Pancreaticobiliary Tract Cytology

  • Judy PangEmail author
  • Andrew Sciallis
Part of the Atlas of Anatomic Pathology book series (AAP)


Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the primary modality for obtaining tissue diagnosis of pancreatic masses. Endoscopic retrograde cholangiopancreatography (ERCP) with bile duct brushings for cytology is an additional minimally invasive modality to obtain material for tissue diagnosis, which can be helpful in the assessment of pancreatic neoplasms, particularly ductal adenocarcinomas. This chapter includes more than 50 images demonstrating the key cytologic features of the commonly encountered neoplasms of the pancreas. The role of ancillary studies as an adjunct to cytology is also discussed.


Pancreas Fine-needle aspiration Bile duct brushing Adenocarcinoma Neuroendocrine tumor Acinar cell carcinoma Solid pseudopapillary tumor Neoplastic mucinous cyst 


  1. 1.
    Al-Haddad M, Eloubeidi MA. Interventional EUS for the diagnosis and treatment of locally advanced pancreatic cancer. JOP. 2010;11:1–7.PubMedGoogle Scholar
  2. 2.
    Erickson RA, Garza AA. Impact of endoscopic ultrasound on the management and outcome of pancreatic carcinoma. Am J Gastroenterol. 2000;95:2248–54.CrossRefPubMedGoogle Scholar
  3. 3.
    Volmar KE, Vollmer RT, Routbort MJ, Creager AJ. Pancreatic and bile duct brushing cytology in 1000 cases: review of findings and comparison of preparation methods. Cancer. 2006;108:231–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Hewitt MJ, McPhail MJ, Possamai L, Dhar A, Vlavianos P, Monahan KJ. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc. 2012;75:319–31.CrossRefPubMedGoogle Scholar
  5. 5.
    Thosani N, Thosani S, Qiao W, Fleming JB, Bhutani MS, Guha S. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Dig Dis Sci. 2010;55:2756–66.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pitman MB, Genevay M, Yaeger K, Chebib I, Turner BG, Mino-Kenudson M, Brugge WR. High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than “positive” cytology. Cancer Cytopathol. 2010;118:434–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Pitman MB, Lewandrowski K, Shen J, Sahani D, Brugge W, Fernandez-del Castillo C. Pancreatic cysts: preoperative diagnosis and clinical management. Cancer Cytopathol. 2010;118:1–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Layfield LJ, Wax TD, Lee JG, Cotton PB. Accuracy and morphologic aspects of pancreatic and biliary duct brushings. Acta Cytol. 1995;39:11–8.PubMedGoogle Scholar
  9. 9.
    McGuire DE, Venu RP, Brown RD, Etzhorn KP, Glaws WR, Abu-Hammour A. Brush cytology for pancreatic carcinoma: an analysis of factors influencing results. Gastrointest Endosc. 1996;44:300–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Ryan ME. Cytologic brushings of ductal lesions during ERCP. Gastrointest Endosc. 1991;37:139–42.CrossRefPubMedGoogle Scholar
  11. 11.
    Jing X, Wamsteker EJ, Li H, Pu RT. Combining fine needle aspiration with brushing cytology has improved yields in diagnosing pancreatic ductal adenocarcinoma. Diagn Cytopathol. 2009;37(8):574.CrossRefPubMedGoogle Scholar
  12. 12.
    Pitman MB. Overview of diagnostic terminology and reporting. In: Pitman MB, Layfield LJ, editors. The Papanicolaou Society of Cytopathology system for reporting pancreaticobiliary cytology. Cham: Springer; 2015. p. 1–3.CrossRefGoogle Scholar
  13. 13.
    Pang JC, Minter RM, Kwon RS, Simeone DM, Roh MH. The role of cytology in the preoperative assessment and management of patients with pancreaticobiliary tract neoplasms. J Gastrointest Surg. 2013;17:501–10.CrossRefPubMedGoogle Scholar
  14. 14.
    Pitman MB. Pancreas and biliary tree. In: Cibas ES, Ducatman BS, editors. Cytology: diagnostic principles and clinical correlates. 4th ed. Philadelphia: Elsevier Saunders; 2014. p. 399–422.Google Scholar
