Milan System: Highly Reliable Clinical Diagnostic Tool for Major Salivary Gland Lesions, Suggests Study
A recent cross-sectional study published in the Indian Journal of Otolaryngology and Head & Neck Surgery in July 2026 highlights the Milan System (MSRSGC) as a highly reliable clinical tool for stratifying major salivary gland lesions (p = 0.001). It significantly enhances diagnostic precision by accurately aligning benign pleomorphic adenomas with category 4a and carcinomas with categories 5 and 6.
While Fine Needle Aspiration Cytology (FNAC) and imaging modalities like MRI, CT, and ultrasound are highly accurate for diagnosing salivary gland lesions, precise subtyping remains a clinical challenge. To address this diagnostic gap, Ahmed et al. investigated the clinical utility of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in evaluating newly diagnosed major salivary gland lesions.
Therefore, the cross-sectional study evaluated 72 patients with newly diagnosed, visible or palpable major salivary gland swellings based on specific inclusion and exclusion criteria. All patients underwent comprehensive ENT examinations, FNAC, and complete surgical excision of the lesions. To assess diagnostic accuracy, researchers used the Pearson chi-square test to compare the preoperative cytological categorizations against the final postoperative histopathology.
Key Clinical Findings of the Study Includes:
• Cohort Distribution: Researchers identified that out of the 72 totally excised lesions analyzed in the cohort, exactly 56 were confirmed as benign while the remaining 16 were definitively malignant upon final histopathological review.
• Statistical Significance: Analysis yielded a highly compelling and significant result (X2 = 108.439; p = 0.001), underscoring the strong predictive value of this specific cytopathology reporting system.
• Benign Correlation: Investigators found that the vast majority of histopathology findings presenting as benign pleomorphic adenoma directly and accurately correlated with the Milan 4a category.
• Malignant Correlation: Findings powerfully demonstrated that cases categorized cytologically as Milan 5 and 6 contained a significantly higher and concentrated number of diagnosed carcinomas.
The results suggest that the application of this standardized reporting system effectively categorizes major salivary gland swellings, reliably differentiating between benign conditions in category 4a and overt malignancies in categories 5 and 6 with exceptional statistical validity (p=0.001). Furthermore, it validates cytopathology as not just a preliminary tool but a highly specific guide when interpreted through the Milan framework for these 72 evaluated patients.
Adopting the universally standardized reporting system may assist clinicians in achieving better diagnostic consistency and improved cytological subtyping when evaluating major salivary gland tumors during routine clinical practice.
Reference
Ahmed, S., Shah, M. U., Patigaroo, S. A., & Rathore, M. H. (2026). The Role of Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in the Evaluation of Major Salivary Gland Lesions. Indian Journal of Otolaryngology and Head & Neck Surgery.
