title: The role of cytology in the preoperative assessment and management of patients with pancreaticobiliary tract neoplasms.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided fine-needle aspiration and bile duct brushings are utilized in the cytologic evaluation of solid and cystic pancreaticobiliary tract lesions. We sought to determine the diagnostic accuracy of cytology.
  
  
  METHODS
  Five hundred seventy-nine pancreatic resections with 727 corresponding cytology specimens were identified from 1997 to 2012. Histologic diagnoses included benign, carcinoma, pancreatic endocrine neoplasm (PEN), nonepithelial neoplasms, cystic neoplasms, and ampullary adenomas. Standard interpretative categories-nondiagnostic, negative, atypical, suspicious, and positive--were utilized for preoperative cytology specimens.
  
  
  RESULTS
  For solid masses, the sensitivity and specificity of positive fine-needle aspiration (FNA) cytology for detecting carcinoma were 74 and 100 %, respectively. FNAs performed better than brushings (sensitivity, 40 %; specificity, 98 %) in detecting carcinomas. Similar findings were seen for PENs and nonepithelial neoplasms. For cystic lesions, the sensitivity of FNA for predicting malignancy was lower (24 %) with a specificity of 97 %. Sequentially combining suspicious and atypical categories with the positive category resulted in increases in sensitivity and decreases in specificity for all cases except for cystic lesions.
  
  
  CONCLUSIONS
  Cytology adds to the assessment of solid masses, but its utility in cystic lesions is less clear. Consideration of a suspicious cytologic interpretation as a positive diagnosis for triaging patients to surgery is supported by our study.
authors.affiliation: Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109-5054, USA. jcpang@med.umich.edu
authors.forename: Judy C
authors.initials: JC
authors.lastname: Pang
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Minter
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.forename: Diane M
authors.initials: DM
authors.lastname: Simeone
authors.forename: Michael H
authors.initials: MH
authors.lastname: Roh
mesh_terms: D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D010181:Pancreatic Cyst / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity