Clinical Impact of On-Site Cytopathologic Interpretation for Endoscopic Ultrasound Guided Fine Needle Aspiration

Abstract

Background: Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has become the procedure of choice for diagnosing gastrointestinal and many thoracic malignancies. Obtaining adequate tissue samples to establish the diagnosis can be problematic, however, without the presence of a cytopathologist on-site during the procedure. We previously demonstrated a trend that the presence of on-site cytopathologist improves the yield of EUS-FNA and reduces the need to subject patients to multiple exams to establish a diagnosis, but due to a limited number of patients did not reach statistical significance. The following is an updated report with two years more data collection. Methods: A retrospective analysis of a prospectively collected database was performed of patients undergoing EUS-guided FNA in two institutions. Patient and procedure-related data were recorded, including patient age, gender, number of needle passes to obtain tissue, target site, number of repeat procedures, and cytologic diagnosis. In one institution, a cytopathologist was present for every procedure. In the second institution, an on-site cytopathologist was not routinely available. In this institution, 5 needle passes were routinely taken for solid masses, and 3 passes were taken for nodes and other lesions. Cytologic diagnoses were categorized as positive or negative for malignancy, suspicious for malignancy, atypical/ indeterminate, or unsatisfactory. The presence (group 1) or absence (group 2) of a cytopathologist during the exam was recorded and these groups were compared. Results: 431 patients (129 group 1, 302 group 2) undergoing 552 EUS-guided FNAs (157 group 1, 395 group 2) were evaluated. There were more males in each group (group 1:1.3/1, group 2: 1.1/1), mean age was 59 in group 1 and 63.7 in group 2. The most common biopsy site was thoraco-abdominal nodes in group 1, and pancreas in group 2. Patients in group 1 had a diagnosis of positive or negative for malignancy more frequently (p = 0.0001) and were less likely to require a repeat procedure to establish a diagnosis. (p = 0.016) Conclusion: The presence of an on-site cytopathologist for immediate interpretation of specimens during EUS-FNA significantly improves the diagnostic yield, and decreases the need for repeat procedures to establish a diagnosis. Based on these results, EUS centers should consider allocation of resources for on-site cytopathology evaluation. Background: Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has become the procedure of choice for diagnosing gastrointestinal and many thoracic malignancies. Obtaining adequate tissue samples to establish the diagnosis can be problematic, however, without the presence of a cytopathologist on-site during the procedure. We previously demonstrated a trend that the presence of on-site cytopathologist improves the yield of EUS-FNA and reduces the need to subject patients to multiple exams to establish a diagnosis, but due to a limited number of patients did not reach statistical significance. The following is an updated report with two years more data collection. Methods: A retrospective analysis of a prospectively collected database was performed of patients undergoing EUS-guided FNA in two institutions. Patient and procedure-related data were recorded, including patient age, gender, number of needle passes to obtain tissue, target site, number of repeat procedures, and cytologic diagnosis. In one institution, a cytopathologist was present for every procedure. In the second institution, an on-site cytopathologist was not routinely available. In this institution, 5 needle passes were routinely taken for solid masses, and 3 passes were taken for nodes and other lesions. Cytologic diagnoses were categorized as positive or negative for malignancy, suspicious for malignancy, atypical/ indeterminate, or unsatisfactory. The presence (group 1) or absence (group 2) of a cytopathologist during the exam was recorded and these groups were compared. Results: 431 patients (129 group 1, 302 group 2) undergoing 552 EUS-guided FNAs (157 group 1, 395 group 2) were evaluated. There were more males in each group (group 1:1.3/1, group 2: 1.1/1), mean age was 59 in group 1 and 63.7 in group 2. The most common biopsy site was thoraco-abdominal nodes in group 1, and pancreas in group 2. Patients in group 1 had a diagnosis of positive or negative for malignancy more frequently (p = 0.0001) and were less likely to require a repeat procedure to establish a diagnosis. (p = 0.016) Conclusion: The presence of an on-site cytopathologist for immediate interpretation of specimens during EUS-FNA significantly improves the diagnostic yield, and decreases the need for repeat procedures to establish a diagnosis. Based on these results, EUS centers should consider allocation of resources for on-site cytopathology evaluation.