Cytopathology System Research Articles

Applicability of the International Cytopathology Reporting System of Serous Fluids in a Brazilian City.

The International Academy of Cytology and the American Society of Cytopathology developed the International System of Serous Fluid Cytopathology (TIS) to standardize cytological reports. Effusions in pleural, peritoneal, and pericardial cavities are valuable sources of information for medical diagnosis, especially in oncological scenarios. The TIS classification is divided into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspected malignancy (SFM), and malignant (MAL). It facilitates global communication between specialists, aiming for future clinical management guidelines based on malignancy risk assessment. This quantitative analytical and retrospective study evaluated serous fluids (pleural, pericardial, and peritoneal) sent to the Instituto de Patologia de Araçatuba (IPAT), São Paulo, Brazil, from public and private hospitals between January 2017 and December 2022. Epidemiological and clinical data were collected from institutional files, including biopsies and immunohistochemical results. The study included 719 patients with 763 serous fluid samples (pericardial, pleural, and peritoneal) analyzed over six years. The majority of samples were from pleural effusions (n = 438; 57.4%), followed by peritoneal (n = 293; 38.4%) and pericardial effusions (n = 32; 4.2%). Samples were classified using the International Serous Fluid Cytopathology System (TIS), revealing the following distribution: ND (0.41%), NFM (70.30%), AUS (0.95%), SFM (11.90%), and MAL (16.44%). The risk of malignancy calculated for each category were ND 66.67%, NFM 23.39%, AUS 28.57%, SFM 48.28%, and MAL 84.17%. The ROM was out of the interval proposed by the TIS in all categories. These findings suggest the applicability of TIS even outside of the cancer center environment, although the presented ROM frequencies were out of the recommended range.

Papanicolaou Society of Cytopathology System vs World Health Organization of Reporting System for Pancreaticobiliary Cytopathology‐Comparison of Risk of Malignancy and Diagnostic Predictive Values: A 3 Year Retrospective Study in India

Papanicolaou Society of Cytopathology System vs World Health Organization of Reporting System for Pancreaticobiliary Cytopathology‐Comparison of Risk of Malignancy and Diagnostic Predictive Values: A 3 Year Retrospective Study in India

Risk of malignancy and overall survival associated with the diagnostic categories in the World Health Organization Reporting System for Pancreaticobiliary Cytopathology.

The World Health Organization (WHO) classification system revised the Papanicolaou Society of Cytopathology (PSC) system for reporting pancreaticobiliary cytopathology. To better stratify intraductal and/or cystic neoplasms by cytologic grade, the neoplastic, other category was replaced by two new categories: pancreaticobiliary neoplasm, low-risk/grade (PaN-Low) and pancreaticobiliary neoplasm, high-risk/grade (PaN-High). Low-grade malignancies were placed in the malignant category, and benign neoplasms were placed in the benign/negative for malignancy category. An institutional pathology database search identified patients who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic lesions from January 2015 to April 2022. The absolute risk of malignancy (ROM) was determined by histologic and/or clinical follow-up of at least 6 months, and overall survival rates were calculated across diagnostic categories, comparing the WHO and PSC systems. In total, 1012 cases were reviewed and recategorized. The ROM for the WHO system was 8.3% for insufficient/inadequate/nondiagnostic, 3.2% for benign/negative for malignancy, 24.6% for atypical, 9.1% for PaN-Low, 46.7% for PaN-High, 75% for suspicious for malignancy, and 100% for malignant. Comparatively, the ROM for the PSC system was 7.4% for nondiagnostic, 3.0% for negative for malignancy, 23.1% for atypical, 0% for neoplastic, benign, 7.3% for neoplastic, other, 75% for suspicious for malignancy, and 100% for malignant. The WHO system demonstrated superior stratification for overall survival. The WHO system significantly improves the stratification of ROM and overall survival across diagnostic categories by introducing the PaN-Low and PaN-High categories and reassigning low-grade malignancies to the malignant category. Analyzing EUS-FNA samples with the WHO system provides critical insights for guiding clinical management.

