Gonzalez-Mancera Miguel S, Ahmadian Saman S, Gomez-Fernandez Carmen, Velez-Torres Jaylou, Jorda Merce, García-Buitrago Monica T
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Pathology and Laboratory Medicine, Jackson Health System, Miami, Florida, USA.
Diagn Cytopathol. 2022 Feb;50(2):49-56. doi: 10.1002/dc.24910. Epub 2021 Dec 1.
BACKGROUND: The guidelines published by the Papanicolaou Society of Cytopathology (PSC) intend to unify the reporting language in pancreaticobiliary specimens and improve communication between cytopathologists and clinicians. The six categories in the system will determine the best management for patients. However, there is limited evidence regarding the risk of malignancy (ROM) associated with each category. METHODS: A retrospective search was performed for pancreaticobiliary fine-needle aspiration (FNA) reports with corresponding surgical follow-up. Cases were reclassified according to the PSC. The ROM, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each category. RESULTS: A total of 297 cases were identified and reclassified as: 30 nondiagnostic (category I), 45 negative for malignancy (II), 20 atypical (III), 42 neoplastic: other (IVB), 19 suspicious for malignancy (V), and 141 malignant (VI). The absolute ROM was 10% for category I, 8.9% for category II, 60% for category III, 4.8% for category IV when the neoplasms were not characterized as malignant, and 100% when categorized as malignant; 100% for category V, and 95.7% for category VI. Sensitivity, specificity, positive predictive value, and negative predictive value for neoplasia and malignancy, including categories IV to VI, were 96.6%, 88.4%, 97.5%, and 84.4%, respectively. CONCLUSIONS: The categories developed by the PSC stratify the ROM. Aspirates designated as categories V and VI had the highest ROM. Our rate of atypical category complies with the recommended rate of <10%. This scheme provides valuable information to clinicians treating patients with pancreatic lesions.
背景：帕帕尼科拉乌细胞病理学协会（PSC）发布的指南旨在统一胰腺胆管标本的报告语言，并改善细胞病理学家与临床医生之间的沟通。该系统中的六个类别将确定患者的最佳管理方案。然而，关于每个类别的恶性肿瘤风险（ROM）的证据有限。 方法：对有相应手术随访结果的胰腺胆管细针穿刺抽吸（FNA）报告进行回顾性检索。根据PSC对病例进行重新分类。计算每个类别的ROM、敏感性、特异性、阳性预测值和阴性预测值。 结果：共识别出297例病例，并重新分类为：30例无法诊断（I类），45例恶性阴性（II类），20例非典型（III类），42例肿瘤性：其他（IVB类），19例恶性可疑（V类），141例恶性（VI类）。I类的绝对ROM为10%，II类为8.9%，III类为60%，IV类中肿瘤未被表征为恶性时为4.8%，表征为恶性时为100%；V类为100%，VI类为95.7%。包括IV至VI类在内的肿瘤和恶性肿瘤的敏感性、特异性、阳性预测值和阴性预测值分别为96.6%、88.4%、97.5%和84.4%。 结论：PSC制定的类别对ROM进行了分层。指定为V类和VI类的抽吸物ROM最高。我们的非典型类别发生率符合推荐的<10%的发生率。该方案为治疗胰腺病变患者的临床医生提供了有价值的信息。
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