帕潘尼古拉乌细胞病理学协会系统和世界卫生组织报告系统对实性胰腺病变中胰胆细胞病理学所定义的诊断类别之恶性风险及预测价值的比较
Comparison of risk of malignancy and predictive value of diagnostic categories defined by Papanicolaou Society of Cytopathology system and WHO reporting system for pancreaticobiliary cytopathology in solid pancreatic lesions.
作者信息
Vasas Béla, Fábián Anna, Bősze Zsófia, Hamar Sándor, Kaizer László, Tóth Tibor, Bacsur Péter, Resál Tamás, Bálint Anita, Farkas Klaudia, Molnár Tamás, Szepes Zoltán, Bor Renáta
机构信息
Department of Pathology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
Department of Internal Medicine, Center for Gastroenterology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
出版信息
Therap Adv Gastroenterol. 2024 Sep 26;17:17562848241271958. doi: 10.1177/17562848241271958. eCollection 2024.
BACKGROUND
The standardized diagnostic categories defined by the World Health Organization (WHO) reporting system support the interdisciplinary interpretation of cytological findings in the management of pancreatic cancer.
OBJECTIVE
To compare this classification to the Papanicolaou Society of Cytopathology (PSC) system in terms of predictive value and risk of malignancy (ROM) in solid pancreatic lesions.
DESIGN
Retrospective cohort study.
METHODS
All consecutive patients with solid pancreatic lesions who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) sampling at the University of Szeged from 2014 to 2021 were retrospectively enrolled. The predictive value and ROM of cytological findings were determined with comparison to histologic outcome and/or clinical follow-up.
RESULTS
A total of 521 EUS-FNAs were performed with a malignancy rate of 81.76%. In both classification systems, the absolute ROM of "non-diagnostic," "negative for malignancy," "atypical," "suspicious for malignancy," and "malignant" categories were 48.2%, 2.3%, 78.1%, 100.0%, and 99.4%, respectively. Despite the heterogeneous nature of the "neoplastic: other" category of the PSC system, the absolute ROM for solid lesions was 100%. Pancreatic neoplasm: high-risk/grade category including only two endosonographically solid cases of high-grade intraductal papillary mucinous neoplasms showed 100% ROM. There were no differences between PSC and WHO systems in sensitivity, specificity, and negative and positive predictive values: excluding the "atypical" category, these were 99.7%, 95.6%, 97.7%, and 99.5%, respectively. The "atypical" category considered benign resulted in a higher decrease in validity and negative predictive value, compared to "atypical" considered true malignant (93.6% vs 97.7% and 65.8% vs 97.7%).
CONCLUSION
For solid pancreatic lesions, the WHO system was identical to the PSC system in terms of ROM and predictive values.
背景
世界卫生组织（WHO）报告系统定义的标准化诊断类别有助于在胰腺癌管理中对细胞学检查结果进行多学科解读。
目的
比较该分类与帕帕尼科拉乌细胞病理学协会（PSC）系统在实性胰腺病变中的预测价值和恶性风险（ROM）。
设计
回顾性队列研究。
方法
回顾性纳入2014年至2021年在塞格德大学接受内镜超声引导下细针穿刺（EUS-FNA）采样的所有连续性实性胰腺病变患者。将细胞学检查结果的预测价值和ROM与组织学结果和/或临床随访进行比较来确定。
结果
共进行了521次EUS-FNA，恶性率为81.76%。在两个分类系统中，“无法诊断”“恶性阴性”“非典型”“恶性可疑”和“恶性”类别的绝对ROM分别为48.2%、2.3%、78.1%、100.0%和99.4%。尽管PSC系统的“肿瘤性：其他”类别性质异质性，但实性病变的绝对ROM为100%。仅包括两例内镜超声检查为实性的高级别导管内乳头状黏液性肿瘤的胰腺肿瘤：高风险/分级类别显示ROM为100%。PSC和WHO系统在敏感性、特异性以及阴性和阳性预测值方面没有差异：排除“非典型”类别后，这些指标分别为99.7%、95.6%、97.7%和99.5%。与视为真正恶性的“非典型”类别相比，视为良性的“非典型”类别导致有效性和阴性预测值下降幅度更大（93.6%对97.7%以及65.8%对97.7%）。
结论
对于实性胰腺病变，WHO系统在ROM和预测值方面与PSC系统相同。
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