Risk of malignancy associated with indeterminate categories in the Milan System for reporting pediatric salivary gland cytopathology: a multi-institutional study.
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INTRODUCTION: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a reporting scheme for salivary gland fine needle aspiration (FNA) and includes 3 indeterminate categories with different management strategies. This multi-institutional study analyzes the risk of malignancy (ROM) associated with indeterminate salivary gland FNAs in children. MATERIALS AND METHODS: Pediatric salivary gland FNAs with indeterminate diagnoses encountered in 6 institutions were retrospectively reviewed and classified as either atypia of undetermined significance (AUS), salivary gland neoplasm of uncertain malignant potential (SUMP), or suspicious for malignancy (SM). The risk of malignancy (ROM) was assessed for each category based on histologic follow-up. RESULTS: Thirty FNAs were included, including 11 (37%) AUS, 16 (53%) SUMP, and 3 (10%) SM diagnoses. On follow-up, 54% were malignant, including 70% AUS, 33% SUMP, and 100% SM cases. The ROMs among published pediatric series (including the current study) varied from 0% to 100% for AUS and 0% to 67% for SUMP, and were consistently 100% in for SM. When the cases from all studies were combined to assemble a cohort for analysis (n = 82), the average ROMs for AUS and SUMP were 44% (12/27 cases) and 29% (12/42 cases), respectively. CONCLUSIONS: The MSRSGC is an effective method for risk stratification of indeterminate salivary gland FNAs in pediatric patients. Each indeterminate MSRSGC category was associated with a specific range of ROM which was higher for AUS and SM in children than those estimated in adult patients.