From the Department of Pathology, Jewish General Hospital and McGill University, Montréal, Canada (Pusztaszeri).
Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy (Rossi).
Arch Pathol Lab Med. 2024 Oct 1;148(10):1092-1104. doi: 10.5858/arpa.2022-0529-RA.
CONTEXT.—: Fine-needle aspiration (FNA) is a well-established procedure for the diagnosis and management of salivary gland lesions, despite challenges imposed by salivary gland tumor 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, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). The MSRSGC consists of 6 diagnostic categories, which incorporate the morphologic heterogeneity and overlap among various nonneoplastic, benign, and malignant lesions of the salivary glands. In addition, each MSRSGC diagnostic category is associated with a risk of malignancy and management recommendations.
OBJECTIVE.—: To review the current status of salivary gland FNA, core needle biopsies, ancillary studies, and the beneficial role of the MSRSGC in providing a framework for reporting salivary gland lesions and guiding clinical management.
DATA SOURCES.—: Literature review and personal institutional experience.
CONCLUSIONS.—: The main goal of the MSRSGC is to improve communication between cytopathologists and treating clinicians, while also facilitating cytologic-histologic correlation, quality improvement, and research. Since its implementation, the MSRSGC has gained international acceptance as a tool to improve reporting standards and consistency in this complex diagnostic area, and it has been endorsed by the 2021 American Society of Clinical Oncology management guidelines for salivary gland cancer. The large amount of data from published studies using MSRSGC served as a basis for the recent update of the MSRSGC.
细针抽吸（FNA）是诊断和处理唾液腺病变的成熟方法，尽管唾液腺肿瘤的多样性、复杂性和细胞形态学重叠带来了挑战。直到最近，世界各地不同机构的唾液腺 FNA 标本报告仍不一致，导致病理学家和临床医生之间存在诊断混淆。2015 年，一组国际病理学家发起了制定基于证据的分层分类报告系统，即米兰唾液腺细胞学报告系统（MSRSGC），用于报告唾液腺 FNA 标本。MSRSGC 由 6 个诊断类别组成，纳入了各种非肿瘤性、良性和恶性唾液腺病变的形态学异质性和重叠。此外，每个 MSRSGC 诊断类别都与恶性风险和管理建议相关。
回顾唾液腺 FNA、核心针活检、辅助研究的现状，以及 MSRSGC 在提供报告唾液腺病变和指导临床管理的框架方面的有益作用。
文献回顾和个人机构经验。
MSRSGC 的主要目标是改善细胞病理学家与治疗临床医生之间的沟通，同时促进细胞病理学与组织病理学的相关性、质量改进和研究。自实施以来，MSRSGC 已获得国际认可，成为改善该复杂诊断领域报告标准和一致性的工具，并得到 2021 年美国临床肿瘤学会唾液腺癌管理指南的认可。使用 MSRSGC 的已发表研究中的大量数据为最近的 MSRSGC 更新提供了依据。
