Update on risk stratification in the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology categories: 3‐Year, prospective, single‐institution experience

Sung, Simon; Portillo, Armando Del; Gonda, Tamas A.; Kluger, Michael D.; Tiscornia-Wasserman, Patricia

doi:10.1002/cncy.22199

Cited by 29 publications

(77 citation statements)

References 19 publications

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“…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).…”

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

“…The main reasons reported for atypical diagnoses include low cellularity and scant mucinous material. 7 Mucinous or dysplastic epithelium on BDB remains in the atypical or suspicious for malignancy categories rather than the Neoplastic:…”

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

“…The biggest difference among published series is among the atypical category with a range of 28% to 100% ( compared with conventional cytology nomenclature, an important characteristic when dealing with aggressive neoplasms. 3,7,9,16 False positive interpretations are rare and, in the majority of the specimens, represent a discordance between cytology and final histological analysis of the grade of atypia of mucinous cysts. 3,12,17 In one study looking at the overall agreement between cytopathologists when applying a two-tiered approach to grading mucinous cyst atypia (low or highgrade), a poor performance was noted particularly in histologically confirmed low-grade cysts, with many of the cytopathologists overinterpreting the grade of atypia.…”

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

“…Recent prospective studies on the use of the PB System have showed a striking difference in ROM between cysts with low vs high-grade atypia, with an absolute ROM close to 90% for cysts with high-grade atypia, which clearly justifies a distinct therapeutic approach for these lesions based on the cytological grade. 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…”

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

“…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…”

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

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

Saieg

Pitman

2020

Diagnostic Cytopathology

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The Papanicolaou Society of Cytopathology developed a set of guidelines for reporting pancreaticobiliary cytology in 2014 (PB System), with a six‐tiered system: Nondiagnostic, Negative, Atypical, Neoplastic (Benign or Other), Suspicious, and Positive. This proposed scheme incorporates ancillary testing such as biochemical testing of cyst fluids for diagnosis and provides terminology that standardizes the category of the various diseases of the pancreas, some of which are difficult to diagnose specifically by cytology alone. Since its initial publication five and half years ago, several groups have published their experiences on the use of the PB System and have shown that most objectives proposed by the original publication have been achieved. They have shown that there is a better understanding and definition of the diagnostic categories with an associated distribution and risk of malignancy. The diagnostic categories of Neoplastic: Other, Suspicious, and Malignant show a high sensitivity and specificity for the diagnosis of malignancy. The System also provides a multi‐specialist view of pancreatic lesions, with biochemical and radiological findings being incorporated into the final pathological report. The present review summarizes these findings and discusses the future perspectives and foreseen changes that are to be incorporated to a second edition of the reporting System.

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Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

Section: Experience With the Use Of The Pb System Worldwidementioning

confidence: 99%

See 3 more Smart Citations

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

Saieg

Pitman

2020

Diagnostic Cytopathology

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Risk of malignancy associated with diagnostic categories of the proposed World Health Organization International System for Reporting Pancreaticobiliary Cytopathology

Hoda

Arpin

Rosenbaum

et al. 2021

Cancer Cytopathology

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Background The World Health Organization (WHO) has proposed an updated international classification system for reporting pancreaticobiliary cytology. Substantial changes to the prior Papanicolaou Society of Cytopathology (PSC) system have been recommended. Chiefly, the “neoplastic: benign” and “neoplastic: other” categories have been replaced by 2 new categories—“pancreatic neoplasia‐low‐grade” (PaN‐Low) and “pancreatic neoplasia‐high‐grade” (PaN‐High)—stratifying neoplastic mucinous cysts by cytological atypia. Low‐grade malignancies are placed in the “malignant” category and benign serous cystadenoma in the “benign/negative” category. Risk of malignancy (ROM) associated with the diagnostic categories of the WHO system has yet to be defined. Methods All patients who underwent endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) for a pancreatic lesion at a single institution from January 2016 to December 2016, prospectively classified using the PSC system, were reclassified using the WHO system. Absolute ROM was determined by histologic outcome and/or clinical follow‐up of at least 6 months. Results A total of 334 EUS‐FNA samples from 322 patients were reviewed and reclassified. Absolute ROM for the WHO system was 7.7% for “insufficient/inadequate/nondiagnostic” category, 1.0% for “benign/negative for malignancy,” 28.0% for “atypical,” 4.8% for “PaN‐Low,” 60.0% for “PaN‐High,” 100% for “suspicious for malignancy,” and 100% for “malignant;” the absolute ROM for the same cohort using the PSC system was 7.7% for “nondiagnostic” category, 1.0% for “negative (for malignancy),” 28.0% for “atypical,” 0.0% for “neoplastic: benign,” 30.3% for “neoplastic: other,” 100% for “suspicious (for malignancy),” and 100% for “positive or malignant.” Conclusions The WHO international system achieves improved stratification by associated ROM compared to the PSC system.

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The World Health Organization classification of pancreaticobiliary cytopathology stratifies risk of malignancy and outcome for endoscopic ultrasound‐guided fine‐needle aspiration of the pancreas

Lui,

Hargett,

Pharaa

et al. 2023

Cancer Cytopathology

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BackgroundThe World Health Organization (WHO) has recently published a classification for reporting pancreaticobiliary cytopathology with differences compared to the Papanicolaou Society of Cytopathology (PSC) classification.MethodsRetrospective data were collected from pancreatic endoscopic ultrasound‐guided fine‐needle aspirations from 2014 to 2017 at a pancreatic cancer center. Absolute risk of malignancy (AROM), relative risk (to benign), performance characteristics, and overall survival were calculated for the entire cohort with comparison of cysts and solid lesions.ResultsIn total, 2562 cases were included: 16% cyst (n = 411) and 84% solid (n = 2151). The histologic confirmation rate was 43% (n = 1101) and the median follow‐up (for benign) was 56 months. For WHO I–VII, overall AROM (%) was 23, 22, 62, 13, 65, 97, and 100; cyst AROM was 7, 0, 19, 13, 38, 78, and 100; and solid AROM was 50, 29, 70, 15, 100, 99, and 100. For PSC I–VI, overall AROM (%) was 23, 29, 64, 0 (IVa), 60 (IVb), 97, and 100; cyst AROM was 7, 0, 19, 0, 21, 78, and 100; and solid AROM was 50, 35, 73, 0, 92, 99, and 100. The difference in relative risk for a cyst (vs. solid) overall was 0.38 for WHO and 0.26 for PSC. WHO and PSC categories showed stratification for the probability of overall survival.ConclusionsCystic versus solid lesion type can dramatically affect AROM, particularly for nondiagnostic (I), benign (II), atypical (III), and WHO V categories. WHO IV conveys a similarly low AROM for cystic and solid types. Both classifications stratify the probability of overall survival, including the newly introduced categories WHO IV and WHO V.

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Update on risk stratification in the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology categories: 3‐Year, prospective, single‐institution experience

Cited by 29 publications

References 19 publications

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

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

Risk of malignancy associated with diagnostic categories of the proposed World Health Organization International System for Reporting Pancreaticobiliary Cytopathology

The World Health Organization classification of pancreaticobiliary cytopathology stratifies risk of malignancy and outcome for endoscopic ultrasound‐guided fine‐needle aspiration of the pancreas

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