Fine-needle aspiration cytology reduces the frequency of surgeries for malignant salivary gland tumors.

BACKGROUND: Salivary gland tumors are rare and heterogeneous head and neck neoplasms. Preoperative distinction between benign and malignant lesions is challenging because imaging is often insufficient. Fine-needle aspiration cytology (FNAC) combined with the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides standardized risk stratification and diagnostic guidance; however, its influence on surgical frequency remains insufficiently characterized. METHODS: This retrospective single-center study included patients with histologically confirmed malignant tumors within the major salivary glands with preoperative FNAC and surgery. The association between MSRSGC category and number of surgeries was evaluated using χ2 tests and multivariate Poisson regression. RESULTS: Overall, 157 patients were included. Those with high-to-intermediate-risk MSRSGC categories (two surgeries: 22.3% vs. one surgery: 77.7%) required significantly fewer surgeries than those with low-risk/nondiagnostic FNAC (two surgeries: 54.2%/53.3% vs. one surgery: 45.8%/46.7%, p < .001). A high-to-intermediate risk compared to a nondiagnostic FNAC results was an independent predictor for fewer surgeries in multivariate analysis (incidence rate ratio, 0.875; 95% confidence interval, 0.773-0.990; p = .034). True-positive results were most frequent in squamous cell carcinoma, whereas acinic cell and mucoepidermoid carcinomas were often misclassified. CONCLUSIONS: The use of the MSRSGC enables reliable preoperative risk stratification of malignant salivary gland tumors. High-to-intermediate-risk categories (Milan III/IVb/V/VI) were associated with a lower likelihood of multiple surgeries. True-positive FNAC results were most frequent in squamous cell carcinoma and metastatic melanoma, whereas acinic cell, mucoepidermoid, and salivary duct carcinomas were prone to misclassification. Structured FNAC reporting improves diagnostic accuracy and informs personalized surgical planning, reducing interventions and optimizing management.