In Room Cytopatologist Adequacy. Is It mandatory During Endoscopic Ultrasonography Fine Needle Aspiration?

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Background: Endoscopic Ultrasonography Fine Needle Aspiration (EUS-FNA) is the safest and most sensitive way to obtain cytopathology specimens from both intra-parietal and extra-parietal lesions. EUS-FNA has not been already extensively applied to patients with suspected malignancy due to the high rates of inadequate specimens (10-20%) and doubt cases (20%), reported with this method. The presence of a cytopathologist in EUS room during FNA to judge specimen adequacy is reported to be effective to increase the rate of adequacy, but no statistic significance has already been showed. Furthermore one recent study supports the data that cytopathologist training increases adequacy. Aims: to evaluate the effectiveness of on site cytopathology on a large population of EUS-FNA and to compare if the level of training has influence on this data. Methods: we have prospectively enrolled all patients referred in our Unit to perform EUS examination for suspected intra or extra-parietal lesions. All EUS procedures have been done by one endosonographer, whilst in room adequacy has been performed by a team of four cytopatology technicians and the final diagnosis has been signed by a team of 4 pathologist. Both teams have good experience on both hystology and cytology but not in evaluation of EUS-FNA. After a 6 month training period, all EUS-FNA procedures has been done with a cytopathology technician in EUS room for 1 year (A), then for other 6 months a consecutive set of FNA has been invoiced directly to cytopathology without in room adequacy (B). Number of passes have been fixed to 3 in group B and variable (but no more than 5) on the basys of adequacy in group A Results: since march 2001 to june 2003, 193 pts. undergone a EUS-FNA. 146 (75%)were pancreatic.During the first 6 months 32 FNA has been performed and in the second period 161. At the end of the enrollment group A has a total of 122 FNA and group B 71. Range of passes in A was 3.8 (range 2-5) as compared to 3 in B (fixed). Reported rate of adequacy in the first 6 months was 68.7% not significantly different compared to 76.4% in the second period (NS). Adequacy rates in group A and group B were respectively 65.7% in group A and 74.6% in group B (NS). Sensitivity and specificity of FNA regarding final diagnosys were 74% and 100% respectively. Conclusions: in this big set of EUS-FNA patients cytopathologist presence in EUS room does not appear to increase adequacy rates and it doesn't seem that increasing experience determs an increase in adequacy rates.