{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:41:02Z","timestamp":1777556462379,"version":"3.51.4"},"reference-count":76,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T00:00:00Z","timestamp":1628640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diagnostic Cytopathology"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Endoscopic ultrasound\u2010guided fine needle aspiration (EUS\u2010FNA) is a sensitive and specific method for diagnosing cancer in solid pancreatic masses. However, some cases receive indeterminate atypical diagnoses, which creates management dilemmas. In the 2014 Papanicolaou Society of Cytopathology (PSC) standardized guidelines for pancreatobiliary cytology, specimens in the \u201cAtypical\u201d category show a spectrum of architectural and\/or cellular changes beyond normal or reactive, but, quantitatively or qualitatively, insufficient for classification as neoplastic (benign\/other), suspicious or positive for malignancy. Implementation of the PSC system decreased atypical diagnoses, particularly for cystic lesions, and redistributed many cases into benign and neoplastic categories. Because no set cytologic criteria exist for the \u201cAtypical\u201d category there is wide variability in its use, and its frequency ranges from 0%\u201316% (mean 6%). It consists of a heterogeneous mix of cases that occur because of preanalytic, lesion\u2010specific (low cellularity, necrosis, cystic, reactive and premalignant changes), to pathologist\u2010dependent factors (experience, expertise, training and institutional case volume). Outcomes of atypical diagnoses in solid pancreatic masses range from benign to premalignant and malignant and include reactive atypia in pancreatitis, well differentiated adenocarcinoma, and non\u2010ductal malignancies. The associated risk of malignancy (ROM) ranges from 28%\u2013100%, with an overall intermediate ROM in large\u2010scale studies. Cytopathologists and institutions should monitor and keep their personal and\/or laboratory's atypical rates low by judiciously using rapid onsite evaluation, ancillary studies, consensus or expert review, as well as correlation with clinical and radiologic findings. Early repeat EUS\u2010FNA is indicated for unresolved cases.<\/jats:p>","DOI":"10.1002\/dc.24848","type":"journal-article","created":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T12:20:43Z","timestamp":1628684443000},"page":"196-207","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Atypical cells in fine needle aspiration biopsies of pancreas: Causes, <scp>work\u2010up,<\/scp> and recommendations for management"],"prefix":"10.1002","volume":"50","author":[{"given":"Kim","family":"HooKim","sequence":"first","affiliation":[{"name":"Department of Pathology, Anatomy and Cell Biology Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3812-4098","authenticated-orcid":false,"given":"Michelle D.","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Pathology Emory University Hospital  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,8,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e3182546e79"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23092"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21427"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21337"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.24393"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.26526"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21389"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11643"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jasc.2018.02.004"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000628"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jasc.2018.02.006"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23565"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/cyt.12502"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21559"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2017-0150-OA"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2017.51"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.20949"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jasc.2019.01.002"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.14105"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23305"},{"key":"e_1_2_8_22_1","first-page":"447A","article-title":"Impact of training and experience on evaluation of biliary brushings (BDB)","volume":"29","author":"Reid M","year":"2016","journal-title":"Mod Pathol"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000164370.81132.25"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.5858\/2009-0357-OA.1"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.22378"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2303.2011.00924.x"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(01)70082-X"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23333"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000157"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21497"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000533"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.21430"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.20715"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.08.046"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21188"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2015.11.037"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2004.30281.x"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23093"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.39012"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2016.12.348"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2011.181"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21627"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2303.2006.00312.x"},{"issue":"2","key":"e_1_2_8_44_1","first-page":"E134","article-title":"Specialized clinical cytology may improve the results of EUS (endoscopic ultrasound)\u2010guided fine\u2010needle aspiration (FNA) from pancreatic tumors","volume":"3","author":"Schneider AR","year":"2015","journal-title":"Endosc Int Open"},{"issue":"9","key":"e_1_2_8_45_1","first-page":"882","article-title":"Accuracy of grading of urothelial carcinoma on urine cytology: an analysis of interobserver and intraobserver agreement","volume":"5","author":"Reid MD","year":"2012","journal-title":"Int J Clin Exp Pathol"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.21093"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23323"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.22199"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.12431"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23078"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23035"},{"issue":"2","key":"e_1_2_8_52_1","first-page":"183","article-title":"Repeat endoscopic ultrasound\u2010guided fine needle aspiration for solid pancreatic lesions at a tertiary referral center will alter the initial inconclusive result","volume":"22","author":"Suzuki R","year":"2013","journal-title":"J Gastrointestin Liver Dis"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1159\/000177025"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1093\/gastro\/gox017"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-013-2750-6"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v9.i14.3308"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.06.005"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.4103\/2303-9027.313800"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.24291"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2011-0326-OA"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqaa014"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPVT8FCLFDTZWI"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.21854"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqx142"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/pin.12045"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.14362"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000559"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2004.02.013"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e31821bd62f"},{"key":"e_1_2_8_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(05)01581-6"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.12.019"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2020.06.038"},{"key":"e_1_2_8_73_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-313586"},{"key":"e_1_2_8_74_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2018-317817"},{"key":"e_1_2_8_75_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-019-0398-2"},{"key":"e_1_2_8_76_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.04.3661"},{"key":"e_1_2_8_77_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCP0HFEY0WFBNAP"}],"container-title":["Diagnostic Cytopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.24848","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/dc.24848","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.24848","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T04:27:04Z","timestamp":1693110424000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/dc.24848"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,11]]},"references-count":76,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1002\/dc.24848"],"URL":"https:\/\/doi.org\/10.1002\/dc.24848","archive":["Portico"],"relation":{},"ISSN":["8755-1039","1097-0339"],"issn-type":[{"value":"8755-1039","type":"print"},{"value":"1097-0339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,11]]},"assertion":[{"value":"2021-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}