Dedicated Cytopathologists vs Community Pathologist Significantly Affects Overall Diagnostic Accuracy of Endoscopic Ultrasound Guided Sampling of Solid Pancreatic Lesions: Outcomes From a Large Healthcare System

Abstract

Endoscopic ultrasound (EUS) is the most sensitive modality in detecting solid lesions of pancreas and is commonly performed for staging, and tissue acquisition. Correct pathologic diagnosis is crucial for timely diagnosis and initiation of therapy in cases of pancreatic adenocarcinoma and could preclude surgery for conditions (i.e. autoimmune pancreatitis) that mimic pancreatic cancer. Aim of our study was to evaluate overall impact of dedicated cytopathologists (DC) versus community pathologists (CP) on overall diagnostic accuracy of EUS guided tissue sampling. EUS fine needle aspiration (FNA) or biopsy (FNB) is currently performed in 6 out of 14 hospitals in our health care system. In only one of the academic tertiary care hospital, EUS FNA is being interpreted by 4 dedicated cytopathologist. In the remaining 5 hospitals, EUS FNA is being interpreted by community pathologists. Total 19 endosonographers performed over 3000 EUS between 2015 to 2019. From this prospective maintained database, we retrospectively reviewed EUS FNA cases for pancreatic solid lesions (PSLs) and collected data regarding patient demographics, PSL size, needle gauge, needle type, adequacy of the obtained sample, the percentage of diagnostic samples and diagnostic accuracy. A total of 575 procedures were performed across the entire hospital system. Mean age of the study population was 65+14. Total of 259 EUS FNA cases were reviewed by CP compared to 316 by DC. EUS FNA samples were more frequently reported as inadequate by CP 63/259 (24.3%), compared to DC 46/316 (14.6%) (p < 0.01). Similarly, overall diagnostic accuracy of EUS FNA was much lower when evaluated by CP 182/259 (70.3%), compared to DC 256/316 (81%) (p < 0.01). In one of the community hospitals, 16 EUS FNA were performed by academic endosonographers and interpretation was done by CP. For the same academic endosonographers, diagnostic yield with CP was 11/16 (68.7%) compared to 270/316 (85.5%) with DC. Our study concludes that EUS-FNA/FNB procedures when performed with dedicated cytopathologist not only improves the diagnostic accuracy but also reduces the chances of inadequate sampling or non-diagnostic results. This approach thereby avoids the necessity of repeating the invasive procedure as well as the delay in accurate diagnosis. Based on this results, further quality improvement initiative will be undertaken to improve overall diagnostic accuracy of EUS-FNA/FNB across the entire hospital system.Tabled 1Table 1DiagnosticCPDCTotalp-valueNo77 (29.7%)60 (14.6%)137 (16.9%)<0.01Yes182 (70.3%)256 (81%)438 (76.2%)Total259316575AdequateCPDCTotalp-valueNo63 (24.3%)46 (14.6%)109 (18.9%)<0.01Yes196 (75.7%)270 (85.4%)466 (81,1%)Total259316575 Open table in a new tab