Cancer cytopathology · 2026
Risk of malignancy for biliary cytology based on World Health Organization (WHO) reporting system for pancreaticobiliary cytopathology.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Abraham Annie Elizabeth, Wang Xinjun, Hargett Imani, Pharaa Zaynab, Sears Camille, Gonen Mithat, Murali Rajmohan, Lin Oscar, Wei Alice, Gonzalez-Aguirre Adrian, Shah Pari, Sigel Carlie
Аннотация
BACKGROUND: The World Health Organization (WHO) classification for pancreaticobiliary cytopathology stratifies risk of malignancy (ROM) and outcome for pancreatic fine-needle aspirations (FNAs). ROM for biliary cytology, particularly for WHO categories Pan-low (IV) and Pan-high (V), has not been well examined.
METHODS: Retrospective data of biliary cytology diagnosed from 2016 to 2019 were collected. WHO classification was assigned. Malignant outcome was determined by histologic correlation or clinical progression/death. Excluding clinical follow-up <3 months (if no histology), the ROM, odds ratio, performance characteristics, and overall survival were calculated.
RESULTS: A total of 1056 biliary cytology cases (from 789 patients) were included. Sample types were: 757 (72%) biliary brush/wash, 115 (11%) FNA, and 184 (17%) other. Same-site histologic correlation was 292 (28%) and histology of metastasis in 124 (12%). The median follow-up (for benign) was 1431 days. Malignant outcome occurred in 704 (n = 789, 89%) of patients. Absolute ROM (%) for WHO I to VII by biliary brush/wash and FNA were: 92, 72, 87, 0, 100, 94, 100, and 50, 46, 73, N/A, 100, 80, 100, respectively. A high-tier (V-VII) category had significantly higher odds of malignancy regardless of biopsy modality, presence of stent, or autoimmune cholangitis.
CONCLUSION: Absolute ROM for biliary lesions is high for WHO I through III and is at least partly because of difficulty in sampling cancers, particularly those extrinsically obstructing the bile duct. The rarity of low-grade biliary lesions impedes AROM assessment for Pan-low (WHO IV). The clinical value of biliary Pan-high (WHO V) remains uncertain because of rarity of high-grade noninvasive lesions and difficulty in cytology diagnosis.
METHODS: Retrospective data of biliary cytology diagnosed from 2016 to 2019 were collected. WHO classification was assigned. Malignant outcome was determined by histologic correlation or clinical progression/death. Excluding clinical follow-up <3 months (if no histology), the ROM, odds ratio, performance characteristics, and overall survival were calculated.
RESULTS: A total of 1056 biliary cytology cases (from 789 patients) were included. Sample types were: 757 (72%) biliary brush/wash, 115 (11%) FNA, and 184 (17%) other. Same-site histologic correlation was 292 (28%) and histology of metastasis in 124 (12%). The median follow-up (for benign) was 1431 days. Malignant outcome occurred in 704 (n = 789, 89%) of patients. Absolute ROM (%) for WHO I to VII by biliary brush/wash and FNA were: 92, 72, 87, 0, 100, 94, 100, and 50, 46, 73, N/A, 100, 80, 100, respectively. A high-tier (V-VII) category had significantly higher odds of malignancy regardless of biopsy modality, presence of stent, or autoimmune cholangitis.
CONCLUSION: Absolute ROM for biliary lesions is high for WHO I through III and is at least partly because of difficulty in sampling cancers, particularly those extrinsically obstructing the bile duct. The rarity of low-grade biliary lesions impedes AROM assessment for Pan-low (WHO IV). The clinical value of biliary Pan-high (WHO V) remains uncertain because of rarity of high-grade noninvasive lesions and difficulty in cytology diagnosis.