Prospective analysis of atypical epithelial cells as a high‐risk cytologic feature for malignancy in pancreatic cysts

Pitman, Martha B.; Yaeger, Kurt; Brugge, William R.; Mino‐Kenudson, Mari

doi:10.1002/cncy.21242

Cited by 41 publications

(48 citation statements)

References 23 publications

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“…The lack of well-established criteria for the various grades of dysplasia in mucinous cysts has hampered a more standardized approach to classification. However, given the management algorithm for mucinous cysts which recommends a conservative approach for cysts at low risk for malignancy,[12] it is imperative that the pathologist relate on the cytology report that a neoplastic mucinous cyst has been detected by FNA (e.g., Neoplastic: Other) and to relate the presence or absence of cytologically high-grade appearing epithelium (e.g., high-grade epithelial atypia that represents at least high-grade dysplasia and possibly invasive carcinoma[1213] (see Category IV).…”

Section: Category Iii: Atypicalmentioning

confidence: 99%

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Standardized terminology and nomenclature for pancreatobiliary cytology: The Papanicolaou Society of Cytopathology Guidelines

et al. 2014

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The Papanicolaou Society of Cytopathology 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 of pancreatobiliary disease, ancillary testing and post-biopsy treatment and management. All documents are based on the expertise of the authors, a review of the literature, discussion 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 Papanicolaou Society of Cytopathology web site [www.papsociety.org]. This document selectively presents the results of these discussions and focuses on a proposed standardized terminology scheme for pancreatobiliary specimens that correlate cytological diagnosis with biological behavior and increasingly conservative patient management of surveillance only. The proposed terminology scheme recommends a six-tiered system: Non-diagnostic, negative, atypical, neoplastic [benign or other], suspicious and positive. Unique to this scheme is the “neoplastic” category separated into “benign” (serous cystadenoma) or “other” (premalignant mucinous cysts, neuroendocrine tumors and solid-pseudopapillary neoplasms (SPNs)). The positive or malignant category is reserved for high-grade, aggressive malignancies including ductal adenocarcinoma, acinar cell carcinoma, poorly differentiated neuroendocrine carcinomas, pancreatoblastoma, lymphoma and metastases. Interpretation categories do not have to be used. Some pathology laboratory information systems require an interpretation category, which places the cytological diagnosis into a general category. This proposed scheme provides terminology that standardizes the category of the various diseases of the pancreas, some of which are difficult to diagnose specifically by cytology. In addition, this terminology scheme attempts to provide maximum flexibility for patient management, which has become increasingly conservative for some neoplasms.

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Section: Category Iii: Atypicalmentioning

confidence: 99%

“…[12] Cells smaller than a 12 μ duodenal enterocyte showing an increased nuclear to cytoplasmic ratio, an abnormal chromatin pattern and background necrosis represent high-grade epithelial atypia placing the cyst at high-risk for malignancy. [213464748]…”

Section: Category Iv: Neoplasticmentioning

confidence: 99%

Standardized terminology and nomenclature for pancreatobiliary cytology: The Papanicolaou Society of Cytopathology Guidelines

et al. 2014

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“…These hurdles make it difficult to reach a formal determination of 'positive' cytology. Cytopathologists from our institution have shown that lowering the threshold from 'positive' cytology to presence of high-grade atypical epithelial cells (which are quantitatively and qualitatively insufficient for a positive cytology interpretation), we can achieve an increase in the accuracy (80-85%) and in the number of cases of HGD and invasive carcinoma detected (12% more than when using 'positive' cytology) [57,58]. Lastly, the continuous progress in genomic technologies holds the promise of accurate diagnosis and risk stratification of pancreatic cysts using molecular analysis of cyst fluid.…”

Section: Cyst Fluid Analysis: Proteins Cytology and Molecular Charamentioning

confidence: 99%

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Strategic Considerations

et al. 2017

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Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms with the potential for progression to pancreatic cancer. Recognized by the global medical community just over two decades ago, IPMN have gained great epidemiological and clinical relevance thanks to the widespread use of cross-sectional abdominal imaging, which has led to a surge in the number of incidental pancreatic cysts being diagnosed. As our understanding of this disease has improved, we now know that some IPMN have a very elevated risk of cancer and require surgical resection, while others are low-risk lesions and can be followed. The approach to IPMN must therefore strike a balance between preventing the over-utilization of surgery and the timely recognition and treatment of patients with high-risk lesions. Several clinical, radiographic, and laboratory parameters have been proposed to risk-stratify IPMN, leading to the publication of management guidelines that do not always converge in their recommendations. The goal of this clinical therapeutic review is to describe the strategic approach to IPMN at the Massachusetts General Hospital, and how our current understanding, management algorithm, and future directions have been informed by research efforts at our institution and other centers.

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“…In one study looking at the overall agreement between cytopathologists when applying a two‐tiered approach to grading mucinous cyst atypia (low or high‐grade), a poor performance was noted particularly in histologically confirmed low‐grade cysts, with many of the cytopathologists over‐interpreting the grade of atypia . In contrast, however, most studies have shown that the cytological grade of a mucinous cyst correlates well with histology, with high‐grade atypia being the only statistically significant predictor of malignancy . Grading the atypia of the cyst lining cells is of utmost importance, since low‐grade lesions are usually managed conservatively, and high‐grade lesions require prompt surgical intervention.…”

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

“…The incorporation of the PB System, as described in the present review, has also assisted its improvement. The use of ROSE has also shown to increase diagnostic yield, decreasing the number of nondiagnostic samples, time of the procedure, and complications . More recently, next‐generation “core‐type” needles have been used, producing larger tissue fragments.…”

Section: Future Perspectivesmentioning

confidence: 99%

Experience and future perspectives on the use of the Papanicolaou Society of Cytopathology Terminology System for reporting pancreaticobiliary cytology

Saieg

Pitman

2020

Diagnostic Cytopathology

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The Papanicolaou Society of Cytopathology developed a set of guidelines for reporting pancreaticobiliary cytology in 2014 (PB System), with a six‐tiered system: Nondiagnostic, Negative, Atypical, Neoplastic (Benign or Other), Suspicious, and Positive. This proposed scheme incorporates ancillary testing such as biochemical testing of cyst fluids for diagnosis and provides terminology that standardizes the category of the various diseases of the pancreas, some of which are difficult to diagnose specifically by cytology alone. Since its initial publication five and half years ago, several groups have published their experiences on the use of the PB System and have shown that most objectives proposed by the original publication have been achieved. They have shown that there is a better understanding and definition of the diagnostic categories with an associated distribution and risk of malignancy. The diagnostic categories of Neoplastic: Other, Suspicious, and Malignant show a high sensitivity and specificity for the diagnosis of malignancy. The System also provides a multi‐specialist view of pancreatic lesions, with biochemical and radiological findings being incorporated into the final pathological report. The present review summarizes these findings and discusses the future perspectives and foreseen changes that are to be incorporated to a second edition of the reporting System.

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Prospective analysis of atypical epithelial cells as a high‐risk cytologic feature for malignancy in pancreatic cysts

Cited by 41 publications

References 23 publications

Standardized terminology and nomenclature for pancreatobiliary cytology: The Papanicolaou Society of Cytopathology Guidelines

Standardized terminology and nomenclature for pancreatobiliary cytology: The Papanicolaou Society of Cytopathology Guidelines

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Strategic Considerations

Experience and future perspectives on the use of the Papanicolaou Society of Cytopathology Terminology System for reporting pancreaticobiliary cytology

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