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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 6 - Head and Neck Surgery

Milan System for Reporting Salivary Gland Cytopathology: Extent of Surgery and Surgical Pathology

Monday, September 30, 2024
2:30 PM – 2:36 PM EDT
Location: MBCC, 208
Disclosure(s):
Randy W. Lesh, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standardized classification system for salivary gland fine needle aspiration cytology (FNAC). This study aims to determine how MSRSGC predicts risk of malignancy, final histopathology, and guides extent of surgery.

Methods: This is a single-institution retrospective study of patients who underwent FNAC of a salivary gland lesion and subsequent surgery after near universal institutional adoption of MSRSGC in a rural healthcare system from November 2022 – January 2024. Data was collected from electronic health records. ROM was calculated for each Milan category. At least 235 patients will be in the final analysis.

Results: A total of 235 salivary gland resections were performed since institutional initiative to use MSRSGC. Preliminary analysis included 37 patients who underwent surgery; 35 (94.6%) lesions were in the parotid gland and 2 in the submandibular gland. ROM for each category was as follows: 100% (MSRSGC not reported), 0% (I: non-diagnostic), 0% (II: non-neoplastic), 57.1% (III: atypia of undetermined significance), 16.7% (IVA: benign), 25% (IVB: salivary gland neoplasm of uncertain malignant potential), 0% (V: suspicious for malignancy), and 100% (VI: malignant). In total, 11 tumors (30%) were malignant with the following distribution: 18.1% acinic cell carcinoma, 18.1% carcinoma ex-pleomorphic adenoma, 18.1% mucoepidermoid carcinoma, 18.1% squamous cell carcinoma, and 27.3% other. Another 26 tumors (70%) were benign with 42.3% pleomorphic adenoma, 34.6% Warthin tumor, and 23.1% other. Another 4 (10.8%) patients had a neck dissection (ND), with two guided by frozen section after a non-malignant preoperative FNAC.

Conclusions: These preliminary results show expected high ROM for MSRGSC category VI (100%), underutilization of category V, and higher than expected ROM for category III (57.1%) and IVA (16.7%) based on reported literature. Intraoperative frozen section guided need for ND in three cases. Surgeons should maintain a high degree of suspicion for malignancy for category III lesions and consider using frozen pathology for categories III and above.

    Presenting Author(s)

  • Randy W. Lesh, MD

    Resident Physician
    Geisinger
    Danville, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Priscilla F. Pichardo, DO

    Resident Physician
    Geisinger Health System
    Danville, PA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Sara E. Monaco, MD

    System Director of Cytopathology
    Geisinger Health System
    Danville, PA, United States

    Disclosure information not submitted.

  • Kevin J. Kovatch, MD

    Assistant Professor, Attending Surgeon
    Geisinger Health System
    Danville, PA, United States

    Disclosure information not submitted.

  • PP

    Phillip K. Pellitteri, DO

    Clinical Professor, Attending Surgeon, Regional Medical Director
    Geisinger Health System
    Bloomsburg , PA, USA

    Disclosure information not submitted.

  • NP

    Nicholas C. Purdy, DO

    Director, Head and Neck Service
    Geisinger Health System
    Danville, PA, United States

    Disclosure information not submitted.