Salivary gland tumors (SGTs) are characterized by remarkable heterogeneity and frequent morphological overlap among different entities, posing diagnostic challenges. Fine-needle aspiration cytology (FNAC) plays a pivotal role in the evaluation of salivary gland lesions (SGLs), facilitating early diagnosis and guiding clinical management. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a six-tiered standardized reporting system developed to improve diagnostic consistency and communication between pathologists and clinicians. The present descriptive cross-sectional study included 80 FNAC cases of salivary gland lesions received in the Department of Pathology from January 2018 to September 2022. Cytological findings were evaluated and categorized according to the MSRSGC, and histopathological correlation was performed wherever available. Out of the total 80 cases, histopathological follow-up was available in 34 cases. The most commonly affected age group was 51–60 years (23.75%) with a male-to-female ratio of 1.9:1. The parotid gland was the most frequently involved site (69%), followed by the submandibular gland (26%) and minor salivary glands (5%). 

According to MSRSGC categories I, II, III, IVA, IVB, V, and VI, the frequency distribution of cases was 8%, 11%, 5%, 53%, 16%, 3%, and 5%, respectively. The corresponding risk of malignancy (ROM) values were 0%, 0%, –, 6.25%, 40%, 100%, and 100%. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were 80%, 100%, 100%, 94.44%, and 95.45%, respectively, highlighting the strong diagnostic performance of FNAC in salivary gland lesions. Among the cases with histological follow-up, the majority belonged to category IVB followed by category VI. FNAC proves to be a reliable and effective diagnostic modality for evaluating salivary gland lesions despite their inherent heterogeneity. The application of the Milan System for Reporting Salivary Gland Cytopathology enhances diagnostic accuracy and risk stratification, thereby aiding clinicians in appropriate treatment planning and improving patient outcomes.

Heer Dabhi completed her postgraduate training in pathology from Government Medical College, Surat, Gujarat, India in 2023. She is currently working at Mahavir Cancer Sansthan, Patna, Bihar, India, where she is actively involved in diagnostic pathology and research activities. Her academic interests include cytopathology, molecular pathology, hematopathology, and surgical pathology. She has contributed to research studies involving cytology and histopathology, including work on salivary gland cytology. She has presented research at national and international academic meetings including conferences organized by the Indian association of pathologists and microbiologists. She remains actively engaged in academic research aimed at improving diagnostic accuracy in pathology.