The Papanicolaou Society of Cytopathology System for Reporting Respiratory Cytology: To Establish Efficacy and Ease to Use in Routine Cytology Practice

Background: Various pulmonary cytology techniques have been established, representing morphological diversity and ranging from non-invasive to minimally invasive. However, there is currently no widely accepted classification system for respiratory cytology. In 2016, the Papanicolaou Society of Cytopathology (PSC) proposed a six-tiered category system for the cytological sample obtained from the respiratory tract. The diagnostic efficacy of such a category system can help in the early diagnosis of lung cancer patients, thereby reducing mortality and morbidity. Aim: The aim of this study was to determine the diagnostic accuracy and utility of PSC guidelines for reporting respiratory cytology specimens in comparison to histopathology. Materials and Methods: This study was conducted over 6 months, from September 2023 to February 2024, on a prospective basis. Out of a total of 165 samples analyzed, 147 (89%) were bronchoalveolar lavage samples, 09 (05%) were bronchial brushings, 03 (02%) were bronchial washings, and 06 (04%) were endobronchial ultrasound-guided transbronchial fine-needle aspiration. These cytological specimens were processed and categorized according to the PSC reporting system for respiratory cytology, as non-diagnostic, benign, atypical, neoplastic (benign/undetermined malignant potential), suspicious of malignancy, and malignant. In all cases, the histopathological correlation with corresponding transbronchial or endobronchial lung biopsy was done. Results: Our study found that 4% of the cases were non-diagnostic, 80% were benign, 13% were atypical, 2% were suspicious for malignancy, and 1% were malignant. When compared with the histological diagnosis, the sensitivity was 53.13%, the specificity was 93.23%, and the overall accuracy was 85.45%. Conclusion: The PSC reporting system for respiratory cytology can easily standardize reporting patterns to enhance communication between cytopathologists and clinicians, ultimately improving patient care.

Reproducibility assessment of WHO reporting system for pancreaticobiliary cytopathology: A single institution experience.

The World Health Organization (WHO) reporting system for pancreaticobiliary cytopathology was released to internationalize the reporting, assisting in correct diagnosis and patient treatment with significant revisions from the previous Papanicolaou Society of Cytopathology (PSC) system. The "neoplastic: benign" and "neoplastic: other" categories have mostly been superseded by two new ones: "pancreatic neoplasia-low-grade" (PaN-low) and "pancreatic neoplasia-high-grade" (PaN-high), which classify intermediate neoplastic lesions based on cytological atypia. We aim to assess the reproducibility and risk of malignancy (ROM) for reporting pancreaticobiliary cytopathology by the WHO system in comparison with the PSC system. A retrospective study by reviewing archival slides sent for pancreaticobiliary cytological evaluation from June 2021 to June 2023, by two pathologists blinded to each other's findings. Absolute ROM was determined by histopathology/cell block study/clinical follow-up (minimum 6 months)/overtly malignant imaging/metastasis. A total of 332 cases from 329 patients met the inclusion criteria, comprising pancreatic, gallbladder, and biliary lesions. The median patient age was 54 years (range, 14-86 years). The overall sensitivity of the test is 74.9% specificity is 93.2%, positive predictive value of 96.8%, negative predictive value of 57.6%, and a diagnostic accuracy of 81.8%. The absolute ROM for each site in all categories was comparable with that of the published data from the WHO system. Our study highlights the reliability of the WHO system for guiding clinical decision-making and patient management in the context of pancreaticobiliary. However, continual efforts among pathologists are essential to maintain consistent accuracy in cytological interpretations.

The World Health Organization Reporting System for Pancreaticobiliary Cytopathology: Overview and Summary.

