 inadequate 7.
These scanned slides were independently and blindly reviewed by 4 cytopathologists, and each aspirate was assigned to 1 of the proposed pattern-based categories if it was considered neoplastic by the observer. Neoplasms with classic cytomorphology are easily diagnosed; however, in difficult cases showing overlapping features, the use of the Milan system could be beneficial. The purpose of this article is to analyze and share the information generated by the survey. Marc Pusztaszeri: Methodology and writing—review and editing. This void motivated a group of experienced cytopathologists to spearhead the development of a uniform reporting system. The objective of the working group was to create a user-friendly system that will promote and standardize communication between cytopathologists and treating clinicians, cyto-histological correlation, and the exchange of information among institutions. Rossi is in the Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, and a professor in the Agostino Gemelli School of Medicine, Rome.
The majority of the participants indicated that ancillary technologies are used from 0% to 10% of the time, mostly on cell block preparations. Each of the diagnostic chapters has information regarding specific risks of malignancy and clinical management strategies. The Milan System for Reporting Salivary Gland Cytopathology. The accuracy of salivary cytology is high for the diagnosis of the most common salivary gland tumors such as pleomorphic adenoma and Warthin tumor, but the specificity for subtyping a particular neoplasm shows a wide range 48 to 94 percent depending on tumor type. Montone and Zubair Baloch, The utility of the Milan System as a risk stratification tool for salivary gland fine needle aspiration cytology specimens , Cytopathology , 30 , 1 , 91-98 , 2018.
The name reflects the first gathering of the core working group during the 2015 annual meeting of the European Congress of Cytology in Milan, Italy. The group consisted of cytopathologists, surgical pathologists, and head and neck surgeons. The types of preparations used for ancillary technique analysis are shown in Table. Demographics There were 515 participants collected from an international audience. Interobserver agreement was scored and aggregated risks of malignancy were calculated for cases with available surgical follow-up.
The survey was available online from November 2015 until February 2016. Conclusions: The proposed pattern-based risk-stratification scheme, which could be implemented with the forthcoming Milan System, has good overall interobserver agreement and successfully stratifies the risk of malignancy. This webinar will familiarize the audience with key cytologic features of many of the more common as well as challenging salivary gland tumors. Several participants underscored the need for specific and detailed morphological features, which can be useful for a correct interpretation and diagnosis. It is an evidence-based system that correlates diagnostic categories with risk of malignancy and clinical management. © 2017 American Cancer Society.
Qualtrics software was used as the study platform. Condensation of similar categories was able to improve interobserver agreement and still maintain stratified risk of malignancy. Nuclei are spindle-shaped and display bends or curves smear, Romanowsky stain. © 2018 American Cancer Society. The remaining 3 chapters are dedicated to 1 a general overview of the Milan System and risk of malignancy; 2 the application of ancillary techniques, and 3 management. This aspirate of schwannoma shows a group of bland spindle cells with wispy cytoplasm. Conclusions The Milan System for Reporting Salivary Gland Cytopathology appears to be a useful tool to guide clinical management and provide an indication of possible risk of malignancy.
Diagnostic challenges in fine needle aspiration cytology of salivary gland lesions. Recommendations are made for close clinical follow-up and radiologic correlation. . Faquin: Conceptualization, methodology, validation, investigation, data curation, writing—original draft, writing—review and editing, supervision, and project administration. Results: In total, 42 samples 84% were considered neoplastic by at least 2 observers and were scored for interobserver agreement: 10 of 42 23.