Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: a single-center prospective pilot study (MOSE study)

• Published in: Gastrointestinal endoscopy 2015, Vol.81 (1), p.177-185
• Main Authors: Iwashita, Takuji, MD, PhD, Yasuda, Ichiro, MD, PhD, Mukai, Tsuyoshi, MD, PhD, Doi, Shinpei, MD, PhD, Nakashima, Masanori, MD, PhD, Uemura, Shinya, MD, PhD, Mabuchi, Masatoshi, MD, Shimizu, Masahito, MD, PhD, Hatano, Yuichiro, MD, Hara, Akira, MD, PhD, Moriwaki, Hisataka, MD, PhD
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Aged; Carcinoma - diagnosis; Carcinoma - pathology; Endoscopic Ultrasound-Guided Fine Needle Aspiration - instrumentation; Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods; Female; Gastroenterology and Hepatology; Humans; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphoma - diagnosis; Lymphoma - pathology; Male; Mediastinal Neoplasms - diagnosis; Mediastinal Neoplasms - pathology; Middle Aged; Needles; Neuroendocrine Tumors - diagnosis; Neuroendocrine Tumors - pathology; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - pathology; Pilot Projects; Prospective Studies
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2014.08.040

Background Although rapid on-site cytologic evaluation provides high efficacy of EUS-guided FNA (EUS-FNA), its availability is limited. Alternatively, macroscopic on-site quality evaluation (MOSE) may increase the efficacy of EUS-FNA. Objective To assess the efficacy of MOSE in estimating the adequacy of histologic core specimens obtained by EUS-FNA using a standard 19-gauge needle (19GN) for solid lesions. Design A prospective pilot study. Setting Tertiary-care referral center. Patients One hundred patients with solid lesions (n = 111 lesions). Interventions EUS-FNA using 19GN Main Outcome Measurements The relation of a macroscopic visible core (MVC) in the FNA specimens on MOSE with histologic core and the diagnostic yields were studied. Results The feasibility of EUS-FNA using a 19GN was 99%. The final diagnoses were malignancy in 83 lesions and benign in 28. MOSE revealed MVC in 91.1% with the median length of 8 mm. Histologic core was confirmed in 78.9%. The receiver-operating characteristic curve of the length of MVC for the presence of histologic core showed the cut-off MVC length of 4 mm with area under the curve of .893. Comparisons of per-pass diagnostic yields showed significantly superior histologic, cytologic, and overall diagnostic yields in MVC ≥ 4 mm as compared with