The recently published WHO Reporting System for Pancreaticobiliary Cytopathology (World Health Organization [WHO] System) is an international approach to the standardized reporting of pancreaticobiliary cytopathology, updating the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology (PSC System). Significant changes were made to the categorization of benign neoplasms, intraductal neoplasms, mucinous cystic neoplasms, and malignant neoplasms considered low grade. Benign neoplasms, such as serous cystadenoma, categorized as Neoplastic: benign in the PSC system, are categorized as Benign/negative for malignancy in the WHO system. Pancreatic neuroendocrine tumor, solid-pseudopapillary neoplasm, and gastrointestinal stromal tumor, categorized as Neoplastic: other in the PSC system, are categorized as Malignant in the WHO System in accord with their classification in the 5th edition WHO Classification of Digestive System Tumours (2019). The two new categories of Pancreaticobiliary Neoplasm Low-risk/grade and Pancreaticobiliary Neoplasm High-risk/grade are mostly limited to intraductal neoplasms and mucinous cystic neoplasms. Low-risk/grade lesions are mucinous cysts, with or without low-grade epithelial atypia. High-risk/grade lesions contain neoplastic epithelium with high-grade epithelial atypia. Correlation with clinical, imaging, and ancillary studies remains a key tenet. The sections for each entity are written to highlight key cytopathological features and cytopathological differential diagnoses with the pathologist working in low resource setting in mind. Each section also includes the most pertinent ancillary studies useful for the differential diagnosis. Sample reports are provided for each category. Finally, the book provides a separate section with risk of malignancy and management recommendations for each category to facilitate decision-making for clinicians.

Reporting Pancreatic FNAC using the Papanicolaou System: Still a Diagnostic Challenge.

The Papanicolaou Society of Cytopathology System for reporting Pancreaticobiliary Cytology (PSCPC) is a reliable method to classify pancreatic fine needle aspiration cytology (FNAC) smears. However, it is not without practical problems which can diminish the diagnostic accuracy of the cytological diagnosis. To determine the diagnostic pitfalls while reporting cytomorphology of pancreatic lesions according to PSCPC on correlating FNAC findings with histopathology. Retrospective analysis of pancreatic FNAC smears received in the Department of Pathology of our tertiary care institute over a period of 2 years was done. The cytological diagnoses were classified according to the Papanicolaou Society of Cytopathology system of reporting pancreaticobiliary cytology and correlated with histopathology. The reasons of cyto-histological discordance were analyzed. Out of 50 cases in which both FNAC and biopsy of pancreatic lesions were done, 34 cases were positive/malignant (Category VI), eight cases were suspicious for malignancy (Category V), three cases were neoplastic (Category IV), two cases were atypical (Category III), two cases were negative for malignancy (Category II), and one case was non-diagnostic (Category I). Out of 50 cases, histopathology was non-diagnostic due to inadequate material in six cases. The cytological diagnoses were compared with histopathology in the remaining 44 cases. Categories III, IV V, and VI were considered as positive for neoplastic pathology. The sensitivity of FNAC to predict neoplastic pathology was 97.5%, while the specificity was 25%. The positive predictive value was 92.9%. Two cases reported as atypical (Category III) turned out to be adenocarcinoma on histopathology. One case reported as neuroendocrine tumor and two cases reported as adenocarcinoma on cytology displayed features of chronic pancreatitis on histology. One case reported as neoplastic mucinous cyst (Category IV) turned out to be adenocarcinoma on histology (limited concordance). The cytopathologist needs to be wary of the potential pitfalls to improve the diagnostic accuracy of FNACs.

The World Health Organization Reporting System for Pancreaticobiliary Cytopathology.

The World Health Organization (WHO) Reporting System for Pancreaticobiliary Cytopathology (WHO System) is the product of a joint venture between the World Health Organization, the International Academy of Cytology, and the International Agency for Research on Cancer. The WHO System revises the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology (PSC System) and replaces the 6-tiered system with a 7-tiered system. To explain the WHO System and the differences with the PSC System. The WHO System and the PSC System of Reporting Pancreaticobiliary Cytopathology. The diagnostic categories of the WHO System are "Insufficient/Inadequate/Nondiagnostic"; "Benign (Negative for Malignancy"'; "Atypical"; "Pancreaticobiliary Neoplasm, Low Risk/Low Grade (PaN-Low)"; "Pancreatic Neoplasm, High Risk/High Grade (PaN-High)"; "Suspicious for Malignancy"; and "Malignant." In the WHO System, the "benign" category includes both nonneoplastic and neoplastic lesions, so the "Neoplastic: Benign" category of the PSC system has been eliminated. Low-grade malignancies, pancreatic neuroendocrine tumors (PanNETs), and solid-pseudopapillary neoplasm (SPN) classified as "Neoplastic: Other" in the PSC System are classified as "Malignant" in the WHO System, leaving in the "Neoplasm" category intraductal lesions, which are divided into 2 new diagnostic categories: "Pancreaticobiliary Neoplasm (PaN)-Low Risk/Grade" and "PaN-High Risk/Grade." As with the PSC System, the WHO System advocates close correlation with imaging and encourages incorporation of ancillary testing into the final diagnosis, such as biochemical (carcinoembryonic antigen [CEA] and amylase) and molecular testing. The WHO System includes risk of malignancy per category, and reporting and diagnostic management options that recognize the variations in resources of low- and middle-income countries.

