Elsevier

Pathology

Volume 48, Issue 4, June 2016, Pages 353-356
Pathology

Anatomical pathology
Observations on the application of the Papanicolaou Society of Cytopathology standardised terminology and nomenclature for pancreaticobiliary cytology

https://doi.org/10.1016/j.pathol.2016.03.004Get rights and content

Summary

In 2014 the Papanicolaou Society of Cytopathology (PSC) published a system of standardised terminology and nomenclature for pancreaticobiliary cytology (STNPC). In the present study, 232 previously reported pancreaticobiliary cytology specimens were categorised according to this set of guidelines in order to identify potential challenges to implementation of the PSC system into routine practice. Overall, 207 (89%) of the cases were found to comply with the PSC scheme in their original form. Twenty-five cases (11%) demonstrated that the application of the PSC system would result in a change of category. In the majority of these cases, the change was related to the method of categorising low grade and premalignant neoplasms, using the categories of ‘Neoplastic: other’ (a new category unique to STNPC classification scheme) and ‘Atypical’, for specimens deemed to be diagnostic of or suspicious for these lesions, respectively. The study also highlighted the emphasis on the inclusion of imaging context and cyst fluid analysis in the interpretation of endoscopic ultrasound guided fine needle aspiration specimens in the guidelines. The STNPC offers an approach to pancreaticobiliary cytology that reflects the considerable variation in the nature and treatment of the entities that may be encountered in these specimens. Challenges in utilisation of the scheme include awareness of the unique approach to the categorisation of premalignant and low grade neoplasms, and the amount and quality of available clinical and imaging information.

Introduction

Standardised reporting systems are increasingly utilised in pathology reports. Ideally, a standardised reporting system facilitates consistent reporting of concise, unambiguous diagnostic information that is relevant to management algorithms, thereby improving usability for clinicians and providing better support for management decisions.1 Additionally, standardised reporting is conducive to data capture, enabling usage in areas such as audit, clinical trials or population based research.2 The implementation of standardised reporting systems has been particularly successful in the reporting of cervical cytology, and more recently, thyroid cytology.3, 4, 5

The Papanicolaou Society of Cytopathology (PSC) has published standardised terminology and nomenclature for pancreaticobiliary cytology (STNPC).6 There are adjunctive clinical guidelines which encompass the indications, techniques and management strategies for endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA).7, 8, 9, 10 The six-tiered classification scheme for pancreaticobiliary reporting is comprised of the following categories:

  • I.

    Non-diagnostic

  • II.

    Negative for malignancy

  • III.

    Atypical

  • IV.

    Neoplastic: benign and other

  • V.

    Suspicious for malignancy

  • VI.

    Positive for malignancy

The scheme applies to both pancreatic EUS-FNA and bile duct brushing (BDB) specimens, with the exception of category IV ‘Neoplastic: benign and other’, which is relevant to EUS-FNA specimens, but not to BDB. The present study aims to identify existing pancreaticobiliary cytology reporting practices that differ from the STNPC proposed by PSC in order to predict challenges that may be encountered in implementing the PSC system.

Section snippets

Materials and methods

All pancreatic EUS-FNA and BDB cases reported at Austin Pathology over a 2 year period between October 2012 and September 2014 were reviewed and re-categorised according to the criteria presented in the STNPC guidelines. Re-categorisation was based on the content of the written report, request form information and results of cyst fluid analysis if performed (no other types of ancillary testing were performed on any of the specimens); slides were not reviewed. When incorporating cyst fluid

Results

The distribution of cases in each category according to the original reports, the adjustments made during re-categorisation, and the distribution of cases in each category following re-categorisation are shown in Table 1, Table 2.

It was assessed that the reports for 111 of 135 (82%) EUS-FNA cases and 96 of 97 (99%) BDB cases readily conformed to the STNPC; that is, these reports demonstrated a conclusion statement equivalent to one of the STNPC categories, accompanied by a microscopic

Discussion

Cytological assessment can be a powerful adjunct in the separation of low grade pancreatic neoplasms from the more common and aggressive pancreatic ductal carcinoma. In our study the greatest differences between existing reporting practices and those proposed in the STNPC relate to the categorisation of low grade neoplasms (including premalignant neoplasms and neoplasms of uncertain malignant potential) such as mucinous neoplasms and neuroendocrine tumours (Fig. 1A–C), in EUS-FNA specimens. The

Conclusion

Structured reporting allows diagnostic information pertaining to cytology specimens to be conveyed in a clear and concise format. The PSC STNPC offers an approach to pancreaticobiliary cytology that reflects the considerable variation in the nature and treatment of the many lesions that may be encountered in these specimens. The STNPC system clearly distinguishes the negative for malignancy and non-diagnostic categories, relating to adequacy of sampling and, for EUS-FNA specimens, correlation

Conflicts of interest and sources of funding

The authors state that there are no conflicts of interest to disclose.

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