Rapid On-site Cytologic Evaluation Research Articles

Endobronchial ultrasound-transbronchial needle aspiration: effectiveness and accuracy in non-small cell lung cancer staging.

Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) has a cardinal role in the diagnosis and staging of non-small cell lung cancer (NSCLC), providing an accurate nodal staging in a less invasive way than surgical biopsy. The aim of this study was to assess the diagnostic accuracy of EBUS-TBNA in the pre-operative NSCLC mediastinal staging, as well as to evaluate EBUS-TBNA specificity and sensibility in our cohort. We retrospectively analyzed data of NSCLC patients who underwent EBUS-TBNA followed by major pulmonary resection between January 2020 and December 2022. EBUS-TBNA was performed in patients with NSCLC (central T ≤ 3cm, peripheral/central T > 3cm), following the ESTS guidelines. The target nodes were selected on the basis of their radiologic/metabolic characteristics. Each procedure was conducted together with rapid on-site cytological evaluation (ROSE). Twenty-five patients were included (M/F = 17/8). At least three needle passages on each target lymph node were performed. No complications during or after the procedures occurred. We found a 100% correspondence between ROSE on the sampled nodes and postoperative pathologic findings. An upstaging occurred in three cases (12%) because of the involvement of stations 5 and 6 (not accessible via EBUS), while the only case of downstaging (N2 → N0, 4%) was probably due to intercurrent neoadjuvant chemotherapy. In all cases, EBUS-TBNA has proved to achieve a diagnostic procedure on the target nodes. EBUS-TBNA is a safe and effective procedure that offers high sensitivity and specificity when performed together with ROSE, which improves the accuracy of sampling. Doubt on nodal stations 5 and 6 involvement should be settled by other techniques.

Rapid on-site evaluation of touch imprint cytology in navigation bronchoscopy for small peripheral pulmonary nodules.

Rapid on-site evaluation (ROSE) of cytopathology plays an important role in determining whether representative samples have been taken during navigation bronchoscopy. With touch imprint cytology (TIC), histologic samples can be assessed using ROSE. Although advised by guidelines, there have been almost no studies on the performance of TIC during navigation bronchoscopy. The objective of this study was to evaluate the value of TIC-ROSE (forceps/cryobiopsy) in combination with conventional ROSE (cytology needle/brush). In this single-center, prospective cohort study, patients who had pulmonary nodules with an indication for navigation bronchoscopy were consecutively included. The primary outcome of the study was the concordance of ROSE and the procedural outcome. The concordance rates of TIC-ROSE and the combination of TIC-ROSE plus conventional ROSE were compared. Fifty-eight patients with 66 nodules were included. Conventional ROSE and TIC-ROSE were assessable in 61 nodules (90.9%) each. By combining both ROSE techniques, all sampled lesions were assessable. Combining conventional ROSE with TIC-ROSE showed concordant results in 51 of 66 cases (77.3%) versus 44 of 66 (66.7%) and 48 of 66 (72.8%) concordant results for conventional ROSE and TIC-ROSE alone, respectively, compared with the procedural outcome. There was no indication of tissue depletion as a result of TIC. The combined ROSE approach had a statistically significant higher concordance rate compared with conventional ROSE alone. TIC-ROSE is a cheap, easily implementable technique that can result in higher concordant ROSE outcomes. This could lead to more efficient procedures and possibly higher diagnostic results. In a monomodality sampling setting with only histologic samples, TIC can provide ROSE.

First Asia-Pacific experience of trans-bronchial core biopsy with a Franseen needle.