Comparison of risk of malignancy and predictive value of diagnostic categories defined by Papanicolaou Society of Cytopathology system and WHO reporting system for pancreaticobiliary cytopathology in solid pancreatic lesions.

The standardized diagnostic categories defined by the World Health Organization (WHO) reporting system support the interdisciplinary interpretation of cytological findings in the management of pancreatic cancer. To compare this classification to the Papanicolaou Society of Cytopathology (PSC) system in terms of predictive value and risk of malignancy (ROM) in solid pancreatic lesions. Retrospective cohort study. All consecutive patients with solid pancreatic lesions who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) sampling at the University of Szeged from 2014 to 2021 were retrospectively enrolled. The predictive value and ROM of cytological findings were determined with comparison to histologic outcome and/or clinical follow-up. A total of 521 EUS-FNAs were performed with a malignancy rate of 81.76%. In both classification systems, the absolute ROM of "non-diagnostic," "negative for malignancy," "atypical," "suspicious for malignancy," and "malignant" categories were 48.2%, 2.3%, 78.1%, 100.0%, and 99.4%, respectively. Despite the heterogeneous nature of the "neoplastic: other" category of the PSC system, the absolute ROM for solid lesions was 100%. Pancreatic neoplasm: high-risk/grade category including only two endosonographically solid cases of high-grade intraductal papillary mucinous neoplasms showed 100% ROM. There were no differences between PSC and WHO systems in sensitivity, specificity, and negative and positive predictive values: excluding the "atypical" category, these were 99.7%, 95.6%, 97.7%, and 99.5%, respectively. The "atypical" category considered benign resulted in a higher decrease in validity and negative predictive value, compared to "atypical" considered true malignant (93.6% vs 97.7% and 65.8% vs 97.7%). For solid pancreatic lesions, the WHO system was identical to the PSC system in terms of ROM and predictive values.

The WHO system versus the Papanicolaou society of cytopathology system for reporting pancreaticobiliary cytology for risk stratification-which is better?

Recently, the World Health Organization (WHO) has proposed a reporting system for pancreaticobiliary cytopathology. We applied this classification for pancreatic lesion samples by fine needle aspiration (FNA) and compared the results to the previous classification of the Papanicolaou Society of Cytopathology (PSC) system for risk stratification. The computerized database was searched for all pancreatic endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and transabdominal ultrasound-guided FNA (TUS-FNA) samples from 2016 to 2020 and cases were reassigned as per the PSC and the WHO diagnostic categories. Cases with follow-up, clinicoradiological, and/or histopathology were included in the study. The risk of malignancy (ROM) was calculated across all diagnostic categories based on clinical data, imaging data, and histopathology wherever available. There were a total of 625 pancreatic FNA. In 230 cases, follow-up information was available which included 116 EUS and 114 TUS-FNA samples. The ROM for PSC categories I-VI was 40%, 19.7%, 28.6%, 57.1%, 94.7%, and 97.9% and for the WHO categories (I-VII), it was 60%, 21.3%, and 35.7%, not representative, not applicable, 94.7% and 94.9%. The overall sensitivity and specificity of PSC was 68.2% and 96.2% when categories V and VI were taken as positive and 78.9% and 93.3% for WHO when categories VI and VII were taken as positive. Pancreatic FNA samples reported as per the WHO system showed better sensitivity as compared to the PSC system resulting in better risk stratification and consequently better patient management. The overall high specificity and moderate sensitivity reaffirm the utility of FNA in pancreatic lesions.

