Analysing diagnostic utility and malignancy risk stratification in pleural fluid cytology specimen by application of international system of reporting serous fluid cytopathology

• Author Details:   
• Shagufta Qadri
• Wajidha PK
• Syeda Iqra Usman ^*
• Roobina Khan

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Introduction: Pleural fluid accumulate in the serous cavity as a result of various etiologies and fluid cytology can provide a diagnostic information. In order to standardise the reporting among different laboratories, the International System for Reporting Serous Fluid Cytopathology (ISRSFC) was proposed by the International Academy of Cytology and the American Society of Cytopathology.

Aim of the study: To apply the ISRSFC for reporting pleural fluid cytology and to assess the risk of malignancy of each category

Materials and Methods: All the pleural fluid specimens from January 2019 to August 2021 were retrieved from the data received in the cytopathology lab in the department of pathology JNMC, Aligarh. The cases were reviewed and re-categorised according to ISRSFC into 5 categories: Non-diagnostic (ND), Negative for malignancy (NFM), Aypia of uncertain significance (AUS), Suspicious for malignancy (SFM), and Malignant (MAL). The risk of malignancy (ROM) for each category was then evaluated after correlating cytohistological reports.

Results: Among the total 704 cases we studied, there were 194 ND, 297 NFM, 11 AUS, 59 SFM and 143 MAL cases. The ROM for the categories were found to be 19.5%, 24.9%, 63.63%, 88.13%, and 100% respectively.

Conclusions: Our study highlights the significance of categorising fluids according to ISRSFC, thereby standardising the management protocol as well as better prognostication. It helps in estimating the risk of malignancy in each category. The study also shows significantly higher risk of Malignancy in SFM as compared to AUS, hence supports the separate diagnostic importance of these 2 categories.