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the standard for evaluating mediastinal and hilar lesions. EBUS-TBNA is limited by small volume of material obtained for immunohistochemistry (IHC) and ancillary studies important for oncological therapies. The Franseen AcquireTM needle is designed for EBUS-transbronchial needle core biopsy (TBNB) allowing larger core sizes with evidence in gastroenterology literature but little in pulmonology. This study reports the first Asia-Pacific experience of EBUS-TBNB and adequacy of samples for diagnosis and ancillary studies. A retrospective cohort study of EBUS-TBNB at the Royal Adelaide Hospital was conducted between December 2019 and May 2021. Diagnostic rate, adequacy for ancillary studies and complications were evaluated. Samples were flushed into formalin for histological processing with no rapid on-site cytological evaluation (ROSE). For suspected lymphoma, samples were flushed into HANKS for flow cytometry. Cases performed with the Olympus VizishotTM during the same 18-month were similarly analysed. One hundred and eighty-nine patients were sampled with the AcquireTM needle. Diagnostic rate was 174/189 (92.1%). Where reported [146/189 (77.2%)], average core aggregate sample size was 13.4 mm × 10.7 mm × 1.7 mm. For non-small cell lung cancer (NSCLC) cases, 45/49 (91.8%) had adequate tissue for programmed cell death-ligand 1 (PD-L1). 32/35 (91.4%) adenocarcinoma cases had sufficient tissue for ancillary studies. There was one false negative malignant lymph node at the first AcquireTM procedure. There were no major complications. One hundred and one patients were sampled with the VizishotTM needle. Diagnostic rate was 86/101 (85.1%) with only 25/101 (24.8%) having reported tissue cores (P<0.0001 of VizishotTM) with the remaining samples processed via cell block. AcquireTM EBUS-TBNB diagnostic rate is comparable to historical data with >90% of cases having sufficient core material for ancillary studies. There appears to be a role for the AcquireTM alongside the standard of care for the work up of lymphadenopathy and particularly for lung cancer.

Impact of macroscopic on-site evaluation on the diagnostic outcomes of endoscopic ultrasound-guided fine-needle aspiration.

Endoscopic ultrasound (EUS)-guided tissue acquisition is the preferred modality for diagnosing pancreatic lesions and mediastinal and abdominal lymph nodes. Rapid on-site cytologic evaluation improves the diagnostic outcome of EUS-guided fine-needle aspiration (FNA) but is unavailable at many centers. Alternatively, macroscopic on-site evaluation (MOSE) may improve the diagnostic outcome of EUS-FNA, but data are limited. Hence, the present study was conducted to assess the efficacy of MOSE in improving adequacy and accuracy. We retrospectively analyzed data of consecutive patients with pancreatic or lymph nodal lesions undergoing EUS-guided FNA at a tertiary care center from December 2020 to December 2022. The study's primary outcomes were adequacy and diagnostic accuracy of the EUS-guided tissue acquisition, with secondary analysis of predictors of adequacy and accuracy. Data from 124 patients (44.4% male, median age: 54 years) who underwent EUS-FNA were included in the present analysis. The presence of macroscopic visible core (MVC) on MOSE was reported in 93/124 (75%) cases. An adequate sample for histopathological or cytological examination was obtained in 110/124 (88.7%) cases, while the diagnostic accuracy was 85.5%. On multivariate analysis, the absence of MVC on MOSE was found to be the independent negative predictor of both adequacy (OR 0.092, 95% CI: 0.024-0.349) and accuracy (OR 0.175, 95% CI: 0.057-0.536). The presence of MVC on MOSE can be an indicator of specimen adequacy and can improve the diagnostic yield of EUS-FNA.

Cheesy material on macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle biopsy: Don't miss the tuberculosis.

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is an excellent investigation to diagnose pancreatic lesions and has shown high accuracy for its use in pathologic diagnosis. Recently, macroscopic on-site evaluation (MOSE) performed by an endoscopist was introduced as an alternative to rapid on-site cytologic evaluation to increase the diagnostic yield of EUS-FNB. The MOSE of the biopsy can estimate the adequacy of the sample directly by the macroscopic evaluation of the core tissue obtained from EUS-FNB. Isolated pancreatic tuberculosis is extremely rare and difficult to diagnose because of its non-specific signs and symptoms. Therefore, this challenging diagnosis is based on endoscopy, imaging, and the bacteriological and histological examination of tissue biopsies. This uncommon presentation of tuberculosis can be revealed as pancreatic mass mimicking cancer. EUS-FNB can be very useful in providing a valuable histopathological diagnosis. A calcified lesion with a cheesy core in MOSE must be suggestive of tuberculosis, leading to the request of the GeneXpert, which can detect Mycobacterium tuberculosis deoxyribonucleic acid and resistance to rifampicin. A decent diagnostic strategy is crucial to prevent unnecessary surgical resection and to supply conservative management with antitubercular therapy.

