Journal
DIAGNOSTIC CYTOPATHOLOGY
Volume 42, Issue 4, Pages 285-291Publisher
WILEY
DOI: 10.1002/dc.23035
Keywords
cytology; bile duct; biliary; brushing; pancreatic
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Brushing cytology is frequently utilized for the investigation of pancreatic and biliary strictures but is associated with low diagnostic sensitivity. The Papanicolaou Society of Cytopathology has presented a system for diagnostic classification which includes the categories benign, atypical, suspicious for malignancy and malignant. We studied a series of 216 pancreatic and biliary brushings with either histologic follow-up or a minimum of 6 months clinical follow-up to determine outcomes for the diagnostic categories (benign, atypical, favor reactive, atypical, not otherwise specified, atypical, suspicious and malignant). Eighty-six of the 216 (39.8%) were designated atypical with 10 of these designated as atypical favor reactive. Forty-five were called atypical not otherwise specified and 31 were interpreted as atypical suspicious for malignancy. On follow-up, 2 of 10 (20%) atypical favor reactive were eventually associated with a malignant diagnosis and 23 of 31 (74.2%) atypical, suspicious for malignancy demonstrated a malignant outcome. The remaining 45 brushings in the atypical category were atypical not otherwise specified, and 62% of these were associated with malignancy on follow-up. Stratification of the atypical category into atypical favor reactive, atypical, not otherwise specified and atypical, suspicious for malignancy improves diagnostic accuracy. The atypical suspicious for malignancy category has a follow-up similar to the malignant category while the atypical favor reactive category is associated with a clinical outcome similar to that of the benign category. Diagn. Cytopathol. 2014;42:285-291. (c) 2013 Wiley Periodicals, Inc.
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