Endoscopic ultrasound-guided fine needle aspiration cytology of pancreatic adenocarcinomas revisited. A detailed cytological analysis

Mallik, Mrinmay K.; Kapila, Kusum; Mohanty, Asit; Inamdar, Shafi Ahmed; Alali, Ali; Naseer, Abdullah Al

doi:10.4103/joc.joc_177_20

Cited by 4 publications

(5 citation statements)

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“…In these cases, the smears did not display each and every cytological feature of malignancy, and thus, these cases were reported as suspicious for malignancy. In a detailed cytological analysis of pancreatic adenocarcinomas, Mallik et al [ 2 ] have also reported that prominent nucleoli were observed in 45%, necrosis in 52%, and irregularly clumped chromatin in one third of their cases. Thus, cytological smears may lack one or more significant features of malignancy, and it is best to categorize such lesions under suspicious category.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 16 ] Similar diagnostic dilemma has been reported by Baek HW et al [ 3 ], who also reported two cases as false positive on cytology, but histopathology showed lymphoplasmacytic sclerosing pancreatitis, a form of chronic pancreatitis. In their study on detailed cytological analysis of pancreatic adenocarcinoma, Mallik et al [ 2 ] have observed that disordered nuclear polarity, nucleomegaly, anisonucleosis, and irregularity of nuclear margins were present in all cases of adenocarcinomas.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, it is detected at an advanced stage, and so, it is associated with poor prognosis. [ 2 ] Hence, early detection and proper treatment are of prime importance. With the advent of advanced imaging techniques, fine needle aspiration cytology (FNAC), under radiological guidance, has emerged as a time-saving, minimally invasive, and well tolerated diagnostic modality for diagnosing pancreatic lesions, which can be performed as an out-patient procedure.…”

Section: Introductionmentioning

confidence: 99%

“…With the advent of advanced imaging techniques, fine needle aspiration cytology (FNAC), under radiological guidance, has emerged as a time-saving, minimally invasive, and well tolerated diagnostic modality for diagnosing pancreatic lesions, which can be performed as an out-patient procedure. [ 2 3 4 ] It also allows the rapid onsite evaluation of the aspirated material to assess the adequacy of the material as well as to provide additional material for ancillary studies. [ 4 ] The Papanicolaou Society of Cytopathology System for reporting Pancreaticobiliary Cytology (PSCPC) categorizes the lesions into six categories, namely, non-diagnostic, negative for malignancy, atypical, neoplastic (benign and others), suspicious for malignancy, and positive or malignant.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Verma,

Goyal,

Tyagi

et al. 2024

Journal of Cytology

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“…The pathologist reported the cellularity of the smear as acellular if there were no cells noted, scant/mild if <10 cell clusters were noted, moderate if 11-30 cell clusters were noted, and dense if more than 30 clusters were observed. This system of grading cellularity is used by the pathologists at our center and has been adapted from several studies [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the diagnostic yield of rapid versus non rapid onsite evaluation in endoscopic ultrasound-guided fine-needle aspiration cytology of solid pancreatic lesions

Jaleel

2024

aog

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Background The role of rapid on-site evaluation (ROSE) for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions is debatable. In this study, we aimed to compare the diagnostic yield of ROSE vs. non-ROSE in solid pancreatic lesions. Methods This retrospective single-center study included patients undergoing EUS-FNA of solid pancreatic lesions from 2019-2021. Patients with cystic lesions, those undergoing fine-needle core biopsy, those undergoing repeat procedures, and patients with non-diagnostic smears with less than 6-month follow up were excluded. The diagnostic yield, need for repeat procedures and number of passes required with and without ROSE were analyzed in these patients. Results Of the 111 patients included, 56 underwent ROSE. The majority of lesions were malignant in both groups (79.6% ROSE vs. 75% non-ROSE). The diagnostic yield was 96.4% in the ROSE group and 94.5% in the non-ROSE group. Repeat samples were needed in 1 ROSE and 2 non-ROSE patients. The median number of passes made was significantly fewer in the ROSE group (3.5, interquartile range - 3,4) compared with the non-ROSE group (4, interquartile range - 3,5) P=0.01. However, the frequency of procedure-related complications was similar in both groups. Conclusion The utilization of ROSE during EUS-FNA of solid pancreatic lesions does not affect the diagnostic yield or the need for repeat samples, but reduces the number of passes needed for acquiring samples.

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Background features in the cytology of pancreatic neoplasms

2022

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Cytology is a useful method for diagnosing pancreatic neoplasms. Although endoscopic ultrasound‐guided fine‐needle aspiration has recently become the mainstream method for the diagnosis of pancreatic neoplasms, pancreatic juice and pancreatic duct brushing cytology continue to be useful diagnostic methods for the investigation of pancreatic neoplasms. Diagnoses using pancreatic cytology are primarily based on the features related to tumor cells; however, evaluation of the background features provides important information that could further aid the diagnosis. Pancreatic neoplasms show various histological types, each of which is associated with its own characteristic background features. The necrotic background, desmoplastic stroma, and presence of cancer‐associated fibroblasts are background features of pancreatic ductal adenocarcinoma, a mucinous background is associated with intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, and hyaline globules are observed in solid pseudopapillary neoplasms. However, some background features are associated with more than one histological type of pancreatic neoplasm, highlighting the importance to base a diagnosis on the results of a comprehensive analysis of not only the background features but also the tumor cells. Here, we provide a review of the key background cytological features of pancreatic neoplasms, which can serve as a guide to improve diagnosis and research.

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Endoscopic ultrasound-guided fine needle aspiration cytology of pancreatic adenocarcinomas revisited. A detailed cytological analysis

Cited by 4 publications

References 13 publications

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

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

Comparison of the diagnostic yield of rapid versus non rapid onsite evaluation in endoscopic ultrasound-guided fine-needle aspiration cytology of solid pancreatic lesions

Background features in the cytology of pancreatic neoplasms

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