Rapid on-site cytologic evaluation during endoscopic ultrasound-guided biopsies of pancreatic solid lesions

Rapid on-site cytologic evaluation during endoscopic ultrasound-guided biopsies of pancreatic solid lesions

Usefulness of rapid onsite cytological evaluation using Cyto Quick staining in endobronchial ultrasound-guided transbronchial needle aspiration cytology

Usefulness of rapid onsite cytological evaluation using Cyto Quick staining in endobronchial ultrasound-guided transbronchial needle aspiration cytology

Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of pulmonary sarcoidosis: A 9-year experience at a single center.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is valuable for diagnosing pulmonary sarcoidosis. We aimed to evaluate the diagnostic yield of EBUS-TBNA and cytology in sarcoidosis during the first 9 years at our institution. Patients who underwent EBUS-TBNA for suspected sarcoidosis between January 2011 and November 2019 were identified retrospectively. EBUS-TBNA was performed with rapid on-site cytological evaluation of the samples. The final diagnosis was based on the pathology and/or cytology results, radiologic features, and clinical follow-up findings. The yield rate was analyzed annually. Eighty patients underwent 83 EBUS-TBNA procedures for suspected sarcoidosis. In total, 136 lymph nodes were sampled. The mean number of lymph node stations sampled was 2.0 ± 0.6; the mean number of needle passes per lymph node was 3.5 ± 0.8. Sixty-five patients were diagnosed with sarcoidosis, with a total of 68 procedures. Nonnecrotizing granulomatous inflammation was detected in the EBUS-TBNA samples from 49/68 procedures (yield rate: 72.1%). Of 19 patients with sarcoidosis who did not obtain a pathological diagnosis with EBUS-TBNA, epithelioid cells and/or multinuclear giant cells suggestive of granulomatous inflammation were detected in five. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for pathological diagnosis of sarcoidosis using EBUS-TBNA were 72.1%, 100%, 100%, and 24.0%, respectively. On using cytology, the sensitivity and NPV increased to 79.4% and 26.3%, respectively. The yield rate did not increase until 2016. EBUS-TBNA is useful for diagnosing sarcoidosis. Cytology resulted in an additional yield rate of 7.3%, which improved as the number of cases increased.

A multivalent activatable aptamer probe with ultralow background signal and high sensitivity for diagnosis of lung adenocarcinoma

Lung adenocarcinoma is the most common subtype of lung cancer. Developing a simple, rapid, and sensitive method for the detection of lung adenocarcinoma is helpful to reduce the clinical workload and facilitate clinical treatment. To detect lung adenocarcinoma cells, this study designed a multivalent activatable aptamer probe (multi-AP) using S1 aptamer that can specifically recognize A549 cells (a lung adenocarcinoma cell line). Firstly, the monovalent activatable aptamer probe (mono-AP) was designed by strand-displacement strategy and fluorescent resonance energy transfer (FRET). The multi-AP was constructed by mono-AP assembled on the nucleic acid scaffold obtained by hybridization chain reaction (HCR). The presence of the target cell activated the multi-AP, the complementary strand was released, and the fluorescence detection signal was reported based on the FRET. The multi-AP has good specificity and sensitivity for detecting A549 in different matrices and greatly reduces the background signal with the lowest detection limit of 6 cells/200 μL. Furthermore, the multi-AP could directly detect the lung adenocarcinoma cells in cytology specimens, indicating a good potential of the multi-AP in clinical cytology specimens for rapid diagnosis, such as rapid on-site cytological evaluation. Besides, the multi-AP was further modified with biotin (bio-multi-AP) and used to detect clinical cytology cell blocks, implying the value of bio-multi-AP in immunocytochemistry for accurate diagnosis of lung adenocarcinoma.