Grading pancreatic adenocarcinomas on fine needle aspiration cytology. The outstanding issues.

The three-tier grading scheme described in "The Papanicolaou Society of Cytopathology (PSC) System for reporting Pancreaticobiliary Cytopathology" (TPSCRPBC) which remained unchanged following the WHO Reporting System for Pancreaticobiliary Cytopathology (WRPBC) was evaluated on pancreatic adenocarcinomas (PACs) reported on endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNAC). The Papanicolaou and May Grunwald Giemsa-stained smears from 116 cases of PACs were graded using the three-tier grading scheme laid down by TPSCRPBC/WRPBC. Cases exhibiting multiple grades were assigned primary, secondary and tertiary grades. Each case was assigned a grade score, either by adding the primary and secondary grades, by adding the primary and tertiary grades when the tertiary grade was 3 or by doubling the grade when only one grade existed. Necrosis was estimated semi-quantitatively. The inter-observer reproducibility in grading was evaluated using Kappa and Kendall's tau-c. Correlations between the various grades, the stage of the tumour and the amount of necrosis were assessed using Spearman rho and Kendall's tau-b. 31.89% of cases showed one grade, and 68.11% showed at least two grades. 16.38% showed three grades. The two commonest grade scores were 3 and 5. The inter-observer reproducibility for grading and grade scoring was satisfactory. A positive correlation was noted between the grades and the amount of necrosis. No significant correlation was found between the grades, grade scores and the stage of the tumours. The TPSCRPBC/WRPBC grading scheme can be suitably applied to PACs with good inter-observer reproducibility. Cases often show multiple grades in the same tumour.

Pancreaticobiliary Cytology Practice in 2021: Results of a College of American Pathologists Survey.

The College of American Pathologists (CAP) surveys provide national benchmarks of pathology practice. To investigate pancreaticobiliary cytology practice in domestic and international laboratories in 2021. We analyzed data from the CAP Pancreaticobiliary Cytology Practice Supplemental Questionnaire that was distributed to laboratories participating in the 2021 CAP Nongynecologic Cytopathology Education Program. Ninety-three percent (567 of 612) of respondent laboratories routinely evaluated pancreaticobiliary cytology specimens. Biliary brushing (85%) was the most common pancreaticobiliary cytology specimen evaluated, followed by pancreatic fine-needle aspiration (79%). The most used sampling methods reported by 235 laboratories were 22-gauge needle for fine-needle aspiration (62%) and SharkCore needle for fine-needle biopsy (27%). Cell block was the most used slide preparation method (76%), followed by liquid-based cytology (59%) for pancreatic cystic lesions. Up to 95% (303 of 320) of laboratories performed rapid on-site evaluation (ROSE) on pancreatic solid lesions, while 56% (180 of 320) performed ROSE for cystic lesions. Thirty-six percent (193 of 530) of laboratories used the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology in 2021. Among all institution types, significant differences in specimen volume, specimen type, ROSE practice, and case sign-out were identified. Additionally, significant differences in specimen type, slide preparation, and ROSE practice were found. This is the first survey from the CAP to investigate pancreaticobiliary cytology practice. The findings reveal significant differences among institution types and between domestic and international laboratories. These data provide a baseline for future studies in a variety of practice settings.

Risk Factors and Interpretation of Inconclusive Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Solid Pancreatic Lesions.

