{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:55:29Z","timestamp":1790999729916,"version":"4.1.0"},"reference-count":58,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"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":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Cytology of soft tissue tumours poses a diagnostic challenge due to their morphological heterogeneity and cytomorphological overlap between benign and malignant lesions. The IAC\u2013IARC\u2013WHO Reporting System for Soft Tissue Cytopathology introduces a standardised six\u2010tier diagnostic framework aligned with the WHO Classification of Tumours. This systematic review and meta\u2010analysis aimed to evaluate the overall diagnostic accuracy of soft tissue cytology and to determine the pooled risk of malignancy (ROM) for each WHO category, thereby assessing the clinical utility of this reporting system as a risk\u2010stratified framework for the management of soft tissue lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic literature search was conducted in PubMed and other electronic databases till February 2026, with no date restrictions, following the PRISMA\u2010DTA guidelines. The studies reported soft tissue cytology cases with the histopathological confirmation and had sufficient categorical detail to map to the IAC\u2013IARC\u2013WHO reporting system; they were eligible for inclusion. Data extraction, category mapping and quality assessment using the QUADAS\u20103 were performed. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR\u2212) and diagnostic odds ratio (DOR) were estimated using a bivariate random\u2010effects model. Hierarchical summary receiver operating characteristic (HSROC) curves were generated, and\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistics were used to assess heterogeneity. Subgroup analyses were performed for cytology method, geographic origin and study design. Meta\u2010regression was conducted using histopathological verification rate, malignancy prevalence and publication year as covariates. The pooled ROM for WHO categories was calculated, and the certainty of evidence was assessed using the GRADE framework.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010seven studies were included; About 32 studies, comprising of 6773 histologically verified cases, were analysed for diagnostic accuracy. The pooled sensitivity was 84.9%, the pooled specificity was 96.8% and the overall diagnostic accuracy was 92.79%. The LR+ was 26.85, the LR\u2212 was 0.155 and the DOR was 172.7. The pre\u2010test probability was 41.3%, and the post\u2010test probability of malignancy was raised to 95%, while a negative result reduced it to 10%. The pooled ROM observed was 26.4%, 4.8%, 31.6%, 48.5%, 74.5% and 93.5% for the insufficient\/non\u2010diagnostic\/inadequate, benign, atypical, STNUMP, suspicious for malignancy and malignant categories, respectively. Significant heterogeneity was observed in sensitivity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200969%), whereas moderate heterogeneity was observed in specificity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200949%). No significant publication bias was detected, and the GRADE certainty of evidence was rated very low (\u2295\u25ef\u25ef\u25ef) due to serious concerns in the risk of bias, indirectness and inconsistency domains.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The present study demonstrates high specificity and an increase in ROM from the benign category, followed by the insufficient\/non\u2010diagnostic\/inadequate category and the malignant categories, confirming validity and supporting the role of cytology as a reliable malignancy\u2010confirmation tool and risk\u2010stratified decision\u2010support system in the preoperative management of soft tissue tumours. The very\u2010low grade certainty was due to incomplete histopathological verification, retrospective study designs and inadequate blinding in most included studies, underscoring the need for well\u2010designed prospective studies that use the WHO soft tissue cytology reporting system and include complete histopathological follow\u2010up to generate high\u2010certainty evidence for clinical guideline development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dc.70199","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T09:04:56Z","timestamp":1786439096000},"page":"849-860","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Accuracy of Soft Tissue Cytology and Risk of Malignancy Across the\n                    <scp>IAC<\/scp>\n                    \u2013\n                    <scp>IARC<\/scp>\n                    \u2013\n                    <scp>WHO<\/scp>\n                    Six\u2010Tier Reporting System: A Systematic Review and Meta\u2010Analysis With Retrospective Category Mapping"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0725-0494","authenticated-orcid":false,"given":"Jitendra Singh","family":"Nigam","sequence":"first","affiliation":[{"name":"Department of Pathology and Lab Medicine All India Institute of Medical Sciences  Bibinagar Telangana India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6255-8286","authenticated-orcid":false,"given":"Ashutosh","family":"Rath","sequence":"additional","affiliation":[{"name":"Department of Pathology and Lab Medicine All India Institute of Medical Sciences  Bibinagar Telangana India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5233-8594","authenticated-orcid":false,"given":"Jyotsna Naresh","family":"Bharti","sequence":"additional","affiliation":[{"name":"Department of Pathology\/Lab Medicine All India Institute of Medical Sciences  Mangalagiri Andhra Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9652-0179","authenticated-orcid":false,"given":"Immanuel","family":"Pradeep","sequence":"additional","affiliation":[{"name":"Department of Pathology and Lab Medicine All India Institute of Medical Sciences  Bibinagar Telangana India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.22888"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.22897"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jasc.2024.09.004"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.25464"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.25017"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/678628"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/cyt.12914"},{"key":"e_1_2_12_9_1","volume-title":"WHO Reporting System for Soft Tissue Cytopathology","author":"International Academy of Cytology, International Agency for Research on Cancer, World Health Organization Joint Editorial Board","year":"2025"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.19163"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2632"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_13_1","unstructured":"J. S.Nigam A.Rath J. N.Bharti andI.Pradeep \u201cDiagnostic Accuracy of Soft Tissue Cytology and Risk of Malignancy Across the IAC\u2013IARC\u2013WHO Six\u2010Tier Reporting System: A Systematic Review and Meta\u2010Analysis With Retrospective Category Mapping \u201d 2026 OSF Registries https:\/\/doi.org\/10.17605\/OSF.IO\/NZAJW."