{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:27:36Z","timestamp":1792013256143,"version":"4.4.0"},"reference-count":46,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"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":["Cytopathology"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The risk of malignancy (ROM) remains an area of interest for further evaluation in reporting systems including in International System for reporting serous fluid cytopathology (TIS), which is a standardized system for reporting effusion cytology. Herein, we report our findings in further investigation of ROM in TIS by studying on paired pleural effusion specimens and corresponding pleural biopsies with emphasis on negative for malignancy, and atypia of undetermined significance categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>The \u00a0Johns Hopkins Hospital pathology database was retrospectively searched for patients with a pleural biopsy (PBX) and a paired pleural effusion (PF) cytology specimens over a 4\u2010year period. We employed the TIS categories. The following statistical parameters were evaluated: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 223 patient cases were included. Effusions TIS reclassification and ROM were as follows: 1.8% non\u2010diagnostic (ROM 75%), 75.8% negative for malignancy (ROM 23%), 4.9% atypical cells of undetermined significance (ROM 45%), 2.2% suspicious for malignancy (ROM 80%), and 15.2% malignant (ROM 100%). Overall accuracy, sensitivity, specificity, PPV and NPV were calculated and were 79.4%, 45%, 97.7%, 91.2% and 77%, respectively. Among, discordant cases diagnosed negative for malignancy on PF and positive for malignancy on PBX, there were significant number of lymphomas, mesotheliomas, and sarcomas. Lung cancer was the most common carcinoma; however, rare types of carcinomas were noted. Cells blocks and immunohistochemistry (IHC) studies were utilized to confirm either malignant conditions or rule out malignancy in both cell blocks and histology biopsies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates the high specificity and ROM for \u2018malignant\u2019 and \u2018suspicious for malignancy\u2019 categories in the TIS reporting system and highlights the modest negative predictive value for the \u2018negative for malignancy\u2019 category. Although Tissue biopsies are usually considered as \u2018gold standard\u2019, any definitive diagnosis of malignancy of body fluid should be considered positive for malignancy in further clinical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cyt.13423","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T02:28:15Z","timestamp":1722565695000},"page":"695-705","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Application of the international system for reporting serous fluid cytopathology on pleural effusion cytology with paired pleural biopsy: A new insight and novel approach on risk of malignancy"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3273-4802","authenticated-orcid":false,"given":"Zahra","family":"Maleki","sequence":"first","affiliation":[{"name":"Department of Pathology The Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashleigh J.","family":"Graham","sequence":"additional","affiliation":[{"name":"Department of Pathology The Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Pathology The Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0124-2437","authenticated-orcid":false,"given":"Ricardo","family":"Pastorello","sequence":"additional","affiliation":[{"name":"Dana Farber\/Brigham and Women's Cancer Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Pathology The Johns Hopkins Hospital  Baltimore Maryland USA"},{"name":"National Institute of Allergy and Infectious Disease  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra C.","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Mayo Clinic Scottsdale  Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika F.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Pathology The Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-53908-5"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000501536"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jasc.2019.08.006"},{"issue":"1","key":"e_1_2_13_5_1","first-page":"98","article-title":"The Bethesda system for reporting cervical and vaginal cytologic diagnoses: report of the 1991 Bethesda workshop","volume":"35","author":"Luff R","year":"1992","journal-title":"J Fam Pract"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21898"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.23092"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-22864-8"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0500"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000450880"},{"issue":"18","key":"e_1_2_13_11_1","first-page":"1754","article-title":"Pleural disease","volume":"378","author":"Feller\u2010Kopman D","year":"2018","journal-title":"N Engl J Med"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2017.08.548"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.07.79"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0019-2016"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000493336"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12496"},{"issue":"7","key":"e_1_2_13_17_1","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1513\/AnnalsATS.201609-709OC","article-title":"Molecular profiling of malignant pleural effusion in metastatic non\u2010small\u2010cell lung carcinoma. 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