The inconclusive cytological findings of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remain a major clinical challenge and often lead to treatment delays. Patients who had undergone EUS-FNA sampling for solid pancreas lesions between 2014 and 2021 were retrospectively enrolled. The "atypical" and "non-diagnostic" categories of the Papanicolaou Society of Cytopathology System were considered inconclusive and the "negative for malignancy" category of malignancy was suspected clinically. We determined the frequency and predictors of inconclusive cytological finding. A total of 473 first EUS-FNA samples were included, of which 108 cases (22.83%) were inconclusive. Significant increases in the odds of inconclusive cytological findings were observed for lesions with a benign final diagnosis (OR 11.20; 95% CI 6.56-19.54, p < 0.001) as well as with the use of 25 G FNA needles (OR 2.12; 95% CI 1.09-4.01, p = 0.023) compared to 22 G needles. Furthermore, the use of a single EUS-FNA technique compared to the combined use of slow-pull and standard suction techniques (OR 1.70; 95% CI 1.06-2.70, p = 0.027) and less than three punctures per procedure led to an elevation in the risk of inconclusive cytology (OR 2.49; 95% CI 1.49-4.14, p < 0.001). Risk reduction in inconclusive cytology findings was observed in lesions between 2-4 cm (OR 0.40; 95% CI 0.23-0.68, p = 0.001) and >4 cm (OR 0.16; 95% CI 0.08-0.31, p < 0.001) compared to lesions ≤2 cm. The more than two punctures per EUS-FNA sampling with larger-diameter needle (19 G or 22 G) using the slow-pull and standard suction techniques in combination may decrease the probability of inconclusive cytological findings.

A brief review of the WHO reporting system for pancreaticobiliary cytopathology.

The World Health Organization (WHO), the International Academy of Cytology, and the International Agency for Research on Cancer have developed an approach to standardized reporting of pancreaticobiliary cytopathology. The WHO Reporting System for Pancreaticobiliary Cytopathology (WHO System) revises the Papanicolaou Society of Cytopathology (PSC) System for Reporting Pancreaticobiliary Cytology published in 2015 and replaces the 6 PSC categories with 7 categories: "Insufficient/Inadequate/Nondiagnostic"; "Benign/Negative for malignancy"; "Atypical"; "Pancreaticobiliary neoplasm, low risk/grade (PaN-low)"; "Pancreatic neoplasm, high risk/grade (PaN-High)"; "Suspicious for malignancy"; and "Malignant". In the PSC system, there is a single category for "Neoplastic" lesions that includes 2 groups, 1 for benign neoplasms and 1 named "Neoplastic-other", dominated by premalignant intraductal neoplasms primarily intraductal papillary mucinous neoplasms and low-grade malignant neoplasms (pancreatic neuroendocrine tumors (PanNET) and solid pseudopapillary neoplasms (SPN). In the WHO System, benign neoplasms with virtually no risk of malignancy are included in the "Benign" category and low-grade malignancies (PanNET and SPN) are included in the "Malignant" category, as per the 5th edition of the WHO Classification of Digestive System Tumors, while the non-invasive pre-malignant lesions of the ducts are divided by the cytomorphological grade of the epithelium into PaN-low and PaN-high with distinctly different risks of malignancy. Within each category, key diagnostic cytopathologic features and the ancillary studies for diagnostic and prognostic evaluation, as well as the implications of diagnosis for patient care and management, are outlined. Reporting and diagnostic management options recognize the variations in the availability of diagnostic and prognostic ancillary testing modalities in low- and middle-income countries.

Diagnostic Performance of The Papanicolaou Society of Cytopathology System for Pancreatic Cystic Lesions and Analysis of the Neoplastic Mucinous Cysts Diagnosis Based on Elevated CEA Levels Only

Diagnostic Performance of The Papanicolaou Society of Cytopathology System for Pancreatic Cystic Lesions and Analysis of the Neoplastic Mucinous Cysts Diagnosis Based on Elevated CEA Levels Only

Classification of endoscopic ultrasound guided fine needle aspiration cytology of pancreatic space occupying lesionsby Papanicolaou Society of Cytopathology System: A five year study.