},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100384\u20104"},{"key":"e_1_2_12_15_1","volume-title":"The Jamovi Project. Version 2.7","author":"Jamovi","year":"2025"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS\u201025\u201002104"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1411"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2005.01.016"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010022\u201001788\u20102"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1666"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1439"},{"key":"e_1_2_12_22_1","unstructured":"University of Illinois Chicago \u201cDiagnostic Test Calculator \u201daccessed September 24 2025 https:\/\/araw.mede.uic.edu\/cgi\u2010bin\/testcalc.pl."},{"key":"e_1_2_12_23_1","unstructured":"Research Gold \u201cFree Research Tools \u201daccessed May 21 2026 https:\/\/researchgold.org\/resources."},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39500.677199.AE"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2019.12.020"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2019.02.003"},{"key":"e_1_2_12_27_1","unstructured":"GRADEpro GDT \u201cGRADEpro Guideline Development Tool \u201d 2023 McMaster University and Evidence Prime Inc. gradepro.org."},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01246145"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00267141"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453678508994359"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.1997.11744703"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102303.2001.00317.x"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.10200"},{"issue":"1","key":"e_1_2_12_34_1","first-page":"45","article-title":"Fine Needle Aspiration Cytology of Soft Tissue Tumours in Correlation With Histopathology","volume":"45","author":"Kulkarni D. R.","year":"2002","journal-title":"Indian Journal of Pathology & Microbiology"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0266\u20107681(03)00225\u20100"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0956\u20105507.2003.00102.x"},{"issue":"3","key":"e_1_2_12_37_1","first-page":"374","article-title":"Fine Needle Aspiration (FNA) of Soft Tissue Tumours (STT)","volume":"5","author":"Hirachand S.","year":"2007","journal-title":"Kathmandu University Medical Journal"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742\u20106413\u20104\u201020"},{"issue":"1","key":"e_1_2_12_39_1","first-page":"42","article-title":"Accuracy, Limitations and Pitfalls in the Diagnosis of Soft Tissue Tumors by Fine Needle Aspiration Cytology","volume":"50","author":"Kumar S.","year":"2007","journal-title":"Indian Journal of Pathology and Microbiology"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970\u20109371.42089"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010010\u20101401\u2010x"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010009\u20101100\u20107"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970\u20109371.97154"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.5146\/tjpath.2015.01325"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2015.20.44.4271"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.4103\/2278\u20100513.178066"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijmpo.ijmpo_132_16"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.5958\/0976\u20105506.2018.00536.3"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.18231\/2394\u20106792.2018.0051"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.patol.2018.10.005"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/cyt.12685"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1272\/jnms.JNMS.2020_87\u2010201"},{"key":"e_1_2_12_53_1","first-page":"1","volume-title":"Sarcoma","author":"Gautam R.","year":"2021"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1159\/000531051"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.5156"},{"issue":"1","key":"e_1_2_12_56_1","first-page":"880","article-title":"Fine Needle Aspiration Cytology (FNAC): A Valuable Tool for Diagnosing Soft Tissue Tumors and Tumor\u2010Like Lesions: A Retrospective Study","volume":"16","author":"Haider Z.","year":"2024","journal-title":"International Journal of Pharmaceutical and Clinical Research"},{"issue":"5","key":"e_1_2_12_57_1","first-page":"1677","article-title":"Utility of Fine Needle Aspiration Cytology in Diagnosing Soft Tissue Tumors and Tumor\u2010Like Lesions","volume":"16","author":"Kumari S.","year":"2024","journal-title":"International Journal of Pharmaceutical and Clinical Research"},{"issue":"4","key":"e_1_2_12_58_1","first-page":"546","article-title":"Spectrum of Soft Tissue Lesions in Upper and Lower Extremities on Fine Needle Aspiration Cytology (FNAC) at Tertiary Care Centre","volume":"6","author":"Doshetty R. S.","year":"2024","journal-title":"International Journal of Academic Medicine and Pharmacy"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.25340"}],"container-title":["Diagnostic Cytopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.70199","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/dc.70199","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.70199","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:26:40Z","timestamp":1790998000000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/dc.70199"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":58,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1002\/dc.70199"],"URL":"https:\/\/doi.org\/10.1002\/dc.70199","archive":["Portico"],"relation":{},"ISSN":["8755-1039","1097-0339"],"issn-type":[{"value":"8755-1039","type":"print"},{"value":"1097-0339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"assertion":[{"value":"2026-06-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}