title: Significance of atypia in pancreatic and bile duct brushings: follow-up analysis of the categories atypical and suspicious for malignancy.
abstract: Brushing cytology is frequently utilized for the investigation of pancreatic and biliary strictures but is associated with low diagnostic sensitivity. The Papanicolaou Society of Cytopathology has presented a system for diagnostic classification which includes the categories benign, atypical, suspicious for malignancy and malignant. We studied a series of 216 pancreatic and biliary brushings with either histologic follow-up or a minimum of 6 months clinical follow-up to determine outcomes for the diagnostic categories ("benign," "atypical, favor reactive," "atypical, not otherwise specified," "atypical, suspicious" and "malignant"). Eighty-six of the 216 (39.8%) were designated "atypical" with 10 of these designated as "atypical favor reactive." Forty-five were called "atypical not otherwise specified" and 31 were interpreted as "atypical suspicious for malignancy." On follow-up, 2 of 10 (20%) "atypical favor reactive" were eventually associated with a malignant diagnosis and 23 of 31 (74.2%) "atypical, suspicious for malignancy" demonstrated a malignant outcome. The remaining 45 brushings in the "atypical" category were "atypical not otherwise specified," and 62% of these were associated with malignancy on follow-up. Stratification of the "atypical" category into "atypical favor reactive," "atypical, not otherwise specified" and "atypical, suspicious for malignancy" improves diagnostic accuracy. The "atypical suspicious for malignancy" category has a follow-up similar to the "malignant" category while the "atypical favor reactive" category is associated with a clinical outcome similar to that of the "benign" category.
authors.affiliation: Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Chadwick
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Layfield
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Witt
authors.forename: Robert L
authors.initials: RL
authors.lastname: Schmidt
authors.forename: R N Kristin
authors.initials: RN
authors.lastname: Cox
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Adler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D001652:Bile Ducts / Q000473:pathology*; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000473:pathology; D003581:Cytodiagnosis / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D012307:Risk Factors; D055815:Young Adult
keywords: bile duct; biliary; brushing; cytology; pancreatic