Pancreas – ASC Archived Cyto-econferences

Pancreas

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Archive Item Code: 3600-G

Item Name: Reporting of Pancreaticobiliary Cytology: A Quest for Standardization
Martha Bishop Pitman, MD

Presentation date: October 27, 2015; Expires: October 27, 2018
The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) biopsy, techniques of EUS-FNA, terminology and nomenclature of pancreatobiliary disease, ancillary testing, and post-biopsy treatment and management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings over an 18-month period, and synthesis of online comments of the draft document on the Papanicolaou Society of Cytopathology web site [www.papsociety.org]. This webinar selectively presents the results of these discussions and focuses on a proposed standardized terminology scheme for pancreaticobiliary specimens that correlate cytological diagnosis with biological behavior and increasingly conservative patient management of surveillance only. The proposed terminology scheme recommends a six-tiered system: Non-diagnostic, Negative, Atypical, Neoplastic [Benign or Other], Suspicious and Positive. Unique to this scheme is the “Neoplastic” category separated into “benign” (serous cystadenoma) or “Other” (premalignant mucinous cysts, neuroendocrine tumors and solid-pseudopapillary neoplasms). The positive or malignant category is reserved for high-grade, aggressive malignancies including ductal adenocarcinoma, acinar cell carcinoma, poorly differentiated neuroendocrine carcinomas, pancreatoblastoma, lymphoma and metastases. Interpretation categories do not have to be used. Some pathology laboratory information systems require an interpretation category, which places the cytological diagnosis into a general category. This proposed scheme provides terminology that standardizes the category of the various diseases of the pancreas, some of which are difficult to diagnose specifically by cytology. In addition, this terminology scheme attempts to provide maximum flexibility for patient management, which has become increasingly conservative for some neoplasms.

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Archive Item Code: 3600-F

Item Name: Importance of Rapid On-site Evaluation (ROSE) for EUS-FNA: Endoscopist Observations and Pathologic Diagnosis
Benjamin L. Witt, MD
Douglas G. Adler, MD

Presentation date: September 23, 2014; Expires: September 23, 2017
This archive will begin with an overview of the literature on the impact of rapid on-site evaluation of EUS-guided pancreatic FNAs. A case-based discussion focusing on specimen triage and intra-procedural communication will follow. The cases will center on common entities and their inherent diagnostic challenges. Both the endoscopist’s and pathologist’s perspectives will be presented.

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Archive Item Code: 3600-G

Item Name: Pancreatic Cysts Evaluated by EUS-FNA: Current Status
Michele D. Reid, MD, MS

Presentation date: October 28, 2014; Expires: October 28, 2017
This is an overview of the challenges and practical clues for the cytologic diagnosis of non-neoplastic and neoplastic cystic pancreatic lesions encountered in every day practice. The lecture will include a brief overview of pancreatic fine needle aspirations (FNAs) and endoscopic ultrasound guided-FNA, its associated pitfalls and limitations, as well as the cytopathologist’s role in rapid on-site evaluation and specimen triage. This will be followed by a detailed discussion of the most commonly encountered low- and high-risk pancreatic cysts. A review of the key cytologic and clinical features, with histologic correlation, and diagnostic terminology will be included. The cytologic features of low- and high-grade atypia in neoplastic mucinous cysts will be included. The judicious use and interpretation of ancillary studies in diagnosing and distinguishing pancreatic cysts from common mimics will also be discussed.

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Archive Item Code: 3500-F

Item Name: Pancreatic Fine Needle Aspiration Biopsy
Edward B. Stelow, MD

Presentation date: September 24, 2013; Expires: September 24, 2016
Pancreatic fine needle aspiration (FNA) clearly represents the majority of pathologic sampling of pancreatic disease.  This presentation focuses on the broad array of FNA samples that can be seen with the sampling of solid or cystic lesions of the pancreas.  The clinicocytologic features of pancreatic ductal adenocarcinoma, pancreatic neuroendocrine tumor, solid pseudopapillary neoplasm, acinar cell carcinoma, mucinous neoplasms, and pancreatitis are discussed.  The use of anclillary testing are also described.

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Archive Item Code:  3400-F

Item Name: EUS-FNA of the Pancreas: Finer Points of a Thin Needle Point
Nirag Jhala MD, MIAC

Presentation date: September 25, 2012; Expires:  September 25, 2015
This webinar will highlight areas of challenges and pitfalls to avoid on common EUS-FNA samples obtained from the pancreas. In addition, it will highlight salient morphologic features of common solid and cystic pancreatic lesions.  Furthermore, the webinar will also highlight differential diagnosis and where indicated how to judiciously use ancillary studies that could help to further confirm the diagnosis on these limited samples.