Evidence map›Paper›PMID 42543414›Full record

ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026

Limitations of FNAC in detecting parotid malignancies: insights from a surgical cohort using the updated Milan System.

Andrea Galli, Bright Oworae Howardson, Carlo Scionti, Emilio Salerno, Carlo Pettirossi, Davide Di Santo, Diego Barbieri, Apostolos Karligkiotis, Gianluigi Arrigoni, Renata Mellone and 3 more

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Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Andrea GalliDepartment of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Bright Oworae HowardsonDepartment of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. bhowardson@gmail.com.ORCID http://orcid.org/0000-0002-1739-4179
Carlo SciontiVita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy.
Emilio SalernoDepartment of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Carlo PettirossiHead and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, 10060, Candiolo, Italy.
Davide Di SantoOtorhinolaryngology, Head and Neck Surgery, University Hospital Leuven, Louvain, Belgium.
Diego BarbieriDepartment of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Apostolos KarligkiotisDepartment of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Gianluigi ArrigoniDepartment of Pathology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Renata MelloneDepartment of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Stefano BondiHead and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, 10060, Candiolo, Italy.
Mario BussiDepartment of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Leone GiordanoDepartment of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo evaluate the diagnostic accuracy of the second edition Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in predicting the risk of malignancy (ROM) in parotid tumors, through correlation with final histopathological diagnoses in a large consecutive single-center surgical series.

methodsA retrospective study was conducted on 249 consecutive patients who underwent parotid surgery between June 2017 and March 2024 in a tertiary referral center. Preoperative fine-needle aspiration cytology (FNAC) results were classified according to the MSRSGC. Diagnostic performance metrics were calculated, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic concordance. Cytological findings were correlated with definitive histopathology to calculate ROM, risk of high-grade malignancy (ROM-HG), and risk of neoplasia (RON). Multivariate logistic regression was performed to identify preoperative predictors of malignancy.

resultsFNAC showed high accuracy in diagnosing pleomorphic adenoma and Warthin tumor. Sensitivity for malignancy detection was 68%, In alternative analyses, sensitivity decreased to 56% and increased to 74% when indeterminate categories (MSRSGC III- AUS and IV - SUMP) were considered test-negative or test-positive, respectively.. Within these indeterminate categories, ROM was 18.6%, while ROM-HG was 0%. Among 29 primary malignant tumors, 86.7% of low/intermediate-grade malignancies were classified as benign or indeterminate on FNAC. Multivariate analysis identified male gender and hypomobility as predictors of malignancy.

conclusionsAlthough the updated MSRSGC has improved FNAC-based classification of parotid tumors, diagnostic performance remains limited for low/intermediate-grade malignancies, which are frequently classified as benign or indeterminate. The absence of HG-malignancies within indeterminate categories suggests a limited clinical impact of these diagnostic uncertainty.

Indexed as

Salivary glands – Parotid – Fine needle aspiration cytology – Malignancy – Milan System for Reporting Salivary Gland Cytopathology

Identifiers

PMID42543414

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