Value of transbronchial needle aspiration combined with a rapid on-site evaluation of cytology in the diagnosis of pulmonary lesions.

BackgroundThe diagnostic value of rapid on-site evaluation (ROSE) of cytology during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains controversial. The purpose of this study was to validate the value of ROSE during the EUBS-TBNA procedure in the diagnosis of pulmonary lesions (PLs).MethodsEnrolled in this study were 260 patients with nodules, masses, cavities, or inflammatory lesions on pulmonary CT images. They were assigned to undergo EBUS-TBNA with ROSE (n = 134) or without ROSE (n = 126). The diagnostic results of ROSE during EBUS-TBNA and the final pathologic reports were analyzed and compared by utilizing SPSS21.0 software to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In addition, we further explored whether the ROSE method during EBUS-TBNA would improve the diagnostic yield and reduce the incidence of complications.ResultsThe overall diagnostic yield of EBUS-TBNA for malignant diseases in the ROSE and the non-ROSE group were 29.9 and 11.1%, respectively. The sensitivity, specificity, PPV and NPV of the ROSE method during EBUS-TBNA were 97.4, 96.9, 92.5, and 98.90%, respectively. The result of the chi-square test effectively proved that ROSE operation during EBUS-TBNA contributes to the diagnosis of malignancy compared with the non-ROSE group (χ2 = 13.858, P < 0.001). The number of punctures in the ROSE group was significantly lower than that in the non-ROSE group (P < 0.001).ConclusionROSE examination during EBUS-TBNA could effectively improve the diagnostic yield of malignant diseases compared with the non-ROSE group and reduce the number of intraoperative punctures, which is a clinical application worth popularizing.

S2813 Compacted Periampullary Diverticulum Masquerading as Pancreatic Head Mass on Endoscopic Ultrasound

Introduction: Endoscopic ultrasound (EUS) has become an increasingly important modality in the diagnosis and treatment of gastrointestinal malignancy as well as both pancreatic and biliary disease. It provides high-resolution, real-time imaging of the GI tract and surrounding structures. EUS is classically operator dependent and can often display suboptimal sensitivity and specificity. Numerous techniques such as Endoscopic guided fine-needle aspiration (EUS-FNA), EUS fine needle biopsy (EUS-FNB), rapid on-site cytological evaluation (ROSE) and contrast harmonic-enhanced EUS (CH-EUS) help to increase the sensitivity and specificity of this diagnostic modality. The following case describes a patient with initial EUS findings concerning for pancreatic head malignancy which was ultimately identified as a periampullary diverticulum compacted with sludge. Case Description/Methods: A 70-year-old patient with a past medical history of prostate cancer and cholelithiasis status post recent cholecystectomy presented with CT imaging findings concerning for pancreatic head mass. The patient underwent initial EGD with EUS which illustrated a well circumscribed, heterogeneously echoic 26.8 x 24 mm uncinate process mass concerning for neuroendocrine tumor (NET). FNB was performed and cytology ultimately showed no evidence of malignancy. Due to continued concern for pancreatic NET, patient underwent repeat EGD and EUS. EUS redemonstrated the large heterogeneously echoic pancreatic head lesion concerning for mass. Attempts were made to visualize the ampulla with linear EUS scope, however there was significant debris in the second portion of the duodenum. Duodenoscope was then passed and a large caliber but narrow opening periampullary diverticulum was visualized and appeared to be filled with compacted sludge. A combination of biopsy forceps and water lavage was used to clean out the compacted sludge. The EUS scope was then re-advanced into the second part of the duodenum and the suspected mass which was previously visualized was no longer visible. (Figure) Discussion: EUS is a an important, minimally invasive diagnostic procedure that has both high clinical success rate with relatively few adverse events. EUS, like many other diagnostic modalities, has limitations when identifying and ruling out malignancy. This case highlights one such limitation showing that although initial findings were concerning for malignancy, further investigation revealed a duodenal diverticulum with compacted debris masquerading as an uncinate mass.Figure 1.: A. EUS showing heterogeneously echoic 26.8 x 24 mm uncinate process mass B. Duodenoscope showing periampullary diverticulum compacted with sludge, removed with lavage and biopsy forceps C. Repeat EUS showing absence of previously visualized uncinate mass.

Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions.

Simple SummaryWith increasing interest in precision medicine for lung cancer, cryobiopsy is expected to improve the success rate not only for histological diagnosis, but also for next-generation sequencing. Rapid on-site evaluation (ROSE) is an immediate cytological evaluation performed during bronchoscopy. However, little is known about its clinical utility during cryobiopsy. We retrospectively reviewed the data of 63 consecutive patients who underwent cryobiopsy with ROSE of touch imprint cytology (ROSE-TIC) for solid peripheral pulmonary lesions. When the results of ROSE-TIC of each patient were compared directly with the histological findings of the corresponding specimen, the sensitivity, specificity, and positive and negative predictive values were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. Therefore, we believe that ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.Cryobiopsy enables us to obtain larger specimens than conventional forceps biopsy despite the caution regarding complications. This study aimed to evaluate the clinical utility of rapid on-site evaluation of touch imprint cytology (ROSE-TIC) during cryobiopsy of peripheral pulmonary lesions (PPLs). We retrospectively reviewed the data of consecutive patients who underwent cryobiopsy for solid PPLs between June 2020 and December 2021. ROSE-TIC was performed on the first specimen obtained via cryobiopsy and assessed using Diff-Quik staining. The results of ROSE-TIC for each patient were compared with the histological findings of the first cryobiopsy specimen. Sixty-three patients were enrolled in this study. Overall, 57 (90.5%) lesions were ≤30 mm in size and 37 (58.7%) had positive bronchus signs. The radial endobronchial ultrasound findings were located within and adjacent to the lesion in 46.0% and 54.0% of the cases, respectively. The sensitivity, specificity, and positive and negative predictive values of the ROSE results for histological findings of the corresponding specimens were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. In conclusion, ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.

EP08.02-143 Shortening of the Turn around time (TAT) in the Examination of Rapid On-Site cytologic Evaluation (ROSE) at transbronchial biopsy.

ROSE has been shown to reduce bronchoscopy time in patients with lung cancer. However, next-generation sequencing (NGS) test is now required in cases of lung cancer, it is unclear whether ROSE can contribute to the implementation of NGS testing. In this study, we examined the diagnostic rate of ROSE cases, the success rate of driver genetic testing, and the success rate of NGS testing.

A Biomarker-Based Approach for the Determination of Sample Adequacy During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Proof of Concept Study

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a highly sensitive, minimally invasive procedure1 and is universally accepted as one of the recommended first steps in mediastinal staging of lung cancer.2 To achieve optimal EBUS-TBNA lymph node assessment and staging, rapid on-site cytologic evaluation (ROSE) is beneficial in providing immediate biopsy evaluation.3,4 Unfortunately, the availability of ROSE is not widespread, which creates disparities both within and across institutions.

A deep learning-based segmentation system for rapid onsite cytologic pathology evaluation of pancreatic masses: A retrospective, multicenter, diagnostic study.

SummaryBackgroundWe aimed to develop a deep learning-based segmentation system for rapid on-site cytopathology evaluation (ROSE) to improve the diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy.MethodsA retrospective, multicenter, diagnostic study was conducted using 5345 cytopathological slide images from 194 patients who underwent EUS-FNA. These patients were from Nanjing Drum Tower Hospital (109 patients), Wuxi People's Hospital (30 patients), Wuxi Second People's Hospital (25 patients), and The Second Affiliated Hospital of Soochow University (30 patients). A deep convolutional neural network (DCNN) system was developed to segment cell clusters and identify cancer cell clusters with cytopathological slide images. Internal testing, external testing, subgroup analysis, and human–machine competition were used to evaluate the performance of the system.FindingsThe DCNN system segmented stained cells from the background in cytopathological slides with an F1-score of 0·929 and 0·899–0·938 in internal and external testing, respectively. For cancer identification, the DCNN system identified images containing cancer clusters with AUCs of 0·958 and 0·948–0·976 in internal and external testing, respectively. The generalizable and robust performance of the DCNN system was validated in sensitivity analysis (AUC > 0·900) and was superior to that of trained endoscopists and comparable to cytopathologists on our testing datasets.InterpretationThe DCNN system is feasible and robust for identifying sample adequacy and pancreatic cancer cell clusters. Prospective studies are warranted to evaluate the clinical significance of the system.FundingJiangsu Natural Science Foundation; Nanjing Medical Science and Technology Development Funding; National Natural Science Foundation of China.

