Utilization of ancillary studies in the cytologic diagnosis of biliary and pancreatic lesions: The papanicolaou society of cytopathology guidelines

Lester Layfield, Hormoz Ehya, Armando Filie, Ralph H Hruban, Nirag Jhala, Loren Joseph, Philippe Vielh, Martha Pitman

Research output: Contribution to journalArticle

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, discussion 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-pseudopapillary neoplasm. Cyst fluid analysis for amylase and carcinoembryonic antigen aids in the pre-operative classification of pancreatic cysts. A number of gene mutations (KRAS, GNAS, von Hippel-Lindau, 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.

Original languageEnglish (US)
JournalCytoJournal
Volume11
Issue number2
DOIs
StatePublished - Jan 1 2014

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Guidelines
Staining and Labeling
Fluorescence In Situ Hybridization
Terminology
Cell Biology
Pancreatic Cyst
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Cyst Fluid
Neoplasms
Carcinoembryonic Antigen
beta Catenin
Amylases
Bile Ducts
Pathologic Constriction
Adenocarcinoma
Biopsy
Costs and Cost Analysis
Mutation
Genes
Proteins

Keywords

  • Ancillary studies
  • biliary tract
  • endoscopic ultrasound
  • fine-needle aspiration
  • molecular diagnosis
  • pancreas

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Utilization of ancillary studies in the cytologic diagnosis of biliary and pancreatic lesions : The papanicolaou society of cytopathology guidelines. / Layfield, Lester; Ehya, Hormoz; Filie, Armando; Hruban, Ralph H; Jhala, Nirag; Joseph, Loren; Vielh, Philippe; Pitman, Martha.

In: CytoJournal, Vol. 11, No. 2, 01.01.2014.

Research output: Contribution to journalArticle

Layfield, Lester ; Ehya, Hormoz ; Filie, Armando ; Hruban, Ralph H ; Jhala, Nirag ; Joseph, Loren ; Vielh, Philippe ; Pitman, Martha. / Utilization of ancillary studies in the cytologic diagnosis of biliary and pancreatic lesions : The papanicolaou society of cytopathology guidelines. In: CytoJournal. 2014 ; Vol. 11, No. 2.
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