Prioritizing parotid gland surgery: A call for the implementation of the MSRSGC classification

• Published in: Cancer cytopathology 2023-11, Vol.131 (11), p.701-707
• Main Authors: Reerds, Sam T. H., Honings, Jimmie, Engen, Adriana C. H., Marres, Henri A. M., Takes, Robert P., Hoogen, Frank J. A.
• Format: Article
• Language: English
• Subjects: Classification; Exocrine glands; fine‐needle; Milan system for reporting salivary gland cytology; MSRSGC; Oral cancer; parotid; salivary gland neoplasms (Mesh); salivary glands; time‐to‐treatment (Mesh); time‐to‐treatment initiation; TTI
• ISSN: 1934-662X; 1934-6638
• DOI: 10.1002/cncy.22747

Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is developed to aid diagnosis and management of salivary gland tumors. This study evaluates the time‐to‐treatment initiation (TTI) for parotid gland tumors in the Netherlands and relates these to the MSRSGC classification. Subsequently, the use of the MSRSGC in the Netherlands is evaluated. Methods Data regarding fine‐needle aspiration cytology (FNAC) and histopathological resections of the parotid were gathered from the Dutch nationwide pathology data bank (PALGA). The TTI was calculated for each MSRSGC category and type of treating center. FNACs performed from 2018 to 2021 were gathered from PALGA to estimate how frequently the MSRSGC classification was applied. Results Median TTI in days were 86 for nondiagnostic (MSRSGC I), 75 for nonneoplastic (MSRSGC II), 65 for atypia of unknown significance (AUS) (MSRSGC III), 89 for benign (MSRSGC IVa), 52 for salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), 31 for suspected malignant (MSRSGC V), and 30 for malignant (MSRSGC VI) categories. Significant variation in the TTI between the types of treating centers was found for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. In the first 3 years after the introduction of the MSRSGC, the pathologist stated the MSRSGC classification in 6.4% of all reports. Conclusions The median TTI for most categories is long, and there is significant interhospital variation in TTI. Preoperative risk stratification and treatment prioritization in parotid gland surgery in the Netherlands should be improved. The MSRSGC could contribute to this. Until 2021, the MSRSGS classification was implemented on a limited scale in the Netherlands. The median time‐to‐treatment initiation for the atypia of unknown significance (AUS) (MSRSGC III), salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), nondiagnostic (MSRSGC I), and nonneoplastic (MSRSGC II) categories are long. There is significant interhospital variation in the time‐to‐treatment initiation for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. Until 2021, the MSRSGS classification was only implemented on a limited scale in the Netherlands.