Significance of atypia in pancreatic and bile duct brushings: Follow‐Up analysis of the categories atypical and suspicious for malignancy. Issue 4 (25th October 2013)

• Record Type: Journal Article
• Authors: Chadwick, Barbara E.; Layfield, Lester J.; Witt, Benjamin L.; Schmidt, Robert L.; Cox, R. N. Kristin; Adler, Douglas G.
• Is Part Of: Diagnostic cytopathology. Volume 42:Issue 4(2014:Apr.)
• Page Start: 285
• Page End: 291
• Publication Date: 2013-10-25
• Subjects: Cytodiagnosis -- Periodicals; Pathology, Cellular -- Periodicals; Cytology -- Periodicals; 616.07582
• DOI: 10.1002/dc.23035
• Languages: English
• ISSNs: 8755-1039

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p>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.</p> <p>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").</p> <p>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.</p> <p>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. © 2013 Wiley Periodicals, Inc.</p> </abstract>