Hoda Raza S, Finer Elizabeth B, Arpin Ronald N, Rosenbaum Matthew, Pitman Martha B
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Soc Cytopathol. 2019 May-Jun;8(3):120-127. doi: 10.1016/j.jasc.2019.01.002. Epub 2019 Jan 15.
Management of pancreatic lesions depends on the risk of malignancy, which is primarily determined from the cytologic and radiologic evaluation findings. The Papanicolaou Society of Cytopathology (PSC) published a classification system for reporting pancreaticobiliary cytology. However, the "neoplastic: other" category can be further stratified by high-grade atypia (HGA). Studies on the risk of malignancy using the PSC system have been limited.
All patients who had undergone endoscopic ultrasound-guided fine-needle aspiration (FNA) for a pancreatic lesion at Massachusetts General Hospital from January 2016 to December 2016 were prospectively classified. The clinical, radiographic, and endoscopic findings, cytologic and histologic diagnoses, and follow-up data from 334 FNA biopsies from 322 patients were reviewed. The neoplastic: other category was subclassified as low-grade atypia or HGA. The absolute risk of malignancy was determined by the histologic outcome or follow-up of ≥6 months.
The absolute risk of malignancy was 7.7% for the nondiagnostic category; 1.0% for negative; 28.0% for atypical; 0.0% for neoplastic: benign; 30.3% for neoplastic: other; 90.0% for neoplastic: other with HGA; 100% for suspicious; and 100% for positive. When the neoplastic: other with HGA, suspicious, and positive cytologic diagnoses were considered positive, the sensitivity, specificity, positive predictive value, and negative predictive value for pancreatic FNA biopsy was 92.2%, 98.8%, 98.3%, and 94.3%, respectively.
Categories of the PSC system each carry an implied absolute risk of malignancy, increasing from the negative to positive categories. The presence of HGA identifies lesions at the greatest risk of malignancy in the neoplastic: other category, and its inclusion with suspicious and positive as positive diagnoses optimizes the diagnostic performance of identifying high-risk lesions that warrant surgical excision.
胰腺病变的管理取决于恶性风险，这主要由细胞学和放射学评估结果决定。帕帕尼科拉乌细胞病理学协会（PSC）发布了一种用于报告胰胆管细胞学的分类系统。然而，“肿瘤性：其他”类别可通过高级别异型增生（HGA）进一步分层。使用PSC系统对恶性风险的研究有限。
对2016年1月至2016年12月在马萨诸塞州总医院因胰腺病变接受内镜超声引导下细针穿刺活检（FNA）的所有患者进行前瞻性分类。回顾了322例患者334次FNA活检的临床、影像学和内镜检查结果、细胞学和组织学诊断以及随访数据。“肿瘤性：其他”类别被细分为低级别异型增生或HGA。恶性肿瘤的绝对风险由组织学结果或≥6个月的随访确定。
非诊断性类别的恶性肿瘤绝对风险为7.7%；阴性为1.0%；非典型为28.0%；肿瘤性：良性为0.0%；肿瘤性：其他为30.3%；肿瘤性：其他伴HGA为90.0%；可疑为100%；阳性为100%。当将肿瘤性：其他伴HGA、可疑和阳性细胞学诊断视为阳性时，胰腺FNA活检的敏感性、特异性、阳性预测值和阴性预测值分别为92.2%、98.8%、98.3%和94.3%。
PSC系统的各个类别都隐含着恶性肿瘤的绝对风险，从阴性类别到阳性类别逐渐增加。HGA的存在可识别肿瘤性：其他类别中恶性风险最高的病变，将其与可疑和阳性诊断一起视为阳性诊断可优化识别需要手术切除的高危病变的诊断性能。