Majority of the pancreatic cancer patients present at an advanced stage and have poor 5year survival rate. Thus, there is a need for early detection of pancreatic cancer with the initiation of the therapy. This is a retrospective study including all the endoscopic ultrasound guided (EUS) guided pancreatic FNAs from 2016 to 2020. The aspirate smears were analyzed and classified according to The Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology (PSCPC). A total of 245 EUS guided FNAs from pancreatic lesions were included. Cyto-histological correlation was done wherever available. Category I (non diagnostic) accounted for 40 cases (16%) cases, Category II (negative) comprised of 44 cases (18%); and Category III (Atypical) had 5 cases (2%). Category IV neoplastic-benign category included 3 cases of serous cystadenoma, while neoplastic-others category included pancreatic neuroendocrine tumors (n=21), solid pseudo-papillary neoplasms (SPEN) (n=12) and mucinous cystic neoplasms (n=4). A total of 7 cases (2.8%) were reported in Category V (Suspicious). A diagnosis of adenocarcinoma (Category VI) was rendered in 105 cases (42.8%) cases. Rarer types included non Hodgkins lymphoma (n=3) and one case of primary undifferentiated carcinoma with osteoclastic giant cells. Cyto-histological correlation in all categories was available in 58 cases with 8 false negative cases. Thus overall sensitivity of EUS guided FNAC was found to be 87.8% with a diagnostic yield of 83.6% while sensitivity in diagnosing adenocarcinoma was 96.9%. The present study highlights the spectrum of EUS guided FNA of pancreatic lesions in a subset of North Indian population and classified them according to PSCPC. EUS guided FNAC is a sensitive investigation which plays a crucial role in confirming the diagnosis of pancreatic space occupying lesions (SOLs)in advanced stage.

Papanicolaou society of cytopathology system for reporting pancreaticobiliary cytology: Risk stratification and cytology scope - 2.5-year study.

Objectives:Diagnosis of pancreatic lesions remains a clinical challenge. Early and accurate diagnosis is extremely important for improving the therapeutic usefulness of pancreatic cancers and Endoscopic ultrasonography - fine needle aspiration (EUS-FNA) cytology has come up with this advantage. For current study the authors evaluated the diagnostic accuracy of EUS-FNAC by applying PSC system for reporting pancreaticobiliary cytology and Calculated the malignancy risk associated with the diagnostic categories.Material and Methods:A retrospective study over the period of 2.5 years (April 2017 to Oct 2019) 60 patients in our cohort EUS-FNAC guided unstained fixed and unfixed slides received of pancreatic lesion and were stained with Papanicolau and Giemsa using standard technique and immunocytochemistry, where required Application of Papanicolaou Society of Cytopathology system for reporting pancreaticobiliary cytology Histopathological and clinical follow-up were retrieved.Results:Our study has comparable results with sensitivity, specificity, PPV, and NPV of 92.8%, 100%, 100%, and 92.59%, respectively. Fuurthermore, a diagnostic accuracy of 96.2%. Risk of malignancy is lower for benign and indeterminate category whereas it is higher for suspicious and malignant categories.Conclusion:The application of the new proposed terminology for pancreaticobiliary cytology brings standardization. Final diagnosis can be reached by the multidisciplinary approach of EUS-FNA cytology, cell block preparation, immunocytochemistry, and immunohistochemistry; if required, can be adopted as an alternative approach to biopsy. The present study showed high sensitivity and specificity for EUS-FNA in the diagnosis of pancreatic carcinoma, which may influence the treatment plans of both surgeons and oncologists.

Diagnostic Accuracy and Cytomorphological Analysis of Biliary Brush and Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA) of the pancreas based on The Papanicolaou Society of Cytopathology System

BackgroundEndoscopic ultrasound guided fine needle aspiration (EUS-FNA) of the pancreas and biliary brushes is a minimally invasive method ofcytology sampling. The purpose of this study was to determine the sensitivity, specificity, and accuracy of examination of biliary brushcytology and EUS-FNA pancreas based on the System of standardized terminology and nomenclature for pancreatobilliary cytology(STNPC) as well as cytology characteristics of pancreatic malignancy.MethodsA search of the biliary brush preparation and EUS-FNA pancreatic in 2017-2020 was carried out in the Archives section of the Department ofAnatomical Pathology FKUI / RSCM. 506 cases of biliary brush cytology and EUS-FNA pancreatic, conducted a search of histopathologicalpreparations and re-categorized based on STNPC.ResultsCytological cases of biliary brushing and pancreatic EUS-FNA paired with histopathology in 2017-2020 151 cases, 85 cases of biliarybrushing and 66 cases of pancreatic EUS-FNA, were re-categorized based on STNPC with results of biliary brushing 27 non-diagnosticcases, 24 atypical cases, 7 suspicious for malignancy (SFM) cases and 17 malignant cases. Meanwhile, for pancreatic EUS-FNA cytology16 non-diagnostic cases, 2 negative cases, 16 atypical cases, 3 other neoplasms, 4 SFM cases and 25 malignant cases. Twenty sevencases of false negative biliary brushes on non-diagnostic and atypical preparations and 4 cases of false negative on pancreatic EUS-FNA onnon-diagnostic and atypical preparations. Biliary brushing diagnostic test results: sensitivity 82.35%, specificity 100%, positive predictivevalue (PPV) 100%, negative predictive value (NPV) 84.21% and accuracy 90.9%. In pancreatic EUS-FNA: sensitivity 84.21%, specificity100%, PPV 100%, NPV 986.67% and accuracy 92.86%.ConclusionCytological diagnosis of biliary brushing and pancreatic EUS-FNA has good specificity, sensitivity and accuracy, but definitive diagnosisrequires histopathological examination

