Risk of malignancy and overall survival associated with the diagnostic categories in the World Health Organization Reporting System for Pancreaticobiliary Cytopathology

IF 2.6 3区医学 Q3 ONCOLOGY Cancer Cytopathology Pub Date : 2024-06-30 DOI:10.1002/cncy.22880

Wen-Yu Hsiao MD, PhD, Qun Wang MD, PhD

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Abstract

Background

The World Health Organization (WHO) classification system revised the Papanicolaou Society of Cytopathology (PSC) system for reporting pancreaticobiliary cytopathology. To better stratify intraductal and/or cystic neoplasms by cytologic grade, the neoplastic, other category was replaced by two new categories: pancreaticobiliary neoplasm, low-risk/grade (PaN-Low) and pancreaticobiliary neoplasm, high-risk/grade (PaN-High). Low-grade malignancies were placed in the malignant category, and benign neoplasms were placed in the benign/negative for malignancy category.

Methods

An institutional pathology database search identified patients who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic lesions from January 2015 to April 2022. The absolute risk of malignancy (ROM) was determined by histologic and/or clinical follow-up of at least 6 months, and overall survival rates were calculated across diagnostic categories, comparing the WHO and PSC systems.

Results

In total, 1012 cases were reviewed and recategorized. The ROM for the WHO system was 8.3% for insufficient/inadequate/nondiagnostic, 3.2% for benign/negative for malignancy, 24.6% for atypical, 9.1% for PaN-Low, 46.7% for PaN-High, 75% for suspicious for malignancy, and 100% for malignant. Comparatively, the ROM for the PSC system was 7.4% for nondiagnostic, 3.0% for negative for malignancy, 23.1% for atypical, 0% for neoplastic, benign, 7.3% for neoplastic, other, 75% for suspicious for malignancy, and 100% for malignant. The WHO system demonstrated superior stratification for overall survival.

Conclusions

The WHO system significantly improves the stratification of ROM and overall survival across diagnostic categories by introducing the PaN-Low and PaN-High categories and reassigning low-grade malignancies to the malignant category. Analyzing EUS-FNA samples with the WHO system provides critical insights for guiding clinical management.

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与世界卫生组织胰胆细胞病理学报告系统诊断类别相关的恶性肿瘤风险和总生存率。

背景：世界卫生组织（WHO）的分类系统修订了巴氏细胞病理学会（PSC）的胰胆管细胞病理学报告系统。为了更好地按细胞学分级对导管内和/或囊性肿瘤进行分层，"肿瘤，其他 "类别被两个新类别取代：胰胆管肿瘤，低风险/分级（PaN-Low）和胰胆管肿瘤，高风险/分级（PaN-High）。低度恶性肿瘤归入恶性类别，良性肿瘤归入良性/恶性阴性类别：通过机构病理学数据库搜索，确定了2015年1月至2022年4月期间因胰腺病变接受内镜超声引导下细针抽吸术（EUS-FNA）的患者。通过至少6个月的组织学和/或临床随访确定恶性肿瘤的绝对风险（ROM），并比较WHO和PSC系统，计算不同诊断类别的总生存率：结果：共对1012个病例进行了复查和重新分类。WHO系统的ROM为8.3%（不充分/不足/无诊断意义）、3.2%（良性/恶性阴性）、24.6%（不典型）、9.1%（PaN-Low）、46.7%（PaN-High）、75%（恶性可疑）和100%（恶性）。相比之下，PSC 系统的 ROM 为：7.4% 为非诊断性，3.0% 为恶性阴性，23.1% 为非典型，0% 为良性肿瘤，7.3% 为其他肿瘤，75% 为可疑恶性肿瘤，100% 为恶性肿瘤。WHO系统对总生存率的分层效果更佳：结论：WHO系统通过引入PaN-Low和PaN-High类别并将低度恶性肿瘤重新归入恶性类别，大大提高了各诊断类别的ROM分层和总生存率。用WHO系统分析EUS-FNA样本为指导临床治疗提供了重要的启示。

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来源期刊

Cancer Cytopathology 医学-病理学

CiteScore

7.00

自引率

17.60%

发文量

130

审稿时长

1 months

期刊介绍： Cancer Cytopathology provides a unique forum for interaction and dissemination of original research and educational information relevant to the practice of cytopathology and its related oncologic disciplines. The journal strives to have a positive effect on cancer prevention, early detection, diagnosis, and cure by the publication of high-quality content. The mission of Cancer Cytopathology is to present and inform readers of new applications, technological advances, cutting-edge research, novel applications of molecular techniques, and relevant review articles related to cytopathology.