A brief review of the WHO reporting system for pancreaticobiliary cytopathology

Martha B Pitman; Barbara A Centeno; Michelle D Reid; Mauro Saeig; Momin T Siddiqui; Lester J Layfield; Miguel Perez-Machado; Birgit Weynand; Edward B Stelow; Maria D Lozano; Noriyoshi Fukushima; Ian A Cree; Ravi Mehrotra; Fernando C Schmitt; Andrew S Field

doi:10.1016/j.jasc.2023.03.002

A brief review of the WHO reporting system for pancreaticobiliary cytopathology

J Am Soc Cytopathol. 2023 Jul-Aug;12(4):243-250. doi: 10.1016/j.jasc.2023.03.002. Epub 2023 Mar 7.

Authors

Affiliations

¹ Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: mpitman@partners.org.
² Department of Pathology, Moffitt Cancer Center, Tampa, Florida.
³ Department of Pathology, Emory University Hospital, Atlanta, Georgia.
⁴ Santa Casa Medical School, Sao Paulo, Brazil.
⁵ Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.
⁶ Pathology and Anatomic Science Department, University of Missouri, Columbia, Missouri.
⁷ Department of Cellular Pathology, Royal Free Hampstead NHS Trust, London, England.
⁸ Department of Pathology, University Hospitals Leuven, Leuven, Belgium.
⁹ Department of Pathology, University of Virginia Hospital, Charlottesville, Virginia.
¹⁰ Department of Pathology, Clinical University of Navarra, Pamplona, Spain.
¹¹ Department of Diagnostic Pathology, Jichi Medical University Hospital, Shimotsuke, Japan.
¹² International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France.
¹³ Indian Cancer Genomic Atlas, Centre for Health, Innovation and Policy Foundation, Noida, India.
¹⁴ Department of Pathology, Faculty of Medicine of University of Porto, Porto, Portugal.
¹⁵ Department of Anatomical Pathology, St Vincent's Hospital, Sydney, and University of New South Wales Sydney and University of Notre Dame, Sydney, Australia.

PMID: 37003924
DOI: 10.1016/j.jasc.2023.03.002

Abstract

The World Health Organization (WHO), the International Academy of Cytology, and the International Agency for Research on Cancer have developed an approach to standardized reporting of pancreaticobiliary cytopathology. The WHO Reporting System for Pancreaticobiliary Cytopathology (WHO System) revises the Papanicolaou Society of Cytopathology (PSC) System for Reporting Pancreaticobiliary Cytology published in 2015 and replaces the 6 PSC categories with 7 categories: "Insufficient/Inadequate/Nondiagnostic"; "Benign/Negative for malignancy"; "Atypical"; "Pancreaticobiliary neoplasm, low risk/grade (PaN-low)"; "Pancreatic neoplasm, high risk/grade (PaN-High)"; "Suspicious for malignancy"; and "Malignant". In the PSC system, there is a single category for "Neoplastic" lesions that includes 2 groups, 1 for benign neoplasms and 1 named "Neoplastic-other", dominated by premalignant intraductal neoplasms primarily intraductal papillary mucinous neoplasms and low-grade malignant neoplasms (pancreatic neuroendocrine tumors (PanNET) and solid pseudopapillary neoplasms (SPN). In the WHO System, benign neoplasms with virtually no risk of malignancy are included in the "Benign" category and low-grade malignancies (PanNET and SPN) are included in the "Malignant" category, as per the 5th edition of the WHO Classification of Digestive System Tumors, while the non-invasive pre-malignant lesions of the ducts are divided by the cytomorphological grade of the epithelium into PaN-low and PaN-high with distinctly different risks of malignancy. Within each category, key diagnostic cytopathologic features and the ancillary studies for diagnostic and prognostic evaluation, as well as the implications of diagnosis for patient care and management, are outlined. Reporting and diagnostic management options recognize the variations in the availability of diagnostic and prognostic ancillary testing modalities in low- and middle-income countries.

Keywords: Bile duct; Cytology; Pancreas; Reporting; Standardized; Terminology; WHO.

Publication types

Review

MeSH terms

Cytodiagnosis
Humans
Pancreatic Neoplasms* / diagnosis
Pancreatic Neoplasms* / pathology
Societies, Medical

Grants and funding

001/WHO_/World Health Organization/International