{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T04:07:10Z","timestamp":1778990830876,"version":"3.51.4"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diagnostic Cytopathology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fine\u2010needle aspiration biopsy (FNAB) is the preferred first\u2010line diagnostic tool for evaluating lymphadenopathy due to its minimally invasive nature and cost\u2010effectiveness. However, cytopathological interpretation of lymph node FNAB remains challenging because of the wide morphological spectrum of lymphoid lesions. The World Health Organization (WHO) Reporting System for Lymph Nodes, Spleen, and Thymus Cytopathology (WHO System) incorporates the \u201cAtypical\u201d and \u201cSuspicious for malignancy\u201d (\u201cSFM\u201d) categories to manage diagnostic uncertainty, yet their reproducibility and clinical implications remain undetermined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This review with illustrative case\u2010based applications of the WHO System discusses the use, diagnostic performance, and limitations of the \u201cAtypical\u201d and \u201cSFM\u201d categories. Comparative analysis of published data, including interobserver concordance and risk of malignancy (ROM) studies, has been performed, with reference to the Sydney System and the multicenter DELYCYOUS study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cases categorized as \u201cAtypical\u201d demonstrate highly variable ROM (28.6%\u201376.9%, mean \u224865%), reflecting heterogeneity in application and ancillary test integration, whereas the \u201cSFM\u201d category consistently exhibits high ROM (82%\u2013100%, mean \u224895%). Interobserver agreement remains poor (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.075 for \u201cAtypical\u201d;\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.104 for \u201cSuspicious for malignancy\u201d), highlighting interpretive subjectivity. Diagnostic pitfalls include artifactual monomorphism mimicking high\u2010grade lymphoma and underdiagnosis of paucicellular Hodgkin lymphoma or T\u2010cell proliferations. Ancillary tests, while essential, may also yield misleading results\u2014such as monoclonal B\u2010cell populations in reactive conditions\u2014potentially leading to overinterpretation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The \u201cAtypical\u201d and \u201cSFM\u201d categories are indispensable for diagnostic stratification and clinical management but suffer from limited reproducibility and intrinsic ambiguity. Their optimal application requires standardized diagnostic criteria of specific lesions, which are provided in the WHO System, institutional consistency, and integrated use of cytomorphological, immunophenotypical, and molecular data to minimize diagnostic uncertainty and improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dc.70118","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T03:22:37Z","timestamp":1775877757000},"page":"449-460","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Atypical and Suspicious for Malignancy Categories of the\n                    <scp>WHO<\/scp>\n                    Reporting System for Lymph Node, Spleen, and Thymus Cytopathology: Review of their\u00a0Diagnostic Utility, Limitations, and Clinical Impact"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6655-0078","authenticated-orcid":false,"given":"Immacolata","family":"Cozzolino","sequence":"first","affiliation":[{"name":"Pathology Unit University Hospital A.O.U. Luigi Vanvitelli  Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2342-1679","authenticated-orcid":false,"given":"Mats","family":"Ehinger","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Division of Pathology Lund University  Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2089-6118","authenticated-orcid":false,"given":"Oscar","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pathology Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4761-6855","authenticated-orcid":false,"given":"Elisabetta","family":"Maffei","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery Universit\u00e0 degli Studi di Salerno  Fisciano Salerno Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7358-5925","authenticated-orcid":false,"given":"Pio","family":"Zeppa","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery Universit\u00e0 degli Studi di Salerno  Fisciano Salerno Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9604-4507","authenticated-orcid":false,"given":"Andrew S.","family":"Field","sequence":"additional","affiliation":[{"name":"University of New South Wales  Sydney Australia"},{"name":"Notre Dame University  Sydney Australia"},{"name":"St Vincent's Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000535906"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.24800"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2020.153294"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-8"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2013-0674-RA"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000506497"},{"key":"e_1_2_13_8_1","volume-title":"International Agency for Research on Cancer; World Health Organization Joint Editorial Board. 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