The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): An international effort toward improved patient care-when the roots might be inspired by Leonardo da Vinci.

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) represents a standardized, evidence-based reporting system for salivary gland fine-needle aspiration (FNA). The role of FNA is well established for the preoperative evaluation of patients with salivary gland lesions; however, the lack of a uniform system for salivary gland FNA has limited its effectiveness. To address this, an international panel of experienced cytopathologists proposed a uniform reporting system in 2015 under the sponsorship of the American Society of Cytopathology and the International Academy of Cytology. The MSRSGC consists of 6 diagnostic tiers: 1) nondiagnostic, 2) non-neoplastic, 3) atypia of undetermined significance, 4) neoplasm (subdivided into benign and salivary gland neoplasm of uncertain malignant potential), 5) suspicious for malignancy, and 6) malignant. On the basis of evidence from the literature, each category has a suggested risk of malignancy that ranges from 5% for the neoplasm-benign category to >90% for the malignant category. The overall goal of the MSRSGC is to improve the effectiveness of salivary FNA by providing a uniform system with the ultimate result of better communication and improved patient care.