Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists

• Published in: Journal of gastroenterology 2009-04, Vol.44 (4), p.322-328
• Main Authors: Hikichi, Takuto, Irisawa, Atsushi, Bhutani, Manoop S, Takagi, Tadayuki, Shibukawa, Goro, Yamamoto, Go, Wakatsuki, Takeru, Imamura, Hidemichi, Takahashi, Yuta, Sato, Ai, Sato, Masaki, Ikeda, Tsunehiko, Hashimoto, Yuko, Tasaki, Kazuhiro, Watanabe, Kazuo, Ohira, Hiromasa, Obara, Katsutoshi
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Biliary Tract; Biopsy, Fine-Needle - methods; Colorectal Surgery; Cytodiagnosis - methods; Databases, Factual; Endosonographer; Endosonography - methods; EUS-FNA; Female; Gastroenterology; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; On-site cytology; Original Article—Liver; Pancreas; Pancreatic mass; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Surgical Oncology
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-009-0001-6

Background Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with rapid on-site evaluation (ROSE) has been reported to provide a more accurate diagnosis than EUS-FNA without such evaluation. However, even endosonographers can evaluate ROSE regarding sample adequacy. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers compared to ROSE by cytopathologists in patients with solid pancreatic masses. Methods Between September 2001 and October 2005, of the 73 EUS-FNA procedures with the final diagnoses, 38 procedures after the introduction of ROSE by endosonographers (September 2001-September 2003, period 1), and 35 procedures after the introduction of ROSE by cytopathologists (October 2003-October 2005, period 2) were included. The specimens were stained with Diff-Quik stain and assessed. When the on-site assessors (endosonographers or cytopathologists) indicated that the amounts of cell samples were adequate, the procedure was stopped. Results Results are presented with 95% confidence limits. The average numbers of needle passes were 4.0 ± 1.6 and 3.4 ± 1.5 in periods 1 and 2, respectively (P = 0.06). The specimen collection rates were 97.4 and 97.1% in periods 1 and 2, respectively (P = 0.51). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy and benign were 92.9, 100, 100, 83.3, and 94.7%, respectively, in period 1, and 93.1, 100, 100, 75.0, and 94.3%, respectively, in period 2 (P = 0.97, P = 1.0, P = 1.0, P = 0.65, P = 0.93, respectively). No complications were seen. Conclusions For accurate diagnosis, ROSE should be performed during EUS-FNA by the endosonographer, if no cytopathologist is available.