Reporting of Pancreatico-biliary Cytopathology

  • Abha GoyalEmail author
Part of the Essentials in Cytopathology book series (EICP, volume 28)


Until recently, there was no standardized reporting system for pancreatico-biliary cytology. In 2014, the Papanicolaou Society of Cytopathology (Pap Society) published guidelines for reporting of pancreatico-biliary cytology. These guidelines were developed by a multidisciplinary group of experts following review of literature and discussion through an interactive Web-based forum and presentation at national and international meetings. The Pap Society reporting scheme includes six diagnostic categories: nondiagnostic, negative, atypical, neoplastic, suspicious for malignancy, and positive. The “neoplastic” category is further subdivided into “neoplastic: benign” and “neoplastic: other.” The premalignant neoplastic mucinous cysts and low-grade neoplasms of the pancreas are categorized as “neoplastic: other.” These categories correlate with the biologic behavior of the various neoplastic and nonneoplastic entities and have been shown to be associated with a risk of malignancy that increases from the negative to the malignant category. These guidelines emphasize a multidisciplinary approach, i.e., incorporating the clinical presentation, the imaging and ultrasound findings, results of cyst fluid biochemistry, and molecular analysis in formulating a cytologic diagnosis. This chapter will discuss the Pap Society nomenclature for pancreatico-biliary cytology and its practical application in daily practice.


Papanicolaou Society Reporting Pancreatico-biliary cytology Risk of malignancy Guidelines 


  1. 1.
    Pitman MB, Centeno BA, Ali SZ, Genevay M, Stelow E, Mino-Kenudson M, et al. Standardized terminology and nomenclature for pancreatobiliary cytology: the Papanicolaou Society of Cytopathology guidelines. Diagn Cytopathol. 2014;42:338–50. Scholar
  2. 2.
    Pitman MB, Layfield LJ. Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: a review. Cancer Cytopathol. 2014;122:399–411. Scholar
  3. 3.
    Wu RI, Yoon WJ, Brugge WR, Mino-Kenudson M, Pitman MB. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) contributes to a triple-negative test in preoperative screening of pancreatic cysts. Cancer Cytopathol. 2014;122:412–9. Scholar
  4. 4.
    Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97. Scholar
  5. 5.
    Barr Fritcher EG, Caudill JL, Blue JE, Djuric K, Feipel L, Maritim BK, et al. Identification of malignant cytologic criteria in pancreatobiliary brushings with corresponding positive fluorescence in situ hybridization results. Am J Clin Pathol. 2011;136:442–9. Scholar
  6. 6.
    Volmar KE, Vollmer RT, Routbort MJ, Creager AJ. Pancreatic and bile duct brushing cytology in 1000 cases: review of findings and comparison of preparation methods. Cancer. 2006;108:231–8.CrossRefGoogle Scholar
  7. 7.
    Stewart CJ, Mills PR, Carter R, O’Donohue J, Fullarton G, Imrie CW, et al. Brush cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol. 2001;54:449–55.CrossRefGoogle Scholar
  8. 8.
    Kocjan G, Smith AN. Bile duct brushings cytology: potential pitfalls in diagnosis. Diagn Cytopathol. 1997;16:358–63.CrossRefGoogle Scholar
  9. 9.
    Logrono R, Kurtycz DF, Molina CP, Trivedi VA, Wong JY, Block KP. Analysis of false-negative diagnoses on endoscopic brush cytology of biliary and pancreatic duct strictures: the experience at 2 university hospitals. Arch Pathol Lab Med. 2000;124:387–92.PubMedGoogle Scholar
  10. 10.
    Virk RK, Gamez R, Mehrotra S, Atieh M, Barkan GA, Wojcik EM, et al. Variation of cytopathologists’ use of the indeterminate diagnostic categories “atypical” and “suspicious for malignancy” in the cytologic diagnosis of solid pancreatic lesions on endoscopic ultrasound-guided fine-needle aspirates. Diagn Cytopathol. 2017;45:3–13. Scholar
  11. 11.
    Abdelgawwad MS, Alston E, Eltoum IA. The frequency and cancer risk associated with the atypical cytologic diagnostic category in endoscopic ultrasound-guided fine-needle aspiration specimens of solid pancreatic lesions: a meta-analysis and argument for a Bethesda system for reporting cytopathology of the pancreas. Cancer Cytopathol. 2013;121:620–8. Scholar
  12. 12.
    Choi WT, Swanson PE, Grieco VS, Wang D, Westerhoff M. The outcomes of “atypical” and “suspicious” bile duct brushings in the identification of pancreaticobiliary tumors: follow-up analysis of surgical resection specimens. Diagn Cytopathol. 2015;43:885–91. Scholar
  13. 13.
    Chadwick BE, Layfield LJ, Witt BL, Schmidt RL, Cox RN, Adler DG. Significance of atypia in pancreatic and bile duct brushings: follow-up analysis of the categories atypical and suspicious for malignancy. Diagn Cytopathol. 2014;42:285–91. Scholar
  14. 14.
    Belsley NA, Pitman MB, Lauwers GY, Brugge WR, Deshpande V. Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer. 2008;114(2):102–10. Scholar
  15. 15.
    Pitman MB, Centeno BA, Genevay M, Fonseca R, Mino-Kenudson M. Grading epithelial atypia in endoscopic ultrasound-guided fine-needle aspiration of intraductal papillary mucinous neoplasms: an international interobserver concordance study. Cancer Cytopathol. 2013;121:729–36. Scholar
  16. 16.
    Bhutani MS, Hawes RH, Baron PL, Sanders-Cliette A, van Velse A, Osborne JF, et al. Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy. 1997;29:854–8.CrossRefGoogle Scholar
  17. 17.
    Layfield LJ, Wax TD, Lee JG, Cotton PB. Accuracy and morphologic aspects of pancreatic and biliary duct brushings. Acta Cytol. 1995;39(1):11–8.PubMedGoogle Scholar
  18. 18.
    Eloubeidi MA, Chen VK, Eltoum IA, Jhala D, Chhieng DC, Jhala N, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol. 2003;98:2663–8.PubMedGoogle Scholar
  19. 19.
    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;122:420–7. Scholar
  20. 20.
    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;124:285–93. Scholar
  21. 21.
    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. Scholar
  22. 22.
    McKinley M, Newman M. Observations on the application of the Papanicolaou Society of Cytopathology standardised terminology and nomenclature for pancreaticobiliary cytology. Pathology. 2016;48:353–6. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineWeill-Cornell Medicine, New York Presbyterian HospitalNew YorkUSA

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