Cytopathological study of salivary gland lesions in rural population: Use of the Milan system for reporting

Introduction: Salivary gland lesions are superficial lesions & seek attention of patient easily. These lesions vary from non-neoplastic to neoplastic ones and from benign to malignant. Impact of changing habits of people may be reflected in spectrum of oral health & lesions of salivary glands. Objectives and Method: Present study includes the spectrum of distribution of various lesions of salivary glands in the patients visiting tertiary care rural hospital. In the present study, the Milan system was used for reporting salivary gland cytopathology in 150 cases. Results: FNAC proved to be a safe and effective modality in diagnosis and planning management of patients with salivary gland lesionsin the rural based population. Conclusion: Milan system was found characteristically significant for cytopathological diagnosis of SGLs.


Introduction
Salivary gland diseases usually present as a swelling of the affected gland. FNAC (Fine needle aspiration cytology) is being increasingly used in the diagnosis of the salivary gland swellings [1]. Salivary gland lesions comprise 2-6.5% of all head and neck neoplasms in adults.
The common presentation is an enlarged mass which is usually accessible for FNAC. Salivary gland tumors are not common; moreover, the associated histopathology of these tumors is extremely varied and complex due to the presence of epithelial and non-epithelial neoplasms, lymphomas, metastatic tumors and non-neoplastic lesions in the salivary glands [2].
The rapidity for diagnosis, low morbidity and a high diagnostic accuracy makes FNAC a popular method for evaluating the salivary gland neoplasms before any surgical intervention [3].

Material and Methods
This study included 150patients presented with salivary gland swellings.
Type of study: Prospective and observational study. Inclusion criteria: All cases of salivary gland lesions were included in the present study.
Exclusion criteria: Patients on conservative treatment and those referred to other hospitals were excluded from the study.
Detail clinical history was taken, and local examination followed by systemic examination was done in all patients. After taking consent, FNAC was done using 21-23-gauge needle attached to a 10 ml syringe and smears were prepared. Smears were wet fixed in 95% ethyl alcohol at least for 30 minutes and Papanicolaou (Pap) staining was done. Air dried smears were stained with May-Grunwald Giemsa (MGG) stain. Stained smears were mounted with DPX (dextrene polystyrene xylene) and examined under the light microscope.

Discussion
FNAC has been well established role in the diagnosis of SGLs & it is a safe, cost-efficient, minimally invasive procedure that helps the clinicians in the formulation of further management [4,5]. However, at many times it becomes a tedious job to diagnose accurately, mainly due to the similar microscopic picture of normal salivary gland elements, heterogeneous nature of salivary gland lesions, overlapping features between benign and malignant lesions, presence of cystic components, and oncocytic metaplasia [6]. Aspirates from SGLs in category I were reported as non-diagnostic only after processing & examining all the material. Cases with mucinous cyst contents were included in AUS category. This comprised of smears with less than 60 lesional cells, poorly prepared slides with artifacts [ Fig:1A], slides with normal salivary gland elements in unilateral swellings, non-mucinous cyst contents showing cyst fluid only or histiocytes [ Fig. 1B].

Table-4: Comparison of age wise distribution pattern in SGL:
Present study showed maximum cases in age group of 31-40 years with a mean age of 39.7 years, which was comparable to studies done by Kakoty S et al [11] & Shafkat A et al [13].  In the present study of 150 salivary gland lesions, male preponderance was observed with male to female ratio of 1.1: 1, which was comparable to studies done by Jain C [14] and Gandhi SH. et al [15].   [18].

Original Research Article
Benign tumors were more common in the age group of 21-60 year and malignant tumors were more common in the age group of 61-80 years which was comparable to the study done by Joshi A et al [20].

Conclusion
150 cases of SGLs were studied in rural based population by using the Milan system of reporting cytopathology. Submandibular salivary gland was most commonly affected followed by parotid gland, minor salivary glands and sublingual gland respectively. Age range in our study was from 2-90 years with mean age 39.7 years. Male preponderance was observed with M: F of 1.11: 1. Non-neoplastic lesions were more common than neoplastic SGL's. Benign tumors were more common in the age group 21-40 years while malignant tumors were more common in the age group of 61-80years. PA was the most common benign tumor and MEC was the most common primary malignant tumor.
Role of FNAC, its diagnostic utility in the rural based population combined with the use of Milan System of reporting cytopathology in SGLs was found characteristically significant for cytological diagnosis.
Both the authors had equally contributed regarding concept, design, literature search, data analysis and preparation of this manuscript. No prior publication, support and conflict of interest.
Findings: Nil; Conflict of Interest: None initiated Permission from IRB: Yes