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Layfield LJ , Ehya H , Filie AC , Hruban RH , Jhala N , Joseph L , Vielh P , Pitman MB , Papanicolaou Society of Cytopathology
Utilization of ancillary studies in the cytologic diagnosis of biliary and pancreatic lesions: the Papanicolaou Society of Cytopathology guidelines for pancreatobiliary cytology
Diagn Cytopathol. 2014 Apr;42(4) :351-62
PMID: 24639398    PMCID: PMC4313905    URL: https://www.ncbi.nlm.nih.gov/pubmed/24639398
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Abstract
The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound-guided fine-needle aspiration, terminology and nomenclature of pancreatobiliary disease, ancillary testing, and post-biopsy management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings, and synthesis of selected online comments of the draft document. This document presents the results of these discussions regarding the use of ancillary testing in the cytologic diagnosis of biliary and pancreatic lesions. Currently, fluorescence in situ hybridization (FISH) appears to be the most clinically relevant ancillary technique for cytology of bile duct strictures. The addition of FISH analysis to routine cytologic evaluation appears to yield the highest sensitivity without loss in specificity. Loss of immunohistochemical staining for the protein product of the SMAD4 gene and positive staining for mesothelin support a diagnosis of ductal adenocarcinoma. Immunohistochemical markers for endocrine and exocrine differentiation are sufficient for a diagnosis of endocrine and acinar tumors. Nuclear staining for beta-catenin supports a diagnosis of solid-pseudopapilary neoplasm. Cyst fluid analysis for amylase and carcinoembryonic antigen aids in the preoperative classification of pancreatic cysts. Many gene mutations (KRAS, GNAS, VHL, RNF43, and CTNNB1) may be of aid in the diagnosis of cystic neoplasms. Other ancillary techniques do not appear to improve diagnostic sensitivity sufficiently to justify their increased costs.
Notes
Layfield, Lester J Ehya, Hormoz Filie, Armando C Hruban, Ralph H Jhala, Nirag Joseph, Loren Vielh, Philippe Pitman, Martha B eng P30 CA006973/CA/NCI NIH HHS/ Practice Guideline Diagn Cytopathol. 2014 Apr;42(4):351-62. doi: 10.1002/dc.23093.