Introduction <p>The role of fine-needle aspiration cytology (FNAC) in the initial evaluation of salivary gland lesions is well established. Many studies have reported excellent sensitivity and specificity of FNAC to differentiate neoplastic vs. non-neoplastic lesions as well as benign vs. malignant neoplasms. Preoperative diagnosis with FNAC can help to determine the surgical decision and planning, as well as help in specific counseling of the patients with a parotid tumor. Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC), is proposed by the American Society of Cytopathology and International Academy of Cytology providing more constructive guidance for clinical management according to the risk of malignancy (ROM) in different categories. This system is still not used very widely across the globe. Further studies are required to determine its effectiveness and ROM of each category of the system, and to establish superiority over conventional FNAC reporting. The present study is to evaluate the diagnostic utility of MSRSGC among the population in rural areas of eastern India.</p> Materials and Methods <p>Total 98 subjects are included in the study from the retrospective FNAC record (kept in the department of Pathology) within January 2022 to December 2024. The FNA slides are re-examined and classified according to MSRSGC. Among the 98 study subjects, 55 cases were operated in the same institution. Histopathology reports are retrieved from the record and compared with the FNAC reports according to Milan System, thus Risk of Malignancies (ROM) are determined.</p> Results <p>Half of the patients (50%) had lesions in Submandibular gland followed by 38.77% cases involving parotid gland and 11.22% involving other minor salivary gland. 6.12% cases (<i>n</i> = 6) are recorded as non-diagnostic in older method of reporting and Cat I (Non diagnostic) by Milan system due to due to inadequate cellularity. In the Cat II (Non neoplastic), there are 29 cases which were previously reported as Acute Adenitis (9 cases), Chronic Sialadenitis (18 cases) and Granulomatous Adenitis (2 cases). In the MSRSGC, Salivary gland neoplasm of uncertain malignant potential (SUMP) was noted in 4.08% of cases. 6.12% of our studied cases (Table 2) were identified within the malignant category (Cat VI). Risk of Malignancy (ROM) is found to be 100% in Category III, V and VI of Milan system when compared with the subsequent histopathology report. Category IV B having 50% and Category I, II and have ROM 0%.</p> Conclusion <p>Milan system of reporting salivary gland cytopathology (MSRSGC) provided a uniform system of reporting salivary gland cytomorphology that may increase the rate of diagnostic accuracy and determine the risk of malignancy (ROM). It may help in limitation of number of surgery by avoiding unnecessary surgeries in set up with limited resources. However, large scale multi-centric prospective studies in the same geographical area are needed for further refinement of results.</p>