The Milan System SUMP Category - 5-Year Diagnostic Performance

Sep 24, 2026

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Salivary gland neoplasms show marked cytomorphological overlap, making diagnosis difficult. Neoplasms classified as salivary gland neoplasms of uncertain malignant potential (SUMP) within the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) reflect this diagnostic challenge. A five-year cohort of salivary gland fine-needle aspirations (2018–2022) classified as SUMP was reviewed with follow-ups through May 31, 2024. Risk of malignancy and workflow and management timelines were analyzed, including age and sex effects.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Milan System and SUMP diagnostic challenge

Reference ROM and expected RON

Diagnostic and management timelines

Methods and Study Cohort

Inclusion criteria and follow-up review

Subtype classification and risk calculations

Impact of age and sex

Results

Frequency of SUMP among SG-FNA

ROM by surgical follow-up and subtype

ROM by sex and subtype

Conclusions

Comparison of ROM with MSRSGC reference

Subtype- and demographic-associated ROM patterns

Diagnostic Cytopathology ORIGINAL ARTICLE OPEN ACCESS The Milan System SUMP Category: 5-Year Diagnostic Performance Henri Lagerstam1,2 | Erkka Tommola1,2 | David Kalfert3 | Saara Kares2 | Heini Huhtala4 | Ivana Kholová1,2,5,6 1Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland | 2Fimlab Laboratories, Pathology, Tampere, Finland | 3Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic | 4Faculty of Social Sciences, Tampere University, Tampere, Finland | 5Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland | 6Department of Clinical Pathology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland Correspondence: Ivana Kholová ([ivana.kholova@tuni.fi](ivana.kholova@tuni.fi)) Received: 1 January 2025 | Revised: 23 April 2025 | Accepted: 26 April 2025 Funding: This study was funded by a VTR grant from Pirkanmaa Hospital District (to I.K.) and the Emil Aaltonen Foundation (to H.L.) . Keywords: fine-needle aspiration | Milan system for reporting salivary cytopathology | salivary gland | salivary gland neoplasm of uncertain malignant potential | SUMP ABSTRACT Background: Salivary gland neoplasms are heterogeneous, with wide cytomorphological overlap. Neoplasms categorized in the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) as salivary gland neoplasms of uncertain malignant potential (SUMP) reflect this diagnostic challenge. Methods: All salivary gland fine-needle aspirations (SG-FNA) diagnosed at Fimlab Laboratories over a 5-year period (January 1, 2018–December 31, 2022) that were classified as SUMP were included. Follow-ups were reviewed until May 31, 2024. The SUMP cases were classified into cytomorphological subtypes. The risk of malignancy (ROM), risk of neoplasm, and median timelines of the pathology laboratory workflow and patient management were calculated. In addition, separate analyses of the impact of age and sex were performed. Results: A total of 1157 SG-FNAs were diagnosed over a 5-year period. Of these, 100 SG-FNAs from 52 females and 33 males were classified as SUMP. A total of 69 (69.0%) SUMP cases underwent histological verification. The ROM was 23.2% for all surgical follow-ups, 35.0% for the oncocytic/oncocytoid subtype, and 18.4% for the basaloid subtype. For the male and female groups, the ROMs were 26.9% and 16.2% for all surgical follow-ups, 40.0% and 14.3% for the oncocytic/oncocytoid subtype, and 18.8% and 16.7% for the basaloid subtype, respectively. Conclusions: The 5-year analysis of SUMP category performance showed a lower ROM in our practice than the MSRSGC reference value. The oncocytic/oncocytoid subtype presented a higher ROM than the basaloid subtype. The ROMs were highest in the male population and in the age group of 30–69 years. 1 | Introduction Salivary gland tumors represent only 3%–6% of all head and neck tumors. In addition to the low incidence of salivary gland neoplasms, the cytomorphology of salivary gland tumors is challenging. This makes salivary gland cytopathology one of the most difficult cytopathology diagnostic areas [1, 2] . Salivary gland tumors are more common in the older population. Most salivary gland tumors occur in people over 40 years of age, and the risk of malignancy also increases with age. The risk of both benign and malignant salivary gland tumors is highest in the sixth and seventh decades of life. Salivary gland This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Diagnostic Cytopathology published by Wiley Periodicals LLC. 370 Diagnostic Cytopathology, 2025; 53:370–381 [https://doi.org/10.1002/dc.25482](https://doi.org/10.1002/

FAQs

What does the SUMP category represent in the MSRSGC?

SUMP includes neoplastic specimens with overlapping benign and malignant features, or specimens that appear benign but show abnormal components or clinical findings suggesting malignancy.

How were SUMP cases selected and followed up in the study?

All salivary gland fine-needle aspirations (SG-FNA) diagnosed at Fimlab Laboratories between January 1, 2018 and December 31, 2022 and classified as SUMP were included, with follow-ups reviewed until May 31, 2024.

What were the main findings about the risk of malignancy (ROM)?

The study reported a lower ROM in practice than the MSRSGC reference value. ROM varied by cytomorphological subtype, with a higher ROM for the oncocytic/oncocytoid subtype than for the basaloid subtype.

Sep 24, 2026

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