Papanicolaou Society of Cytopathology new guidelines have a greater ability of risk stratification for pancreatic endoscopic ultrasound-guided fine-needle aspiration specimens

Abstract

The Papanicolaou Society of Cytopathology has recently proposed a standardized terminology and nomenclature guidelines for pancreatic cytology. However the risk of malignancy associated with the new guidelines has been scarcely studied. In this study, a series of pancreatic cytology cases obtained by endoscopic ultrasound-guided fine-needle aspiration from 294 Chinese patients were retrospectively re-categorized into six categories according the new guidelines. The risks of malignancy were 18.1% for “negative,” 20.0% for “neoplastic,” 57.1% for “nondiagnostic,” 69.2% for “atypical,” 87.5% for “suspicious,” and 100.0% for “positive” respectively. The area under the receiver operating characteristic curve was 0.93 (95% Confidence Interval, 0.90-0.96), which was significantly higher than that associated with old classification system (0.82; 95% Confidence Interval, 0.77-0.87) conventionally used in China. Our investigation demonstrated that the new guidelines have a greater ability of risk stratification than the old classification system conventionally used in China. This may be helpful in giving better predictions of malignancy, thus leading to more personalized treatment strategies.

The benefits of the Papanicolaou Society of Cytopathology System for reporting pancreatobiliary cytology: A 2‐year review from a single academic institution

“…One of the most egregious results in the study was the high rate of inadequacy in specimens. The nondiagnostic rate of 21.2% is higher than rates reported by other authors, ranging from 3.8%‐11.7% 9‐12 . The explanation is multifactorial.…”

The applicability of Papanicolaou Society of Cytopathology system on reporting endoscopic ultrasound‐guided fine needle aspiration cytology specimens of pancreatic lesions in situations with limited availability of ancillary tests. Experience at a single laboratory

“…Studies by Chen et al, 12 Hoda et al 13 and Sung et al 14 have demonstrated the reliability of the PSC categories in malignancy risk stratification.…”

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

“…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.…”

“…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).…”

“…The use of ROSE has also shown to increase diagnostic yield, decreasing the number of nondiagnostic samples, time of the procedure, and complications. 2,17,20,21 More recently, next-generation "core-type" needles have been used, producing larger tissue fragments. Various authors have published their experiences with different types of needles, and these novel larger, thicker needles have apparently contributed to a higher diagnostic yield from solid lesions, with a decrease in the number of suspicious and atypical cases.…”