title: Standardized terminology and nomenclature for pancreatobiliary cytology: The Papanicolaou Society of Cytopathology Guidelines.
abstract: The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) biopsy, techniques of EUS-FNA, terminology and nomenclature of pancreatobiliary disease, ancillary testing and post-biopsy treatment and 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 over an 18 month period and synthesis of online comments of the draft document on the Papanicolaou Society of Cytopathology web site [www.papsociety.org]. This document selectively presents the results of these discussions and focuses on a proposed standardized terminology scheme for pancreatobiliary specimens that correlate cytological diagnosis with biological behavior and increasingly conservative patient management of surveillance only. The proposed terminology scheme recommends a six-tiered system: Non-diagnostic, negative, atypical, neoplastic [benign or other], suspicious and positive. Unique to this scheme is the "neoplastic" category separated into "benign" (serous cystadenoma) or "other" (premalignant mucinous cysts, neuroendocrine tumors and solid-pseudopapillary neoplasms (SPNs)). The positive or malignant category is reserved for high-grade, aggressive malignancies including ductal adenocarcinoma, acinar cell carcinoma, poorly differentiated neuroendocrine carcinomas, pancreatoblastoma, lymphoma and metastases. Interpretation categories do not have to be used. Some pathology laboratory information systems require an interpretation category, which places the cytological diagnosis into a general category. This proposed scheme provides terminology that standardizes the category of the various diseases of the pancreas, some of which are difficult to diagnose specifically by cytology. In addition, this terminology scheme attempts to provide maximum flexibility for patient management, which has become increasingly conservative for some neoplasms.
authors.affiliation: Address: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Martha B
authors.initials: MB
authors.lastname: Pitman
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Centeno
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Ali
authors.affiliation: Hospital de Pathologie Clinique, Geneva, Switzerland.
authors.forename: Muriel
authors.initials: M
authors.lastname: Genevay
authors.affiliation: University of Virginia Medical Center, Charlottesville, Virginia, USA.
authors.forename: Ed
authors.initials: E
authors.lastname: Stelow
authors.affiliation: Address: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mari
authors.initials: M
authors.lastname: Mino-Kenudson
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Carlos Fernandez-Del
authors.initials: CF
authors.lastname: Castillo
authors.affiliation: Deparment of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.affiliation: Deparment of Surgery, Indiana University Medical Center, Indianapolis, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
authors.affiliation: Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Layfield
keywords: Guidelines; Papanicolaou Society of Cytopathology; nomenclature; pancreas; terminology