Diagnostic Performance of Pancreatic Cytology with the Papanicolaou Society of Cytopathology System: A Systematic Review, before Shifting into the Upcoming WHO International System.

The Papanicolaou Society of Cytopathology (PSC) reporting system classifies pancreatobiliary samples into six categories (I–VI), providing guidance for personalized management. As the World Health Organization (WHO) has been preparing an updated reporting system for pancreatobiliary cytopathology, this systematic review aimed to evaluate the risk of malignancy (ROM) of each PSC category, also the sensitivity and specificity of pancreatic FNA cytology using the current PSC system. Five databases were investigated with a predefined search algorithm. Inclusion and exclusion criteria were applied to select the eligible studies for subsequent data extraction. A study quality assessment was also performed. Eight studies were included in the qualitative analysis. The ROM of the PSC categories I, II, III, IV, V, VI were in the ranges of 8–50%, 0–40%, 28–100%, 0–31%, 82–100%, and 97–100%, respectively. Notably, the ROM IVB (“neoplastic—benign”) subcategory showed a 0% ROM. Four of the included studies reported separately the ROMs for the IVO subcategory (“neoplastic—other”; its overall ROM ranged from 0 to 34%) with low (LGA) and high-grade atypia (HGA). ROM for LGA ranged from 4.3 to 19%, whereas ROM for HGA from 64 to 95.2%. When the subcategory IVO with HGA was considered as cytologically positive, together with the categories V and VI, there was a higher sensitivity of pancreatic cytology, at minimal expense of the specificity. Evidence suggests the proposed WHO international system changes—shifting the IVB entities into the “benign/negative for malignancy” category and establishing two new categories, the “pancreatic neoplasm, low-risk/grade” and “pancreatic neoplasm, high-risk/grade”—could stratify pancreatic neoplasms more effectively than the current PSC system.

EUS-FNA and ROSE in solid lesions of the pancreas; have the same diagnostic efficacy compared to pancreatic sites?

Various techniques, needle types, and additional methods such as on-site pathological evaluation (ROSE) are used to increase the sensitivity of endoscopic ultrasound-fine needle aspiration (EUS-FNA), which is used in the diagnosis of pancreatic solid lesions. In this study, diagnosticity of the lesions according to the regions of the pancreas with EUS-FNA and ROSE performed with the slow pull technique using a 22 G needle will be evaluated. A total of 82 patients who underwent EUS-FNA between January 2, 2015, and March 14, 2020, were included in the study. General and clinical information of the patients were recorded retrospectively. The patients were diagnosed according to The Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology Classification. If the diagnosis could not be made with EUS-FNA and ROSE, the diagnosis was made with alternative methods of surgery or percutaneous biopsy. Patients diagnosed as benign with EUS-FNA and ROSE were followed for at least 1 year and were accepted as benign. The mean age of the patients was 63.2±10.5 years and 54 (69.6%) of them were male. The mean lesion size was 36.8 mm and the number of needle passes was 2.87. The overall sensitivity was 82.9% and the specificity was 100%. The sensitivity of EUS-FNA and ROSE in solid lesions in the head and body of the pancreas was higher than in lesions in the tail region (p=0.024). EUS-FNA and ROSE are an effective method in the diagnosis of pancreatic solid lesions. The use of a 22 G needle may be more diagnostic in the head and body of the pancreas than in the tail region.