  15. 15.
    Ohara Y, Oda T, Hashimoto S, Akashi Y, Miyamoto R, Enomoto T, et al. Pancreatic neuroendocrine tumor and solid-pseudopapillary neoplasm: key immunohistochemical profiles for differential diagnosis. World J Gastroenterol. 2016;22:8596–604.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Tajima S, Waki M, Azuma M, Koda K, Ohata A. E-cadherin-negative acinar cell carcinoma of the pancreas: report of a case showing a solid pseudopapillary growth pattern. Med Mol Morphol. 2016;49:177–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Farrell JM, Pang JC, Kim GE, Tabatabai ZL. Pancreatic neuroendocrine tumors: accurate grading with Ki-67 index on fine-needle aspiration specimens using the WHO 2010/ENETS criteria. Cancer Cytopathol. 2014;122:770–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas. 2010;39:707–12.CrossRefPubMedGoogle Scholar
  19. 19.
    Brugge WR. The use of EUS to diagnose cystic neoplasms of the pancreas. Gastrointest Endosc. 2009;69(2 Suppl):S203–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Petrone MC, Arcidiacono PG. Role of endosocopic ultrasound in the diagnosis of cystic tumours of the pancreas. Dig Liver Dis. 2008;40:847–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Tanaka M. International consensus on the management of intraductal papillary mucinous neoplasm of the pancreas. Ann Transl Med. 2015;3:286.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Fritcher EGB, Kipp BR, Halling KC, Clayton AC. FISHing for pancreatobiliary tract malignancy in endoscopic brushings enhances the sensitivity of routine cytology. Cytopathology. 2014;25:288–301.Google Scholar
  23. 23.
    Bangarulingam SY, Bjornsson E, Enders F, Barr Fritcher EG, Gores G, Halling KC, Lindor KD. Long-term outcomes of positive fluorescence in situ hybridization tests in primary sclerosing cholangitis. Hepatology. 2010;51:174–80.CrossRefPubMedGoogle Scholar
  24. 24.
    Fritcher EG, Kipp BR, Halling KC, Oberg TN, Bryant SC, Tarrell RF, et al. A multivariable model using advanced cytologic methods for the evaluation of indeterminate pancreatobiliary strictures. Gastroenterology. 2009;136:2180–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Gonda TA, Glick MP, Sethi A, Poneros JM, Palmas W, Iqbal S, et al. Polysomy and p16 deletion by fluorescence in situ hybridization in the diagnosis of indeterminate biliary strictures. Gastrointest Endosc. 2012;75:74–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Kipp BR, Stadheim LM, Halling SA, Pochron NL, Harmsen S, Nagorney DM, et al. A comparison of routine cytology and fluorescence in situ hybridization for the detection of malignant bile duct strictures. Am J Gastroenterol. 2004;99:1675–81.CrossRefPubMedGoogle Scholar
  27. 27.
    Moreno Luna LE, Kipp B, Halling KC, Sebo TJ, Kremers WK, Roberts LR, et al. Advanced cytologic techniques for the detection of malignant pancreatobiliary strictures. Gastroenterology. 2006;131:1064–72.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Smoczynski M, Jablonska A, Matyskiel A, Lakomy J, Dubowik M, Marek I, et al. Routine brush cytology and fluorescence in situ hybridization for assessment of pancreatobiliary strictures. Gastrointest Endosc. 2012;75:65–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Charatcharoenwitthaya P, Enders FB, Halling KC, Lindor KD. Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis. Hepatology. 2008;48:1106–17.CrossRefPubMedGoogle Scholar
  30. 30.
    Levy MJ, Baron TH, Clayton AC, Enders FB, Gostout CJ, Halling KC, et al. Prospective evaluation of advanced molecular markers and imaging techniques in patients with indeterminate bile duct strictures. Am J Gastroenterol. 2008;103:1263–73.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PathologyThe University of MichiganAnn ArborUSA

Personalised recommendations