Papanicolaou Society Of Cytopathology Research Articles

Interobserver reproducibility and agreement with original diagnosis in the categories "atypical" and "suspicious for malignancy" for bile and pancreatic duct brushings.

The Papanicolaou Society of Cytopathology has developed a set of guidelines which include a diagnostic scheme with the categories "atypical" and "suspicious for malignancy." These intermediate categories may help stratify risk of malignancy for samples obtained from the bile and pancreatic ducts. However, the reproducibility of these intermediate categories is currently unknown. Twenty sequential brushing specimens of bile or pancreatic ducts from each of the categories "atypical" and "suspicious for malignancy" were identified and the slides retrieved. All 40 cases were reviewed independently by four cytopathologists blinded to the original diagnoses. Resulting review diagnoses were statistically analyzed for agreement and the Kappa statistic calculated. Agreement of the observers' diagnoses with original diagnoses was also evaluated. Interobserver agreement was graded as slight to fair with observers agreeing in about 50% of cases. The corresponding kappa statistic for the category "atypical" was 0.21 and 0.18 for the category "suspicious for malignancy." Reviewer agreement with the original reference diagnosis occurred in approximately one half of review diagnoses. Analysis of agreement shows that interobserver agreement was only slight to fair. Despite the categories "atypical" and "suspicious for malignancy" having distinct risks of malignancy (62% versus 74%), the reproducibility of these categories is relatively poor. A single intermediate category may improve reproducibility over the scheme proposed by the Papanicolaou Society of Cytopathology while maintaining an ability to stratify risk of malignancy.

Pancreaticobiliary tract cytology: Journey toward "Bethesda" style guidelines from the Papanicolaou Society of Cytopathology.

The current series of articles related to the Papanicolaou Society of Cytopathology (PSC) guidelines for pancreaticobiliary cytology are the product of significant efforts by many experts working on different PSC guidelines committees.[1] The PSC guidelines for cytologic interpretation and reporting of variety of body site specimens have been described previously.[2,3,4,5,6] These are comparable to the guidelines from the National Cancer Institute for cervical cytology[7] and fine needle aspiration cytology of breast and thyroid.[8,9] Most of these systems are designed to stratify the risk of malignancy with diagnostic categories for guiding appropriate management algorithms. The current guidelines[10,11,12,13,14] follow the strategies comparable to the Bethesda System for Reporting Thyroid Cytopathology. The guidelines not only consider diagnostic categories and criteria, but also attempt to provide details on other aspects including techniques for obtaining specimens, which patient would benefit most from cytologic evaluation, information on ancillary testing, and patient follow-up/management. The scheme addresses the wide spectrum of approaches to acquire diagnostic material for cytopathologic evaluation from a variety of pancreaticobiliary lesions. A six-tiered system is recommended for the standardized nomenclature in pancreaticobiliary cytology. The categories proposed are: Non-diagnostic, negative, atypical, neoplastic (benign or other), suspicious, and positive.[12] “Atypical” and “suspicious” categories have relatively well reported malignancy risks.[15,16] Potentially, the most challenging and controversial category is “neoplastic (benign and other)” with the widest range of interpretations. The entities included in this category range from innocuous lesions such as benign cystic neoplasms (serous cystadenoma) to others like pre-malignant mucinous cysts (cystic mucinous neoplasm and intraductal papillary mucinous neoplasm), low-grade well-differentiated neuroendocrine tumors (NETs), and solid-pseudopapillary neoplasms. The premalignant mucinous cysts without unequivocal features of malignancy would fall in this category with very wide management options.[17] The NETs similarly have many challenges with controversies related to their categorical assignment. Due to their malignant potential, some favor these neoplasms be categorized as “malignant.” European Neuroendocrine Tumor Society (ENETS) and World Health Organization categorize low and intermediate grades of these as “tumor” or “neoplasm” in the absence of high-grade criteria (>50 mitoses per 50 high power field for NETs of pancreas and >20 mitoses per 10 high power field or Ki-67 index >20% for NETs of other sites).[18,19] Undoubtedly, the lesions with unequivocal cytological features of either small cell carcinoma or large cell undifferentiated carcinoma belong to the “malignant” category. An increasing trend with incidental NETs in surgically unfit older patients, favors a conservative approach for small NETs as an alternative management strategy. The categories proposed in the current guidelines permit practical flexibility by surgeons in order to assure that conservative strategies may be a better option than the surgery. This would be more confusing if these cases of low grade neoplasms automatically fell in a “malignant” category! Utilization of ancillary testing including molecular testing in cystic lesions is also addressed in appropriate areas.[13] With input from the guidelines by the National Cancer Center Network (www.nccn.org) and by the multidisciplinary international groups in the field of pancreatology, post cytologic evaluation and management are also covered.[14] A “triple test” approach similar to that applied for FNA of breast lesions is recommended. Patient management should be determined by correlating the clinical findings in concert with endoscopic, imaging, and cytologic findings. Effective application of such guidelines is heavily dependent on the collaborative, multidisciplinary interactions between endoscopists, pancreaticobiliary surgeons, radiologists, and cytopathologists. The current CytoJournal supplement issue with individual articles[10,11,12,13,14] covering various areas highlighted above would be a great resource under Open access platform[20,21] for all involved in the management of pancreaticobiliary lesions. These PSC guideline articles published under Open Access charter may be disseminated by multiple journals/platforms[22,23,24,25,26] including e-CytoJournal issue http://www.cytojournal.com/browse.asp?sabs=n.[27]

Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: A review.

The newest installment on state-of-the-art standards of practice in cytopathology from the Papanicolaou Society of Cytopathology (PSC) focuses on the pancreaticobiliary system. Similar to the National Cancer Institute recommendations for aspiration cytology of the thyroid, the PSC guidelines for pancreaticobiliary cytology addresses indications, techniques, terminology and nomenclature, ancillary studies, and postprocedure management. Each committee was composed of a multidisciplinary group of experts in diagnosing, managing, and treating patients with pancreaticobiliary disease. Draft documents were posted on an interactive Web-based forum hosted by the PSC Web site (www.papsociety.org) and the topics of terminology, ancillary testing, and management were presented at national and international meetings over an 18-month period for discussion and feedback from practicing pathologists around the world. This review provides a synopsis of these guidelines.

Postbrushing and fine‐needle aspiration biopsy follow‐up and treatment options for patients with pancreatobiliary lesions: The papanicolaou society of cytopathology guidelines

The papanicolaou society of cytopathology (PSC) has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) biopsy, techniques of EUS-FNA, terminology and nomenclature for pancreatobiliary cytology, ancillary testing, and postprocedure management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings over an 18 month period and synthesis of online comments of the draft document on the PSC web site [www.papsociety.org]. This document selectively presents the results of these discussions and focuses on the follow-up and treatment options for patients after procedures performed for obtaining cytology samples for the evaluation of biliary strictures and solid and cystic masses in the pancreas. These recommendations follow the six-tiered terminology and nomenclature scheme proposed by Committee III.

The papanicolaou society of cytopathology guidelines for pancreaticobiliary tract cytology: A new installment in the “Bethesda” style of guidelines from the papanicolaou society of cytopathology

The papanicolaou society of cytopathology guidelines for pancreaticobiliary tract cytology: A new installment in the “Bethesda” style of guidelines from the papanicolaou society of cytopathology

Post-brushing and fine-needle aspiration biopsy follow-up and treatment options for patients with pancreatobiliary lesions: The Papanicolaou Society of Cytopathology Guidelines.

The Papanicolaou Society of Cytopathology (PSC) has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) biopsy, techniques of EUS-FNA, terminology and nomenclature for pancreatobiliary cytology, ancillary testing and post-procedure management. All documents are based on the expertise of the authors, a review of the literature and discussions of the draft document at several national and international meetings over an 18 month period and synthesis of online comments of the draft document on the PSC web site (www.papsociety.org). This document selectively presents the results of these discussions and focuses on the follow-up and treatment options for patients after procedures performed for obtaining cytology samples for the evaluation of biliary strictures and solid and cystic masses in the pancreas. These recommendations follow the six-tiered terminology and nomenclature scheme proposed by committee III.

Significance of atypia in pancreatic and bile duct brushings: Follow‐Up analysis of the categories atypical and suspicious for malignancy

