PWE-013 Assessment of rapid on site evaluation for cytology of solid pancreatic masses evaluated by endoscopic ultrasound fine-needle aspiration: impact on a new team's learning curve

Abstract

Introduction Rapid on site evaluation (ROSE) of cytology from endoscopic ultrasound fine-needle aspiration (EUS-FNA) is uncommon in the UK. The impact of ROSE in the learning curve of a new EUS-FNA service is largely unknown. Documenting the yield of malignancy in solid pancreatic lesions may provide a benchmark for performance of EUS-FNA. Aim We report the initial findings of ROSE and its impact on the first 36 consecutive cases of solid pancreatic mass lesions (SPML). Methods We prospectively collected data on the first 70 patients referred for an EUS-FNA incorporating a single endosonographer competent in radial EUS, a single cytotechnologist (ROSE) and two pathologists. Result The average age was 62.9 with a M/F ratio of 42:28. SPML accounted for 36/70 (51.4%). No samples were deemed inadequate. Cytology confirmed adenocarcinoma in 30/36 (83.3%). Of the remaining six, follow-up data (cytology, subsequent surgery, oncology, clinical follow-up) confirmed two cases consistent with chronic pancreatitis; one suspicious for malignancy (subsequent CT revealed lung metastases), while EUS criteria suggested malignancy in the remaining three cases cytology was non-diagnostic. One patient elected for a Whipples which showed pT3N1 pancreatic cancer, one remains under current surveillance follow-up, one died of metastatic tumour presumed pancreatic in origin. ROSE suggested malignancy in 34/36 (94%) cases. There was good agreement therefore between on site evaluation and final cytology reporting. Conclusion EUS FNA gave a high yield in the diagnosis of adenocarcinoma in solid pancreatic tumours in 30/34 (88%) one further case was suspicious for malignancy. ROSE had an immediate impact on determination of necrotic centres within tumour masses, immediate feedback on tissue acquisition and blood contaminating specimens thus guiding decisions re suction vs no suction, limiting the number of passes when material was deemed adequate thus optimising the procedure time, and guiding the evolving technique of FNA passes within a tumour mass. No case returned for a second EUS FNA. In a new FNA service ROSE contributed to the accuracy of staging, the learning curve of the team and enabled decision making to take place on the day of the procedure.