{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:20:27Z","timestamp":1787656827419,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diagnostic Cytopathology"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Salivary gland fine\u2010needle aspirates (FNAs) with low\u2010grade oncocytic features are diagnostically challenging due to the substantial morphologic overlap between benign oncocytic tumors and their malignant mimickers. This study evaluates the diagnostic discriminators, performance, and risk of malignancy of these lesions using the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively reviewed salivary gland FNA cases (2021\u20132025) categorized as Milan IVa: Benign neoplasm with oncocytic features, including Warthin tumor and oncocytoma\/nodular oncocytic hyperplasia (NOH), and Milan IVb: Salivary gland neoplasm of uncertain malignant potential (SUMP) with oncocytic features, with surgical follow\u2010up. Cytomorphological analysis was performed on liquid\u2010based cytology (LBC), direct smears, and cell blocks. Features including architectural patterns, cytological details, and background were correlated with histology.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Forty\u2010nine cases were included. All 43 cases diagnosed as Milan IVa were confirmed as Warthin tumor or oncocytoma\/nodular oncocytic hyperplasia. Warthin tumor shows cohesive, flat clusters of oncocytes along with a cystic debris\u2010like background, while oncocytoma\/NOH shows compact globoid clusters of oncocytes with a \u201cbunch of grapes\u201d pattern and clean background. In the six Milan IVb cases, follow\u2010up histology included oncocytic mucoepidermoid carcinoma (OMEC,\n n<\/jats:italic>\n \u2009=\u20092), oncocytoma\/nodular oncocytic hyperplasia (\n n<\/jats:italic>\n \u2009=\u20092), oncocytic lipoadenoma (\n n<\/jats:italic>\n \u2009=\u20091), and spindle cell lipoma (\n n<\/jats:italic>\n \u2009=\u20091). The OMEC cases form discohesive clusters and single cells. Cell block preparations revealed focal glandular structures and rare intracytoplasmic mucin.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The MSRSGC effectively risk\u2010stratifies low\u2010grade oncocytic salivary gland lesions. While cohesive, organoid architecture supports a benign diagnosis, the presence of isolated cells and discohesive clusters is better classified as SUMP. Cell block preparation is useful for identifying mucin and glandular differentiation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/dc.70202","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:35:46Z","timestamp":1787654146000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fine\u2010Needle Aspiration of Salivary Gland Tumors With Low\u2010Grade Oncocytic Features: Focusing on Oncocytoma Versus Oncocytic Mucoepidermoid Carcinoma"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0409-3118","authenticated-orcid":false,"given":"Lois","family":"Araneta","sequence":"first","affiliation":[{"name":"Rizal Medical Center Pasig City Metro Manila Philippines"},{"name":"Chinese General Hospital College of Medicine Manila Philippines"},{"name":"Department of Pathology and Laboratory Medicine Taipei Veterans General Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4408-8588","authenticated-orcid":false,"given":"Ying\u2010Ju","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Taipei Veterans General Hospital Taipei Taiwan"},{"name":"Department of Pathology, School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4299-2784","authenticated-orcid":false,"given":"Jen\u2010Fan","family":"Hang","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Taipei Veterans General Hospital Taipei Taiwan"},{"name":"Department of Pathology, School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s12105-022-01459-0","article-title":"Distribution and Frequency of Salivary Gland Tumours: An International Multicenter Study","volume":"16","author":"Alsanie I.","year":"2022","journal-title":"Head and Neck Pathology"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3390\/jcm8050566","article-title":"Characteristics of 5015 Salivary Gland Neoplasms Registered in the Hiroshima Tumor Tissue Registry Over a Period of 39\u2009Years","volume":"8","author":"Sentani K.","year":"2019","journal-title":"Journal of Clinical Medicine"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"6112","DOI":"10.1007\/s12070-021-02764-w","article-title":"Oncocytic Salivary Gland Tumours: Cytological Features and Diagnostic Pitfalls","volume":"74","author":"Prabhakar P.","year":"2022","journal-title":"Indian Journal of Otolaryngology and Head & Neck Surgery"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1002\/dc.23716","article-title":"Reporting of Fine Needle Aspiration (FNA) Specimens of Salivary Gland Lesions: A Comprehensive Review","volume":"45","author":"Wei S.","year":"2017","journal-title":"Diagnostic Cytopathology"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1309\/AJCPOIE0CZNAT6SQ","article-title":"A Systematic Review and Meta\u2010Analysis of the Diagnostic Accuracy of Fine\u2010Needle Aspiration Cytology for Parotid Gland Lesions","volume":"136","author":"Schmidt R. L.","year":"2011","journal-title":"American Journal of Clinical Pathology"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1002\/cncy.21710","article-title":"The Impact of FNAC in the Management of Salivary Gland Lesions: Institutional Experiences Leading to a Risk\u2010Based Classification Scheme","volume":"124","author":"Rossi E. D.","year":"2016","journal-title":"Cancer Cytopathology"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5858\/2005-129-26-PISGFC","article-title":"Pitfalls in Salivary Gland Fine\u2010Needle Aspiration Cytology: Lessons From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology","volume":"129","author":"Hughes