Brushing cytology is frequently utilized for the investigation of pancreatic and biliary strictures but is associated with low diagnostic sensitivity. The Papanicolaou Society of Cytopathology has presented a system for diagnostic classification which includes the categories benign, atypical, suspicious for malignancy and malignant. We studied a series of 216 pancreatic and biliary brushings with either histologic follow-up or a minimum of 6 months clinical follow-up to determine outcomes for the diagnostic categories ("benign," "atypical, favor reactive," "atypical, not otherwise specified," "atypical, suspicious" and "malignant"). Eighty-six of the 216 (39.8%) were designated "atypical" with 10 of these designated as "atypical favor reactive." Forty-five were called "atypical not otherwise specified" and 31 were interpreted as "atypical suspicious for malignancy." On follow-up, 2 of 10 (20%) "atypical favor reactive" were eventually associated with a malignant diagnosis and 23 of 31 (74.2%) "atypical, suspicious for malignancy" demonstrated a malignant outcome. The remaining 45 brushings in the "atypical" category were "atypical not otherwise specified," and 62% of these were associated with malignancy on follow-up. Stratification of the "atypical" category into "atypical favor reactive," "atypical, not otherwise specified" and "atypical, suspicious for malignancy" improves diagnostic accuracy. The "atypical suspicious for malignancy" category has a follow-up similar to the "malignant" category while the "atypical favor reactive" category is associated with a clinical outcome similar to that of the "benign" category.

Pancreatic Cyst Cytology Utilizing the Papanicolaou Society of Cytopathology's Proposed Terminology Scheme for Pancreatobiliary Cytology: A Single Institution's Experience

Pancreatic Cyst Cytology Utilizing the Papanicolaou Society of Cytopathology's Proposed Terminology Scheme for Pancreatobiliary Cytology: A Single Institution's Experience

Quality Improvement Opportunities in Gynecologic Cytologic-Histologic Correlations: Findings From the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference Working Group 4

Cytopathology experts, interested stakeholders, and representatives from the College of American Pathologists, the Centers for Disease Control and Prevention, the American Society of Cytopathology, the Papanicolaou Society of Cytopathology, the American Society for Clinical Pathology, and the American Society of Cytotechnology convened the Gynecologic Cytopathology Quality Consensus Conference to present preliminary consensus statements developed by working groups, including the Cytologic-Histologic Correlations Working Group 4, using results from surveys and literature review. Conference participants voted on statements, suggested changes where consensus was not achieved, and voted on proposed changes. To document existing practices in gynecologic cytologic-histologic correlation, to develop consensus statements on appropriate practices, to explore standardization, and to suggest improvement in these practices. The material is based on survey results from 546 US laboratories, review of the literature from 1988 to 2011, and the College of American Pathologists Web site for consensus comments and additional survey questions. Cytologic-histologic correlations can be performed retrospectively, during initial case review, or both. At minimum, all available slides should be reviewed for a high-grade squamous intraepithelial lesion Papanicolaou test with negative biopsies. The preferred monitor for correlations is the positive predictive value of a Papanicolaou test. Laboratories should design cytologic-histologic correlation programs to explore existing or perceived quality deficiencies.

Automation in cytology: a survey conducted by the New Technology Task Force, Papanicolaou Society of Cytopathology.

Despite the overwhelming interest in the development of several computer based technologies in the last several years, the role of automation in cytology has remained controversial. The potential of these technologies in the reduction of false negative results in pap smears is well recognized. However, there is still remarkable confusion as how to incorporate automation in the routine practice of cytology. This prompted the New Technology Task Force of the George Papanicolaou Society of Cytopathology to design a survey to seek the opinion of those engaged in cervicovaginal cytology screening regarding the value of automation in cytology. In 1996, a ten question survey was sent to 1800 cytopathology laboratories throughout the nation. The response rate was 23% (416/1800). The responders represented laboratories varying from those with less than 5,000 pap smears to those with over 100,000 cases per year. The majority of the responders did not believe that automation is essential for cervicovaginal cytology. This was evidenced by the fact that only 12% of the laboratories were engaged in automated cytology and predominantly used it for quality control measures. The inability of small laboratories to absorb the extra expense involved in the integration of automated cytology in their practice, particularly in the current era of managed care was a major concern. There was also concern about the potential for compromise of patient care by the drive for corporate profits and the dissemination of wrong information to the public and physicians. Suggestions most frequently proposed included appropriate patient and physician education about the merits and pitfalls of the pap smear, and also endorsing an affordable universal fee for pap smears. Rescreening for all pap smears, reassessing the benefits of automation in cytology and development of the standards were other proposals. Partnership with larger cytology laboratories, creation of "cytology consortiums" with shared resources to provide regionalized automated rescreening services were also strongly suggested. This survey clearly indicates the need for further evaluation of automation in cytopathology and a focused attention to various issues surrounding cervicovaginal cytology screening.

On the American scene: the American Society of Cytopathology and the Papanicolaou Society of Cytopathology.

On the American scene: the American Society of Cytopathology and the Papanicolaou Society of Cytopathology.

On the American scene: The papanicolaou society of cytopathology and the united states and canadian academy of pathology

On the American scene: The papanicolaou society of cytopathology and the united states and canadian academy of pathology