The role of cytology in the investigation and management of pancreatobiliary lesions with a transition towards a standardised reporting system: An institutional perspective

Hanks, Matthew; Ryder, Stephen; Zaitoun, Abed M.

doi:10.1111/cyt.13115

Cited by 3 publications

(11 citation statements)

References 24 publications

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“…Sung S et al [ 8 ] have reported the specificity of malignancy as high as 99% when Categories V and VI were considered as positive for malignancy and sensitivity to predict neoplasm as high as 70% when Categories III and IV: others were also counted as positive results. We have taken Categories III, IV, V, and VI as positive for neoplastic pathology, and we have found the sensitivity of Pancreatic FNAC to be 97.5%, which is comparable with other studies[ 3 12 13 14 15 16 17 ] [ Table 1 ]. Shennawy MS[ 16 ] has observed 99% sensitivity and 93.75% specificity with a positive predictive value of 99%.…”

Section: Discussionsupporting

confidence: 86%

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

Verma,

Goyal,

Tyagi

et al. 2024

Journal of Cytology

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Introduction: 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. Aims and Objectives: To determine the diagnostic pitfalls while reporting cytomorphology of pancreatic lesions according to PSCPC on correlating FNAC findings with histopathology. Materials and Methods: 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. Results: 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). Conclusion: The cytopathologist needs to be wary of the potential pitfalls to improve the diagnostic accuracy of FNACs.

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Section: Discussionsupporting

confidence: 86%

“…A few authors have studied the ROM for all six categories of the PSCPC. [ 6 7 8 9 10 11 12 13 14 15 16 17 ]…”

Section: Introductionmentioning

confidence: 99%

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

Verma,

Goyal,

Tyagi

et al. 2024

Journal of Cytology

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“…ROSE is a widely used and effective diagnostic procedure during a needle aspiration biopsy of different organs [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. In the field of thoracic pathologies, several studies have demonstrated the utility of ROSE during both transbronchial and percutaneous needle aspiration techniques [ 1 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The performance of ROSE in thoracic pathology requires close cooperation between cytopathologists and bronchoscopists, possibly guided by a standardized, univocal, prompt and clear procedural language preventing misleading indications, as widely adopted in other settings, namely, breast, thyroid, pancreas and salivary gland diseases [ 19 , 20 , 21 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Validation of a Cytological Classification System for the Rapid On-Site Evaluation (Rose) of Pulmonary and Mediastinal Needle Aspirates

et al. 2022

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Rapid on-site evaluation (ROSE) is a procedure that allows immediate assessment of adequacy of cytological specimens obtained by fine needle aspiration (FNA). The application of ROSE diagnostic categories has been applied in various organs, but not in thoracic pathology. We aimed to retrospectively assess the concordance with the final diagnosis of a categorization from C1 (inadequate) to C5 (neoplastic) during ROSE performed with bronchoscopic or percutaneous sampling procedures of thoracic lesions in a large series of consecutive cases. This retrospective single-center study evaluated 2282 consecutive ROSEs performed on 1827 patients from January 2016 to December 2020 in 994 cases of transbronchial needle aspiration (TBNA) in peripheral pulmonary lesions, in 898 transthoracic FNAs, in 318 ultrasound-guided TBNAs, in 50 conventional TBNAs and in 22 endobronchial TBNAs. False positive and false negative cases of ROSE were 43 (1.88%) and 73 (3.2%), respectively, when compared with the definitive diagnosis. The sensitivity, specificity and the positive and negative prognostic values of ROSE were 94.84%, 95.05%, 96.89% and 91.87%, respectively. Overall concordance between ROSE and the final diagnosis was 0.8960 (Cohen’s kappa). No significant differences were observed in terms of sampling procedures and type and location of the lesions. A tiered classification scheme of ROSE from C1 to C5 during bronchoscopic and percutaneous sampling procedures is helpful in effectively guiding clinical management of patients with thoracic lesions.

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Pancreatic neuroendocrine tumours: a comparison of cytological classification systems

Ackroyd,

Hanks,

Bancu

et al. 2024

J Clin Pathol

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AimsCytological classification systems provide a standardised interpretation framework for reporting cytological specimens. Three well-known classification systems can be applied when reporting pancreatic cytology. This study aimed to compare the accuracy of these classification systems (C1–C5 system, the Papanicolaou system and the WHO classification) for the assessment of pancreatic neuroendocrine lesions.MethodsWe analysed 73 pancreatic neuroendocrine tumour resections, 49 of which had corroborative cytology available, reported over a 12-year period, at a single UK tertiary referral centre. Each cytology case was classified using the aforementioned systems. The final tumour grade allocated at resection was used to assess and compare the accuracy of each cytological classification system.ResultsCytological assessment accurately reported 77.6% of neuroendocrine lesions as category IVB (neoplastic - other) on Papanicolaou grading, 77.6% as C5 (malignant) lesions and 85.7% as VII (malignant) on WHO grading. 74.3% of resected tumours were grade 1, 17.1% grade 2 and 8.6% grade 3. Complete resection was achieved in 80.8% of cases.ConclusionsThe results demonstrated that the WHO classification appeared to provide reduced ambiguity when compared with both ‘C’ and Papanicolaou classification systems; with a lower proportion of cases being classified as suspicious of malignancy as opposed to malignant. The Papanicolaou system was able to supersede the other two systems through its ability to distinguish neuroendocrine tumours from more aggressive entities such as pancreatic adenocarcinoma, thus, offering flexibility in management while still retaining a similar level of accuracy to the WHO classification system in distinguishing benign from malignant lesions.

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The role of cytology in the investigation and management of pancreatobiliary lesions with a transition towards a standardised reporting system: An institutional perspective

Cited by 3 publications

References 24 publications

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

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

Validation of a Cytological Classification System for the Rapid On-Site Evaluation (Rose) of Pulmonary and Mediastinal Needle Aspirates

Pancreatic neuroendocrine tumours: a comparison of cytological classification systems

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