Application of the International System for Reporting Serous Fluid Cytopathology with Cytohistological Correlation and Risk of Malignancy Assessment.

Alexandros Pergaris,Helen Gogas,Dimitra Stefanou,Panagiota Keramari,Panagiota Mikou,Nikolaos Kavantzas,Stylianos Sousouris

doi:10.3390/diagnostics11122223

Abstract

The International System for Reporting Serous Fluid Cytopathology (TIS) classifies serous effusions into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of unknown significance (AUS), suspicious for malignancy (SFM) and malignant (MAL). The main objectives of this classification comprise the establishment of a universal code of communication between cytopathologists and clinicians and histopathologists, as well as between different laboratories worldwide, paving the way for the setting of clinical management guidelines based on the risk of malignancy assessment for each diagnostic category. We retrieved the total number of pleural and peritoneal effusion cases of our department for the three-year time period between 2018 and 2020, yielding a total of 528 and 500 cases, respectively. We then proceeded to reclassify each specimen according to TIS guidelines and calculate the risk of malignancy (ROM) for each category by searching each patients’ histology records, medical history and clinical follow-up. For pleural effusions, 3 (0.57%) cases were classified as ND, 430 (81.44%) cases as NFM, 15 (2.84%) as AUS, 15 (2.84%) as SFM and 65 (12.31%) as MAL. ROM amounted to 0%, 5.3%, 33.33%, 93.33% and 100% for each category, respectively. As far as peritoneal effusions are concerned, 6 (1.2%) were categorized as ND with ROM estimated at 16.66%, 347 (69.4%) as NFM (ROM = 9%), 13 (2.6%) as AUS (ROM = 38.46%), 12 (2.4%) as SFM (ROM = 83.33%) and 122 (24.4%) as MAL (ROM = 100%). Our results underline the utility of the current classification, both as a means of communication between doctors of different specialties and as general guidelines for the further clinical management of patients.

Highlights

Serous effusions, both in the pleural and the peritoneal cavities, result from an imbalance between the production and reabsorption of serous fluid [1,2]
Peritoneal and pericardial effusions constitute a significant proportion of a cytopathology laboratory workload
A systematic search of the database of the cytopathology department of Laiko General Hospital was performed in order to retrieve the total number of serous effusion cases between the years 2018 and 2020

Summary

Introduction

Both in the pleural and the peritoneal cavities, result from an imbalance between the production and reabsorption of serous fluid [1,2]. Their presence is always considered a pathologic condition, and they reflect a wide range of diseases from benign to malignant [3]. Peritoneal and pericardial effusions constitute a significant proportion of a cytopathology laboratory workload Unlike other specimens, such as urinary and bronchial specimens, which represent organ-specific pathology, they are related to pathological conditions of a great variety, including malignancy with origin in many different organs.

Methods

Results

Discussion

Conclusion