The Impact of a Training Program for Endosonographers in Cytopathology for Endoscopic Ultrasound-guided Fine Needle Aspiration

Abstract

Introduction: Onsite cytopathology services have a significant impact on the efficiency and accuracy of endoscopic ultrasound-guided fine needle * Exempt Fellow **Current Off-Cycle Fellow to date aspiration (EUS-FNA). This pilot study evaluated the impact of an intensive two day training program to educate endosonographers in EUS-related cytopathology. Materials and Methods: Six endosonographers (maleZ 5; median ageZ35yrs) with minimal prior cytopathology exposure, representing all time zones in the United States, with a median annual EUS volume of 250 procedures (academic: private practiceZ3:3) comprised the study cohort. A preand post-training cytopathology test was administered at the beginning and end of the two-day program. Training commenced with a 90 minute cytopathology tutorial focusing on four performance measures: specimen adequacy, sample interpretation, specimen processing and preliminary diagnosis. Eight live EUS-FNA cases were then performed and study participants independently completed four questions based on the performance measures for each case. The ability to independently smear and stain slides and operate a microscope was additionally assessed after a hands-on tutorial. Main outcome measures were improvement in pre and posttraining scores, improvement in performance measures for live cases, and the ability to independently handle specimens and operate a microscope. Results: Compared to pre-training, the mean post-training test scores improved by 63% from 48 to 78 out of 100. The mean live case performance score was 95%. Performances improved from 89% on day 1 to 100% on day 2. After training, all endosonographers could independently smear and stain slides and operate a microscope. Conclusions: An intensive two day program was effective in training endosonographers in some functions related to EUS-cytopathology. Incorporating basic cytopathology in EUS fellowship curriculum will likely improve the diagnostic performance of tissue acquisition and handling and lead to substantial cost and time savings for cytopathologists, because many programs do not have onsite cytopathology this training could have a major impact in advancing/improving EUS-FNA worldwide.