{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:37Z","timestamp":1787027917976,"version":"build-2736575974"},"reference-count":39,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009960","name":"Pirkanmaan Sairaanhoitopiiri","doi-asserted-by":"publisher","award":["X5211"],"award-info":[{"award-number":["X5211"]}],"id":[{"id":"10.13039\/501100009960","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009960","name":"Pirkanmaan Sairaanhoitopiiri","doi-asserted-by":"publisher","award":["Support Foundation"],"award-info":[{"award-number":["Support Foundation"]}],"id":[{"id":"10.13039\/501100009960","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006706","name":"Tampereen Tuberkuloosis\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["2019"],"award-info":[{"award-number":["2019"]}],"id":[{"id":"10.13039\/501100006706","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007397","name":"Univerzita Karlova v Praze","doi-asserted-by":"publisher","award":["Progres Q28\/LF1 (UNCE 204013)"],"award-info":[{"award-number":["Progres Q28\/LF1 (UNCE 204013)"]}],"id":[{"id":"10.13039\/100007397","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>(1) Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018, bringing an organ-specific classification system for salivary gland cytopathology. The aim of present study is to evaluate the MSRSGC prospectively, based on a two-year experience in the tertiary care center pathology department, and evaluate the role of routine cell block (CB) preparation in salivary gland cytopathological diagnostics. (2) Methods: In our institution, the Department of Pathology, Fimlab Laboratories, Tampere, Finland, the MSRSGC has been implemented in salivary gland cytopathology since January 2018 and, over a two-year period (January 2018\u2013December 2019), there were 365 fine-needle aspirations, of which 164 had a surgical follow-up. The CB methods used were Plasma-thrombin, the collection of visible fragments, and the Shandon and in-house methods. (3) Results: The MSRSGC diagnostic figures were as follows: accuracy 87.5%, sensitivity 45.8% and specificity 98.9%. For diagnostic categories of MSRSGC (non-neoplastic, benign neoplasm and malignant neoplasm) (n = 63) diagnostic accuracy was 98.4%, and for undetermined categories (atypia of undetermined significance, salivary gland neoplasm of uncertain malignant potential and suspicious for malignancy) (n = 49) diagnostic accuracy was 73.5%. Non-contributory cell blocks resulted more often in a false negative diagnosis (25%, 3\/12) than a true negative diagnosis (10%, 7\/73, p &lt; 0.001), and is, most likely, an insufficient cytological diagnosis (86%, 18\/21, p &lt; 0.001). (4) Conclusion: The application of MSRSGC and CBs are beneficial in salivary gland cytological diagnosis, increasing diagnostic accuracy and, thus, patients\u2019 management and treatment.<\/jats:p>","DOI":"10.3390\/diagnostics11101778","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T10:39:20Z","timestamp":1632739160000},"page":"1778","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The Contributory Role of Cell Blocks in Salivary Gland Neoplasms Fine Needle Aspirations Classified by the Milan System for Reporting Salivary Gland Cytology"],"prefix":"10.3390","volume":"11","author":[{"given":"Erkka","family":"Tommola","sequence":"first","affiliation":[{"name":"Fimlab Laboratories, Department of Pathology, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4369-4113","authenticated-orcid":false,"given":"David","family":"Kalfert","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heli","family":"Hakso-M\u00e4kinen","sequence":"additional","affiliation":[{"name":"Fimlab Laboratories, Department of Pathology, Tampere University Hospital, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4089-0450","authenticated-orcid":false,"given":"Ivana","family":"Kholov\u00e1","sequence":"additional","affiliation":[{"name":"Fimlab Laboratories, Department of Pathology, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Faquin, W.C., Rossi, E.D., Baloch, Z., Barkan, G.A., Foschini, M.P., Kurtycz, D.F., Pusztaszeri, M., and Vielh, P. (2018). The Milan System for Reporting Salivary Gland Cytopathology, Springer.","DOI":"10.1007\/978-3-319-71285-7"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1002\/cncy.22040","article-title":"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","volume":"126","author":"Rossi","year":"2018","journal-title":"Cancer Cytopathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1002\/lary.27905","article-title":"A call for universal acceptance of the Milan System for Reporting Salivary Gland Cytopathology","volume":"130","author":"Barbarite","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_4","first-page":"1","article-title":"Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-year experience in a single Japanese institution","volume":"28","author":"Hirata","year":"2020","journal-title":"Acta Cytol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1002\/dc.24536","article-title":"The Milan System for Reporting Salivary