{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T16:54:15Z","timestamp":1773248055178,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T00:00:00Z","timestamp":1646611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Cytopathology"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>The diagnosis of well\u2010differentiated adenocarcinoma on bile aspiration is a well\u2010known challenge. This study was aimed at improving the diagnostic performance and providing a biliary cytology learning atlas.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This single\u2010center, retrospective study included 135 cases of informative biliary samples collected between 2009 and 2018 that were classified as benign, atypical, or malignant. A double assessment was performed by a novice and a cytopathologist experienced in biliary cytology to establish the specificities, sensitivities, and inter\u2010 and intraobserver \u03ba index agreements of 24 cytological criteria, which were illustrated in a learning atlas.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A multivariate logistic regression was used to assess whether the most specific and reproducible criteria were associated with malignancy. A scoring system was statistically determined: 6 points were attributed in the presence of a 3\u2010dimensional (3D) cluster, anisonucleosis, and a nuclear to cytoplasmic (N:C) ratio &gt; 0.5, whereas 4 points were given in the presence of an enhanced nuclear membrane. A score higher than 10 points resulted in a malignancy diagnosis with 96% sensitivity and 97% specificity.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>A diagnostic tree of malignancy based on 4 criteria, together with a multidisciplinary approach, allows the diagnosis of adenocarcinoma with a specificity of 100% and a sensitivity of 88% or 72% depending on the presence of a single malignant cell or the presence of 3 combined criteria (a 3D cluster, anisonucleosis, and an N:C ratio &gt; 0.5). It comes with a learning atlas useful for cytopathologist training and accuracy in this uncommon cytology.;<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncy.22565","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T08:38:38Z","timestamp":1646642318000},"page":"433-442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Biliary cytology: A diagnostic tree for adenocarcinoma based on a cohort of 135 patients with endoscopic retrograde cholangiopancreatography for stenosis of the extrahepatic bile duct"],"prefix":"10.1002","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0353-1216","authenticated-orcid":false,"given":"Diane","family":"Giovannini","sequence":"first","affiliation":[{"name":"Pathology and Cytology Department Grenoble Alpes University Hospital  Grenoble 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