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

Abstract

Introduction : The Papanicolaou Society of Cytopathology (PSC) system of reporting pancreatobiliary cytology is a standardised reporting nomenclature that uses a six-tiered scheme of diagnostic categories utilising routine microscopy and ancillary tests such as biochemical and molecular analysis of cyst fluids and immunochemistry. The objective of this study was to determine the applicability of the PSC system on endoscopic ultrasound-guided fine needle aspiration cytology samples reported at the cytopathology laboratory, Mubarak Al Kabeer Hospital, in Kuwait with special emphasis on situations with limited availability of ancillary tests. Methods: In total, 132 cases of endoscopic ultrasound-guided fine needle aspiration cytology samples from pancreatic lesions were categorised according to PSC system guidelines after examining the glass slides and reviewing the clinical, imaging and ancillary test findings. These review diagnoses were compared with the diagnoses rendered during initial reporting. Correlation with histopathology reports was done wherever available. Results: In 23 (17.42%) of 132 cases, re-categorisation was necessary between initial and reviewed diagnoses. In 16 cases, re-categorisations were because of nonanalogous categories between initial and reviewed diagnosis. In the remaining seven, they were due to identification of newer cytomorphological and imaging findings or because of issues arising from unavailability of sufficient material for ancillary investigations. Conclusion: All cases could be categorised using the PSC system with a moderate number of re-categorisations between initial and reviewed diagnoses. In certain circumstances, limited availability of ancillary tests, resulted in non-diagnostic | 565 MALLIK et AL. How to cite this article: Mallik MK, Qadan LR, Al Naseer A, et al. 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.

Humoral Predictors of Malignancy in IPMN: A Review of the Literature

“…Positive cytology for high-grade dysplasia or malignancy is considered an absolute indication for surgery [ 7 ]. According to the Papanicolaou Society of Cytopathology (PSC), the pancreatobiliary cytology can be classified into six diagnostic categories: (1) Non-diagnostic (a specimen that provides no diagnostic information about the solid or cystic lesion); (2) Negative for malignancy (a specimen that contains adequate cellular or extracellular tissue without consistent evidence of malignancy); (3) Atypical (a specimen that contains cells with cytoplasmic, nuclear, or architectural features that are not consistent with physiological or reactive changes); (4-A) Neoplastic (a specimen consistent with a benign lesion), (4-B) Neoplastic (a neoplasm that is pre-malignant or low-grade malignant); (5) Suspicious for malignancy (a specimen that presents features of malignancy, but the findings are qualitatively or quantitatively insufficient for a conclusive diagnosis); (6) Positive (a specimen that contains malignant cytological features) [ 57 , 58 ]. Thornton G. D. et al performed a metanalysis of 18 studies with 1438 patients affected by IPMN that underwent EUS-FNA.…”

Diagnostic Accuracy and Cytomorphological Analysis of Biliary Brush and Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA) of the pancreas based on The Papanicolaou Society of Cytopathology System

“…Selain memberikan kriteria diagnosis berdasarkan kategori, sistem pelaporan ini juga memberikan rekomendasi manajemen penatalaksanaan dari setiap kategori. 5,6,9 Keganasan pankreatobilier tersering menurut kepustakaan adalah adenoakarsinoma dengan presentase sekitar 90%. 10 Kriteria karakteristik sitologi yang digunakan untuk diagnosis adenokarsinoma pankreas dan saluran bilier adalah hiperselularitas, drunken honeycomb, anisonukleosis 4:1, diskohesifitas sel/single cells, perubahan kromatin, pleomorfisitas inti, 3D cluster, membran inti ireguler, anak inti nyata, rasio inti dan sitoplasma (N/C) meningkat.…”

“…Tidak ada diagnosis yang dapat ditegakkan atau informasi yang kurang kuat tentang sampling lesi. 6,9 Ya/Tidak Negatif Gambaran sitologi tidak mengandung sel tumor ganas maupun sel atipik. 13 Ya/Tidak Atipik Gambaran sitologi dan arsitektur yang lebih menyimpang daripada gambaran atipia reaktif, tetapi kurang memenuhi karakteristik kategori mencurigakan keganasan.…”

“…Contoh: cystadenoma, teratoma kistik. 6,9 Neoplasma lainnya adalah neoplasma baik premaligna intraductal papillary mucinous neoplasm (IPMN) atau mucinous cystic neoplasm (MCN), maupun neoplasma seluler padat seperti Pancreatic neuroendocrine tumour (PanNET) dengan diferensiasi baik atau solid pseudopapillary neoplasm (SPN). 13 Ya/Tidak Curiga ganas Gambaran sitologi menunjukkan perubahan yang signifikan pada arsitektur dan morfologi sel (inti membesar, rasio inti sitoplasma meningkat sedang, kromatin kasar moderat, anak inti prominen, anisonucleosis pada kelompok kecil sel, membran inti ireguler) 13 Ya/Tidak Positif keganasan Gambaran neoplasma derajat tinggi dan atau agresif seperti Pancreatic ductal adenocarcinoma (PDAC), kolangiokarsinoma, karsinoma sel asinar, neuroendocrine carcinoma (NEC) berdiferensiasi buruk (NEC sel kecil atau sel besar), pankreatoblastoma, limfoma, sarkoma, dan lesi metastasis di pankreas.…”

“…Pengelompokkan kategori menjadi kelompok lesi jinak dan lesi ganas didasarkan pada kemiripan dalam manajemen terapi yang hampir serupa dan tidak memberi dampak klinis yang signifikan. 6 Pemeriksaan histopatologi digunakan sebagai baku emas/ gold standard pada penelitian ini. Diagnosis histopatologik dikategorikan menjadi jinak dan ganas.…”