Gland Cytopathology: A comprehensive review of the literature","volume":"48","author":"Jalaly","year":"2020","journal-title":"Diagn. Cytopathol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1159\/000510720","article-title":"The Milan System for Reporting Salivary Gland Cytopathology: Assessment of cytohistological concordance and risk of malignancy","volume":"65","author":"Jha","year":"2021","journal-title":"Acta Cytol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Tommola, E., Tommola, S., Porre, S., and Kholov\u00e1, I. (2019). Salivary gland FNA diagnostics in a real-life setting: One-year-experiences of the implementation of the Milan system in a tertiary care center. Cancers, 11.","DOI":"10.3390\/cancers11101589"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1159\/000489769","article-title":"Cell block in cytological diagnostics: Review of preparatory techniques","volume":"62","author":"Krogerus","year":"2018","journal-title":"Acta Cytol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/cyt.12627","article-title":"Cell blocks in cytopathology: An update","volume":"29","author":"Nambirajan","year":"2018","journal-title":"Cytopathology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4103\/cytojournal.cytojournal_20_19","article-title":"CellBlockistry: Chemistry and art of cell-block making\u2014A detailed review of various historical options with recent advances","volume":"16","author":"Shidham","year":"2019","journal-title":"CytoJournal"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1159\/000501817","article-title":"New cell block method to enhance the cellular yield in mucous and\/or bloody samples","volume":"64","year":"2020","journal-title":"Acta Cytol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.jasc.2020.06.004","article-title":"Navigating small biopsies of salivary gland tumors: A pattern-based approach","volume":"9","author":"Nix","year":"2020","journal-title":"J. Am. Soc. Cytopathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jasc.2020.01.008","article-title":"The Milan System for Reporting Salivary Gland Cytopathology: A universal language to improve patient care","volume":"9","author":"Maleki","year":"2020","journal-title":"J. Am. Soc. Cytopathol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/PAP.0000000000000224","article-title":"Salivary gland fine needle aspiration and introduction of the Milan reporting system","volume":"26","author":"Pusztaszeri","year":"2019","journal-title":"Adv. Anat. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1002\/dc.23255","article-title":"Diagnostic problems of salivary gland tumors","volume":"43","author":"Tyagi","year":"2015","journal-title":"Diagn. Cytopathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1002\/dc.23597","article-title":"Impact of routine cell block preparation on results of head and neck fine needle aspirates","volume":"44","author":"Carter","year":"2016","journal-title":"Diagn. Cytopathol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/cyt.12222","article-title":"Cell blocks are not a substitute for cytology: Why pathologists should understand cytopathology particularly in their chosen speciality","volume":"25","author":"Herbert","year":"2014","journal-title":"Cytopathology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/cyt.12174","article-title":"Cell blocks in cytopathology: A review of preparative methods, utility in diagnosis and role in ancillary studies","volume":"25","author":"Jain","year":"2014","journal-title":"Cytopathology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1002\/dc.24137","article-title":"Assessment of cell block technique in head and neck pathology diagnoses: A preliminary study","volume":"47","author":"Desai","year":"2019","journal-title":"Diagn. Cytopathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/dc.24400","article-title":"Cell-block as ancillary tool for the diagnosis of cystic and cyst-like jaw lesions","volume":"48","author":"Melo","year":"2020","journal-title":"Diagn. Cytopathol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1002\/dc.23548","article-title":"Fine-needle aspiration of cervical lymph nodes yields adequate materials for accurate HPV testing in metastatic head and neck squamous cell carcinomas","volume":"44","author":"Hou","year":"2016","journal-title":"Diagn. Cytopathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/dc.24629","article-title":"FNA diagnostics of secondary malignancies in the salivary gland: Bi-institutional experience of 36 cases","volume":"49","author":"Porre","year":"2021","journal-title":"Diagn. Cytopathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1002\/dc.24515","article-title":"The Milan system for reporting salivary gland cytopathology: Single center experience with cell blocks","volume":"48","author":"Behaeghe","year":"2020","journal-title":"Diagn. Cytopathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1111\/apm.12950","article-title":"Cytopathological features of secretory carcinoma of salivary glands and ancillary techniques in its diagnostics: Impact of new Milan system for