J. H.","year":"2005","journal-title":"Archives of Pathology & Laboratory Medicine"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1002\/cncy.22753","article-title":"Second Edition of the Milan System for Reporting Salivary Gland Cytopathology: Refining the Role of Salivary Gland FNA","volume":"132","author":"Rossi E. D.","year":"2024","journal-title":"Cancer Cytopathology"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1002\/cncy.22066","article-title":"Subtyping Salivary Gland Neoplasm of Uncertain Malignant Potential Based on Cell Type Demonstrates Differential Risk of Malignancy","volume":"126","author":"Hang J. F.","year":"2018","journal-title":"Cancer Cytopathology"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/cncy.22427","article-title":"Analysis of the Risk of Malignancy Associated With the Basaloid and Oncocytic Subtypes of the Salivary Gland Neoplasm of Unknown Malignant Potential (SUMP) Category in the Milan System","volume":"129","author":"Manucha V.","year":"2021","journal-title":"Cancer Cytopathology"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1002\/dc.25482","article-title":"The Milan System SUMP Category: 5\u2010Year Diagnostic Performance","volume":"53","author":"Lagerstam H.","year":"2025","journal-title":"Diagnostic Cytopathology"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1159\/000544802","article-title":"Oncocytic Tumors in the Salivary Gland: A Tri\u2010Focal Review \u2010 Integrated Cytopathological, Pathological, and Molecular Features","volume":"69","author":"Skalova A.","year":"2025","journal-title":"Acta Cytologica"},{"key":"e_1_2_9_14_1","first-page":"809","volume-title":"WHO Classification of Tumours: Head and Neck Tumours","author":"Board WHOCoTE, World Health O, International Agency for Research on C","year":"2024"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13256-018-1941-3","article-title":"Infarcted Warthin Tumor With Mucoepidermoid Carcinoma\u2010Like Metaplasia: A Case Report and Review of the Literature","volume":"13","author":"Yorita K.","year":"2019","journal-title":"Journal of Medical Case Reports"},{"key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/ajcp\/97.1.40","article-title":"Necrotizing Squamous\/Mucinous Metaplasia in Oncocytic Salivary Gland Tumors. A Potential Diagnostic Problem","volume":"97","author":"Taxy J. B.","year":"1992","journal-title":"American Journal of Clinical Pathology"},{"key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jasc.2025.09.003","article-title":"Fine Needle Aspiration Cytomorphology of Parotid Gland Oncocytoma: A Case Series","volume":"15","author":"Ferreira J. E.","year":"2026","journal-title":"Journal of the American Society of Cytopathology"},{"key":"e_1_2_9_18_1","first-page":"347","article-title":"Oncocytic Lipoadenoma of the Salivary Glands: A Poorly Known and Underestimated Tumor?","volume":"46","author":"Spinelli A.","year":"2026","journal-title":"Annales de Pathologie"},{"key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"313","DOI":"10.4103\/ams.ams_115_21","article-title":"Intraoral Oncocytic Mucoepidermoid Carcinoma \u2013 A Rare Case Report and Review of the Literature","volume":"11","author":"Sripodok P.","year":"2021","journal-title":"Annals of Maxillofacial Surgery"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s12105-025-01768-0","article-title":"Oncocytic Mucoepidermoid Carcinoma of the Parotid Gland","volume":"19","author":"Argyris P. P.","year":"2025","journal-title":"Head and Neck Pathology"},{"key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1159\/000538069","article-title":"Pitfalls in Salivary Gland Cytology","volume":"68","author":"Saoud C.","year":"2024","journal-title":"Acta Cytologica"},{"key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/dc.24308","article-title":"Fine\u2010Needle Aspiration Cytology of the Apocrine Variant of Epithelial\u2010Myoepithelial Carcinoma","volume":"48","author":"Perez D.","year":"2020","journal-title":"Diagnostic Cytopathology"},{"key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1002\/cncy.22568","article-title":"Salivary Duct Carcinoma: A Report of 70 FNA Cases and Review of the Literature","volume":"130","author":"Wakely P. 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G.","year":"2025","journal-title":"Journal of Oral Pathology & Medicine"},{"key":"e_1_2_9_27_1","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1177\/0003489419842582","article-title":"Sensitivity of Fine\u2010Needle Aspiration and Imaging Modalities in the Diagnosis of Low\u2010Grade Mucoepidermoid Carcinoma of the Parotid Gland","volume":"128","author":"Garrett S. L.","year":"2019","journal-title":"Annals of Otology, Rhinology and Laryngology"},{"key":"e_1_2_9_28_1","doi-asserted-by":"crossref","first-page":"260","DOI":"10.4103\/jmu.JMU-D-24-00020","article-title":"Comparison of Color Doppler Ultrasound Characteristics Between Parotid Mucoepidermoid Carcinoma and Basal Cell Adenoma","volume":"33","author":"Chen S.","year":"2025","journal-title":"Journal of Medical Ultrasound"}],"container-title":["Diagnostic Cytopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.70202","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/dc.70202","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.70202","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:35:50Z","timestamp":1787654150000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/dc.70202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":27,"alternative-id":["10.1002\/dc.70202"],"URL":"https:\/\/doi.org\/10.1002\/dc.70202","archive":["Portico"],"relation":{},"ISSN":["8755-1039","1097-0339"],"issn-type":[{"value":"8755-1039","type":"print"},{"value":"1097-0339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"assertion":[{"value":"2026-07-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"dc.70202"}}