Verma Parul, Goyal Saloni, Tyagi Ruchita, Ghuman Mehar, Mahajan Ramit, Selhi Arshneet Kaur, Kaur Harpreet, Selhi Pavneet Kaur
Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
J Cytol. 2024 Apr-Jun;41(2):123-130. doi: 10.4103/joc.joc_90_23. Epub 2024 Apr 24.
INTRODUCTION: The Papanicolaou Society of Cytopathology System for reporting Pancreaticobiliary Cytology (PSCPC) is a reliable method to classify pancreatic fine needle aspiration cytology (FNAC) smears. However, it is not without practical problems which can diminish the diagnostic accuracy of the cytological diagnosis. AIMS AND OBJECTIVES: To determine the diagnostic pitfalls while reporting cytomorphology of pancreatic lesions according to PSCPC on correlating FNAC findings with histopathology. MATERIALS AND METHODS: Retrospective analysis of pancreatic FNAC smears received in the Department of Pathology of our tertiary care institute over a period of 2 years was done. The cytological diagnoses were classified according to the Papanicolaou Society of Cytopathology system of reporting pancreaticobiliary cytology and correlated with histopathology. The reasons of cyto-histological discordance were analyzed. RESULTS: Out of 50 cases in which both FNAC and biopsy of pancreatic lesions were done, 34 cases were positive/malignant (Category VI), eight cases were suspicious for malignancy (Category V), three cases were neoplastic (Category IV), two cases were atypical (Category III), two cases were negative for malignancy (Category II), and one case was non-diagnostic (Category I). Out of 50 cases, histopathology was non-diagnostic due to inadequate material in six cases. The cytological diagnoses were compared with histopathology in the remaining 44 cases. Categories III, IV V, and VI were considered as positive for neoplastic pathology. The sensitivity of FNAC to predict neoplastic pathology was 97.5%, while the specificity was 25%. The positive predictive value was 92.9%. Two cases reported as atypical (Category III) turned out to be adenocarcinoma on histopathology. One case reported as neuroendocrine tumor and two cases reported as adenocarcinoma on cytology displayed features of chronic pancreatitis on histology. One case reported as neoplastic mucinous cyst (Category IV) turned out to be adenocarcinoma on histology (limited concordance). CONCLUSION: The cytopathologist needs to be wary of the potential pitfalls to improve the diagnostic accuracy of FNACs.
引言：巴氏细胞病理学协会胰腺胆管细胞学报告系统（PSCPC）是对胰腺细针穿刺抽吸细胞学（FNAC）涂片进行分类的可靠方法。然而，它并非没有实际问题，这些问题可能会降低细胞学诊断的准确性。 目的：根据PSCPC报告胰腺病变的细胞形态学，将FNAC结果与组织病理学相关联，以确定诊断中的陷阱。 材料与方法：对我们三级医疗中心病理科在2年期间收到的胰腺FNAC涂片进行回顾性分析。细胞学诊断根据巴氏细胞病理学协会胰腺胆管细胞学报告系统进行分类，并与组织病理学相关联。分析细胞组织学不一致的原因。 结果：在50例同时进行胰腺病变FNAC和活检的病例中，34例为阳性/恶性（VI类），8例可疑恶性（V类），3例为肿瘤性（IV类），2例为非典型（III类），2例恶性阴性（II类），1例无法诊断（I类）。50例中，6例因取材不足组织病理学无法诊断。其余44例将细胞学诊断与组织病理学进行比较。III、IV、V和VI类被视为肿瘤性病理学阳性。FNAC预测肿瘤性病理学的敏感性为97.5%，特异性为25%。阳性预测值为92.9%。2例报告为非典型（III类）的病例组织病理学结果为腺癌。1例细胞学报告为神经内分泌肿瘤，2例报告为腺癌的病例组织学显示为慢性胰腺炎特征。1例报告为肿瘤性黏液囊肿（IV类）的病例组织学结果为腺癌（一致性有限）。 结论：细胞病理学家需要警惕潜在的陷阱，以提高FNAC的诊断准确性。
J Pathol Transl Med. 2015-1
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