Introduction: Demonstration of diagnostic contribution of Papanicolaou Society of Cytopathology-standardized nomenclature for pancreaticobiliary cytology (PSC-PC) in endoscopic ultrasonography (EUS) fine-needle biopsy (FNA) biopsies is important for widespread use and further development. Methods: 179 EUS-FNA biopsies (89: solid, 90: cystic) and PSC-PC categories were compared with surgical definite histopathology and definite clinical diagnosis. Overall risk of malignancy (oROM) was calculated for each PSC-PC category. Diagnostic accuracy was evaluated. Results: The cytopathology of lesions was nondiagnostic in 27%. Ductal dilatation, lymphadenopathy, and solid characteristic (independently) were associated with diagnostic result, while lesion size was not. PSC-PC categories had 89% diagnostic consistency with surgical definite histopathology. Category mismatch was detected in 3 patients (11%), of which 2 had adenocarcinoma. oROM was 14.3% for nondiagnostic group, 46% for cat. III (atypia), and 12% for cat. IVB (neoplastic – other). In terms of malignancy, the PSC-PC system had 100% specificity; PPV, 92% sensitivity, and 81% NPV; and the diagnostic accuracy was 94%. Conclusion: Using PSC-PC in EUS-FNA biopsies, pancreatic malignancy can be diagnosed with high diagnostic accuracy. In mucinous cystic lesions, some malignancies may be missed. To predict the malignancy risk of cat. IVB, assessment of dysplasia seems important. Although PSC-PC is not the only parameter in terms of diagnosing malignancy, its contribution to the clinical decision is quite high.

1.
Rawla
P
,
Sunkara
T
,
Gaduputi
V
.
Epidemiology of pancreatic cancer: global trends, etiology and risk factors
.
World J Oncol
.
2019
;
10
(
1
):
10
27
. .
2.
Mertz
HR
,
Sechopoulos
P
,
Delbeke
D
,
Leach
SD
.
EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma
.
Gastrointest Endosc
.
2000
;
52
(
3
):
367
71
. .
3.
Eloubeidi
MA
,
Jhala
D
,
Chhieng
DC
,
Chen
VK
,
Eltoum
I
,
Vickers
S
,
Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma
.
Cancer
.
2003
;
99
(
5
):
285
92
. .
4.
Luk
Y
,
She
WH
,
Chow
FCL
,
Ma
KW
,
Tsang
SHY
,
Dai
WC
,
Evaluation of pancreatic lesions with endoscopic ultrasound and fine needle aspiration
.
Surg Innov
.
2020
;
27
(
5
):
431
8
. .
5.
Hasan
MK
,
Hawes
RH
.
EUS-guided FNA of solid pancreas tumors
.
Gastrointest Endosc Clin N Am
.
2012
;
22
(
2
):
155
67, vii
. .
6.
Saieg
MA
,
Munson
V
,
Colletti
S
,
Nassar
A
.
The impact of the new proposed Papanicolaou Society of Cytopathology terminology for pancreaticobiliary cytology in endoscopic US-FNA: a single-institutional experience
.
Cancer Cytopathol
.
2015
;
123
(
8
):
488
94
. .
7.
Fitzpatrick
MJ
,
Hernandez-Barco
YG
,
Krishnan
K
,
Brugge
W
,
Casey
B
,
Pitman
MB
.
Diagnostic yield of the SharkCore EUS-guided fine-needle biopsy
.
J Am Soc Cytopathol
.
2019
;
8
(
4
):
212
9
. .
8.
Hebert-Magee
S
,
Bae
S
,
Varadarajulu
S
,
Ramesh
J
,
Frost
AR
,
Eloubeidi
MA
,
The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis
.
Cytopathology
.
2013
;
24
(
3
):
159
71
. .
9.
Pitman
MB
,
Centeno
BA
,
Ali
SZ
,
Genevay
M
,
Stelow
E
,
Mino-Kenudson
M
,
Standardized terminology and nomenclature for pancreatobiliary cytology: the Papanicolaou Society of Cytopathology guidelines
.
Diagn Cytopathol
.
2014
;
42
(
4
):
338
50
. .
10.
McKinley
M
,
Newman
M
.
Observations on the application of the Papanicolaou Society of Cytopathology standardised terminology and nomenclature for pancreaticobiliary cytology
.
Pathology
.
2016
;
48
(
4
):
353
6
. .
11.
Pitman
MB
,
Layfield
LJ
.
Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: a review
.
Cancer Cytopathol
.
2014
;
122
(
6
):
399
411
. .
12.
Rockacy
M
,
Khalid
A
.
Update on pancreatic cyst fluid analysis
.
Ann Gastroenterol
.
2013
;
26
(
2
):
122
7
.
13.