reporting salivary gland cytopathology","volume":"127","author":"Tommola","year":"2019","journal-title":"APMIS"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1002\/cncy.22016","article-title":"The role of the Milan System for Reporting Salivary Gland Cytopathology: A 5-year institutional experience","volume":"126","author":"Viswanathan","year":"2018","journal-title":"Cancer Cytopathol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/cyt.12642","article-title":"The utility of the Milan System as a risk stratification tool for salivary gland fine needle aspiration cytology specimens","volume":"30","author":"Song","year":"2019","journal-title":"Cytopathology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.5858\/arpa.2016-0125-RA","article-title":"The state of cell blocks and ancillary testing: Past, present, and future","volume":"140","author":"Saqi","year":"2016","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1159\/000514906","article-title":"The role of cell blocks and immunohistochemistry in thyroid atypia of undetermined significance\/follicular lesion of undetermined significance Bethesda category","volume":"65","author":"Abram","year":"2021","journal-title":"Acta Cytol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1002\/cncy.21850","article-title":"Preanalytic specimen triage: Smears, cell blocks, cytospin preparations, transport media, and cytobanking","volume":"125","author":"Saieg","year":"2017","journal-title":"Cancer Cytopathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1159\/000497109","article-title":"The role of ancillary techniques in salivary gland cytopathology specimens","volume":"64","author":"Griffith","year":"2020","journal-title":"Acta Cytol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1002\/cncy.22311","article-title":"Immunocytochemistry practices in European cytopathology laboratories-Review of European Federation of Cytology Societies (EFCS) online survey results with best practice recommendations","volume":"128","author":"Bongiovanni","year":"2020","journal-title":"Cancer Cytopathol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Dubucs, C., Basset, C., D\u2019Aure, D., Courtade-Sa\u00efdi, M., and Evrard, S.M. (2019). A 4-year retrospective analysis of salivary gland cytopathology using the Milan system for reporting salivary gland cytology and ancillary studies. Cancers, 11.","DOI":"10.3390\/cancers11121912"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5858\/2005-129-26-PISGFC","article-title":"Pitfalls in salivary gland fine-needle aspiration cytology: Lessons from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology","volume":"129","author":"Hughes","year":"2005","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1002\/dc.24214","article-title":"The risk of malignancy according to Milan reporting system of salivary gland fine-needle aspiration with Becton Dickinson SurePath liquid-based processing","volume":"47","author":"Nergiz","year":"2019","journal-title":"Diagn. Cytopathol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1002\/cncy.21900","article-title":"Three-year cytohistological correlation of salivary gland FNA cytology at a tertiary center with the application of the Milan system for risk stratification","volume":"125","author":"Rohilla","year":"2017","journal-title":"Cancer Cytopathol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1002\/dc.24109","article-title":"A critical appraisal of the Milan system for reporting salivary gland cytology (MSRSGC) with histological correlation over a 3-year period: Indian scenario","volume":"47","author":"Pujani","year":"2019","journal-title":"Diagn. Cytopathol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jasc.2019.04.001","article-title":"Mucoepidermoid carcinoma, acinic cell carcinoma, and adenoid cystic carcinoma on fine-needle aspiration biopsy and The Milan System: An international multi-institutional study","volume":"8","author":"Miller","year":"2019","journal-title":"J. Am. Soc. Cytopathol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1002\/dc.24350","article-title":"The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in-house salivary gland fine-needle aspiration cytology at a comprehensive cancer center","volume":"48","author":"Lubin","year":"2020","journal-title":"Diagn. Cytopathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1002\/cncy.22322","article-title":"Should uncertainty concerning the risk of malignancy be included in diagnostic (nongynecologic) cytopathology reports?","volume":"129","author":"Poller","year":"2021","journal-title":"Cancer Cytopathol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/10\/1778\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:05:56Z","timestamp":1760166356000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/10\/1778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,27]]},"references-count":39,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["diagnostics11101778"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11101778","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,27]]}}}