Reclassification of lesions in biopsies by fine-needle aspiration of pancreas and biliary tree using Papanicolaou classification

Abstract

Background: Our aim was to evaluate the application of the classification of the Papanicolaou Cytopathology Society for the report of biopsies by fine-needle aspiration (FNA) of pancreas and bile duct. Methods: The FNAs obtained consecutively during 1 year were analyzed. Descriptive statistics were performed and sensitivity, specificity, positive predictive value, negative predictive value, and cytohistological correlation were determined. The reference standard test was the histopathological study. Results: A total of 134 cases of FNA were reclassified with ultrasound guidance according to the classification of the Papanicolaou Society, the median age was 59 years (range, 25-80 years). A case interpreted as non-diagnostic was reclassified to category 4 and 3 cases with atypical cells were reclassified to category 5. All malignant cases remained unchanged. Surgical follow-up was performed in 35 patients (26.1%), with a cytohistological concordance in 21 cases (91.3%) and 2 discordant cases (8.7%), the reasons for the discrepancy were due to sampling error, one of them with scarce material to make a diagnosis of higher category, the other case with partial agreement, because cytology was observed atypical cylindrical epithelium, with histology of grade 2 neuroendocrine neoplasia and low grade mucinous intraepithelial neoplasia. In general, the sensitivity and specificity were 100% and 75% respectively, the positive predictive value 88% and the negative predictive value 100%. Conclusions: The FNA guided with endoscopic ultrasound (EUS) and interpreted according to the Papanicolaou Cytopathology Society Classification is an accurate method to evaluate pancreatic and biliary tract lesions with a high positive predictive value of 88%.

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

“…This is mainly due to clear cytological criteria and the incorporation of radiologic features and biochemical cyst fluid analysis into the final diagnosis, which is particularly important for the diagnosis of FNAs of pancreatic cysts . Accordingly, in studies evaluating the PB System for reclassification of cytological samples previously classified using conventional cytology nomenclature, a decrease was noted in the overall number of cases classified as atypical and nondiagnostic . This is especially true for cysts where the use of the PB System with its multimodal approach incorporating biochemical and radiological analysis into the cytological diagnosis has reportedly decreased the number of nondiagnostic samples and increased both sensitivity and negative predictive value for the detection of mucinous cysts .…”

“…The distribution of the cases using the PB system from studies looking at pancreatic FNA specimens places most cases in the negative for malignancy and malignant categories [2][3][4][5][6][7][8][9] (Table 1). In fact, one of the clear benefits of implementing the PB System is the ability to decrease the number of indeterminate interpretations (eg, atypical and nondiagnostic).…”

“…1,6,10 Accordingly, in studies evaluating the PB System for reclassification of cytological samples previously classified using conventional cytology nomenclature, a decrease was noted in the overall number of cases classified as atypical and nondiagnostic. 5,9 This is especially true for cysts where the use of the PB System with its multimodal approach incorporating biochemical and radiological analysis into the cytological diagnosis has reportedly decreased the number of nondiagnostic samples and increased both sensitivity and negative predictive value for the detection of mucinous cysts. [11][12][13] Although mucinous neoplasms may present with a low CEA, cyst fluid with an elevated CEA level above 192 ng/mL is highly specific for a mucinous neoplasm with only rare exceptions such as lymphoepithelial cysts or very rarely, pseudocysts.…”

“…3,7 False negative interpretations also represent a small percentage of cases in most series, most of them related to scant cellularity or sampling error, and most common with cystic lesions. 3,5,7,9 The ROM may not accurately represent the true risk given the…”

Comparison of Papanicolaou and Diff‐Quick staining in pancreatic endoscopic ultrasound‐fine needle aspiration biopsy with rapid on‐site cytologic evaluation

“…Although there were reports on the usefulness of rapid Papanicolaou, difference in the diagnostic rate using different staining methods was minimal . Hence, the Diff‐Quick staining method may be used for diagnosis, as it is relatively simple and easy to perform.…”