{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:26:45Z","timestamp":1786706805268,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["539250008"],"award-info":[{"award-number":["539250008"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Salivary gland lesions (SGL) are a rare and heterogeneous group of benign and malignant masses. Fine\u2010needle aspiration cytology (FNAC), guided by the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), offers a minimally invasive method for early differentiation of SGL. The purpose of this study was to evaluate the cost\u2010effectiveness of FNAC in diagnosing major SGL within the MSRSGC framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three decision tree models were created based on probabilities from real\u2010world and literature data. Real\u2010world data was derived from the previously published largest single\u2010center study evaluating FNAC performance of SGL to date. Costs were determined from German and American fee catalogs. Multiple Monte Carlo simulations were run to assess the cost\u2010effectiveness of performing FNAC within the MSRSGC framework under different conditions for both health care systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Using decision analysis, FNAC followed by surgery, if indicated, was less costly than upfront surgery. The cost reduction through FNAC was over 30% for all models. Cost reduction per case through FNAC followed by surgery, if indicated, compared to upfront surgery ranged between $5606 and $13,096 in the US model (average costs for upfront surgery: $17,472) and between 2465\u20ac and 5337\u20ac in the German model (average costs for upfront surgery: 8018\u20ac). When enhancing the German model with real world data, the cost reduction ranged between 2478\u20ac and 5954\u20ac (average costs for upfront surgery: 7988\u20ac).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this model based on MSRSGC estimates and real\u2010world data, FNAC followed by surgery, if indicated, proved to be a more cost\u2010efficient approach to diagnosing SGL than upfront surgery. Thus, patients and healthcare systems benefit from high\u2010output centers that guarantee expert cytopathological diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71579","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T02:44:22Z","timestamp":1770605062000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness Analysis of the Milan System for Reporting Salivary Gland Cytopathology in Fine\u2010Needle Aspiration Cytology of Salivary Gland Lesions"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0332-1099","authenticated-orcid":false,"given":"Louis","family":"Jansen","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty and University Hospital Cologne University of Cologne  Cologne Germany"},{"name":"Center for Molecular Medicine Cologne 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