Layfield
LJ
,
Dodd
L
,
Factor
R
,
Schmidt
RL
.
Malignancy risk associated with diagnostic categories defined by the Papanicolaou Society of Cytopathology pancreaticobiliary guidelines
.
Cancer Cytopathol
.
2014
;
122
(
6
):
420
7
. .
14.
Chen
B
,
Zhao
Y
,
Gu
J
,
Wu
H
,
Liang
Z
,
Meng
Z
.
Papanicolaou Society of Cytopathology new guidelines have a greater ability of risk stratification for pancreatic endoscopic ultrasound-guided fine-needle aspiration specimens
.
Oncotarget
.
2017
;
8
(
5
):
8154
61
. .
15.
Wright
PK
,
Shelton
DA
,
Holbrook
MR
,
Thiryayi
SA
,
Narine
N
,
Slater
D
,
Outcomes of endoscopic ultrasound-guided pancreatic FNAC diagnosis for solid and cystic lesions at Manchester Royal Infirmary based upon the Papanicolaou Society of Cytopathology pancreaticobiliary terminology classification scheme
.
Cytopathology
.
2018
;
29
(
1
):
71
9
. .
16.
Lopez-Ramirez
AN
,
Villegas-Gonzalez
LF
,
Serrano-Arevalo
ML
,
Flores-Hernandez
L
,
Lino-Silva
LS
,
Gonzalez-Mena
LE
.
Reclassification of lesions in biopsies by fine-needle aspiration of pancreas and biliary tree using Papanicolaou classification
.
J Gastrointest Oncol
.
2018
;
9
(
5
):
847
52
. .
17.
Hoda
RS
,
Finer
EB
,
Arpin
RN
 3rd
,
Rosenbaum
M
,
Pitman
MB
.
Risk of malignancy in the categories of the Papanicolaou Society of Cytopathology system for reporting pancreaticobiliary cytology
.
J Am Soc Cytopathol
.
2019
;
8
(
3
):
120
7
. .
18.
Khan
MA
,
Grimm
IS
,
Ali
B
,
Nollan
R
,
Tombazzi
C
,
Ismail
MK
,
A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment
.
Endosc Int Open
.
2017
;
5
(
5
):
E363
75
. .
19.
Nelsen
EM
,
Buehler
D
,
Soni
AV
,
Gopal
DV
.
Endoscopic ultrasound in the evaluation of pancreatic neoplasms-solid and cystic: a review
.
World J Gastrointest Endosc
.
2015
;
7
(
4
):
318
27
. .
20.
Sung
S
,
Del Portillo
A
,
Gonda
TA
,
Kluger
MD
,
Tiscornia-Wasserman
PG
.
Update on risk stratification in the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology categories: 3-year, prospective, single-institution experience
.
Cancer Cytopathol
.
2020
;
128
(
1
):
29
35
. .
21.
Chen
G
,
Liu
S
,
Zhao
Y
,
Dai
M
,
Zhang
T
.
Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a meta-analysis
.
Pancreatology
.
2013
;
13
(
3
):
298
304
. .
22.
Smith
AL
,
Abdul-Karim
FW
,
Goyal
A
.
Cytologic categorization of pancreatic neoplastic mucinous cysts with an assessment of the risk of malignancy: a retrospective study based on the Papanicolaou Society of Cytopathology guidelines
.
Cancer Cytopathol
.
2016
;
124
(
4
):
285
93
. .
23.
Young
NA
,
Al-Saleem
T
.
Diagnosis of lymphoma by fine-needle aspiration cytology using the revised European-American classification of lymphoid neoplasms
.
Cancer
.
1999
;
87
(
6
):
325
45
. .
24.
Saieg
M
,
Pitman
MB
.
Experience and future perspectives on the use of the Papanicolaou Society of Cytopathology Terminology System for reporting pancreaticobiliary cytology
.
Diagn Cytopathol
.
2020
;
48
(
5
):
494
8
. .
25.
Singhi
AD
,
McGrath
K
,
Brand
RE
,
Khalid
A
,
Zeh
HJ
,
Chennat
JS
,
Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia
.
Gut
.
2018
;
67
(
12
):
2131
41
. .
26.
Pitman
MB
,
Genevay
M
,
Yaeger
K
,
Chebib
I
,
Turner
BG
,
Mino-Kenudson
M
,
High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than “positive” cytology
.
Cancer Cytopathol
.
2010
;
118
(
6
):
434
40
. .
27.
Pitman
MB
,
Yaeger
KA
,
Brugge
WR
,
Mino-Kenudson
M
.
Prospective analysis of atypical epithelial cells as a high-risk cytologic feature for malignancy in pancreatic cysts
.
Cancer Cytopathol
.
2013
;
121
(
1
):
29
36
. .
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