The value of second opinion consultation in pancreaticobiliary cytopathology.

Abstract

Introduction: A few studies have highlighted the importance of cytopathology consultation in guiding patient care. In this study we have exclusively focused on consultation in pancreaticobiliary cytopathology, and its impact on patient management.

Methods: We reviewed all consult cases related to pancreaticobiliary cytopathology between July 2021 and November 2023. We categorized the cases as major or minor diagnostic discrepancies based on a comparison between the original diagnoses and the consult diagnoses. A major diagnostic discrepancy was defined as a 2-step deviation on a scale of "unsatisfactory, benign, atypical, suspicious, and malignant" or a change in patient management.

Results: Of 147 cases, including 49 bile duct brushings and 98 pancreatic fine needle aspirations (FNAs), we identified 49 (33%) discrepant cases: 15 (30.6%) major and 5 (10.2%) minor discrepancies in bile duct brushings, and 17 (17.3%) major and 11 (11.2%) minor discrepancies in pancreatic FNAs. There was a change in management in almost all major discrepancy cases for which follow-up information was available, with 12 of 15 biliary brushings resulting in chemotherapy (7), rebiopsy (2), and surgery (3), and 12 of 17 pancreatic FNAs leading to chemotherapy (5), rebiopsy (4), surgery (2), monitoring (1), and no change (1).

Conclusions: Our major diagnostic discrepancy rates of 30.6% and 17.3% for bile duct brushing and pancreas, respectively, are higher than previously reported rates in general cytopathology/histopathologic consultations. Pancreaticobiliary-cytopathology poses significant diagnostic challenges. Hence, a second opinion at a tertiary institution may be particularly critical for pancreaticobiliary cytopathology samples, allowing for more reliable patient-care.