Pancreaticobiliary cytology is one of the most challenging areas in cytology and plays a pivotal role in patient management. Both false-negative and false-positive diagnoses carry grave consequences. The interpretive errors arise from difficulties in recognizing special tumor types (such as mucinous and papillary carcinoma), and underestimating the reactive changes that can occur in this area. Along with endoscopic retrograde cholangiopancreatogaphy (ERCP), endoscopic ultrasound (EUS) has broadened the ability to obtain specimens from a wide variety of pancreaticobiliary lesions. However, contaminant along the EUS-guided needle path adds to the complexity of interpretation. In addition to being familiar with the cytologic pitfalls in this area, an understanding of endoscopic findings of various entities may be helpful to meet the above challenge.

Five common bile duct brushing cases and five endoscopic ultra-sound guided pancreatic fine needle aspiration cases with their corresponding histology/clinical follow-up will be used to discuss the characteristic endoscopic (with or without ultrasound) and cytologic features of various lesions with differential diagnosis and pitfalls. The cases include reactive/metaplastic changes as well as neoplastic lesions, such as intraductal papillary mucinous neoplasm, well-differentiated adenocarcinoma, metastatic carcinoma, solid-pseudopapillary tumor of the pancreas, pancreatic endocrine tumor, and serous cystadenoma of the pancreas.

Upon completion of the course, participants should be able to: 1) review the clinical and endoscopic context of lesions in this area; 2) explain the morphology of contaminants sampled along the path of the needle in this area; 3) discuss the morphology of well-differentiated adenocarcinoma and other common entities in this area; 4) identify diagnostic criteria to distinguish between well-differentiated tumors and benign reactive changes.

The course is designed for advanced residents and general pathologists, as well as those specialized in cytopathology and GI pathology. Pre-registrants will be able to view case histories, virtual slide and still images of cytologic specimens prior to the meeting on the USCAP website. A comprehensive syllabus will be distributed at the course. After the meeting, all course registrants will have access to the PowerPoint presentation with the text portion of the syllabus on the USCAP website.

(NEW COURSE) This course may be used for CME credits or SAM credits.