Endoscopic Ultrasound-Guided Fine-Needle Biopsy Using 22G Franseen Needles without Rapid On-Site Evaluation for Diagnosis of Intraabdominal Masses.

Background: The impact of rapid on-site cytologic evaluation (ROSE) on endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is widely debated. This study aims to assess the diagnostic performance of EUS-FNB in the absence of ROSE in abdominal masses. Methods: Patients with abdominal masses undergoing EUS-FNB using 22-gauge Franseen needles and the slow-pull technique were prospectively enrolled in this study. Macroscopic on-site evaluation (MOSE) was performed without ROSE. Results: 100 patients were recruited between 2018 and 2020. Seventy-eight patients had neoplasms, and twenty-two patients had benign diseases. Common diagnoses included pancreatic cancer (n = 27), mesenchymal tumors (n = 17), and metastatic tumors (n = 14). The mean mass size was 3.9 ± 2.6 cm. The median pass number was three. Eighty-nine percent had adequate specimens for histologic evaluation. Malignancy increased the odds of obtaining adequate tissue (OR 5.53, 95% CI, 1.36–22.5). For pancreatic cancer, FNB had a sensitivity of 92.3%, a specificity of 100%, a positive predictive value (PPV) of 100%, a negative predictive value (NPV) of 97%, and an AUROC of 0.96. The sensitivity, specificity, PPV, NPV, and AUROC for mesenchymal cell tumors were 100%, 95.9%, 84.2%, 100%, and 0.98, respectively. For metastatic tumors, FNB was 100% sensitive and specific, with an AUROC of 1.00. There were no procedure-related complications. Conclusions: 22-gauge Franseen needles with the slow-pull technique and MOSE without ROSE provide excellent diagnostic performances for malignant lesions. Thus, MOSE should be implemented in real-world practice, and ROSE can be obviated when EUS-FNB is employed.

A Pilot Study of Image-associative Teaching Versus Traditional Didactic Teaching for Novice Endosonographers Learning Cytopathology Effectively

Background and AimsInsufficient cytology staff limited the spread of rapid onsite cytology evaluation (ROSE). Therefore, trained endosonographers performing ROSE became an option. To explore the effect of visualization aids for memory in cytology learning, we assessed the impact of image-associative teaching vs traditional didactic teaching of cytopathology for novice endosonographers in a limited time. MethodsEndoscopic ultrasound trainees without previous training in cytopathology were invited to participate in this study. Participants in Period 1 attended traditional didactic learning, and trainees in Period 2 received images-associative teaching. The images in the Period 2 tutorial were cytopathology images combined with their simulation images, whereas in Period 1, cytopathologic images were described in pathological terminology only. After the theoretical study, trainees received a knowledge quiz and an assessment for real smear interpretation. ResultsSeventeen trainees attended traditional didactic learning, whereas the other 8 participated in image-associative learning. In the theory test, the overall correct rate of trainees in Period 2 was higher than that of the trainees in Period 1 (76.92% vs 53.85%). In the evaluation of real smear reviews, the performance of trainees in Period 2 was still better than that of the trainees in Period 1 (the median correct rate 100% vs 75%). ConclusionThe use of image-associative tutorials allows for more efficient use of time and is thus feasible for the study of ROSE.

A Deep Learning-Based Segmentation System for Rapid Onsite Cytologic Pathology Evaluation of Pancreatic Masses: A Retrospective, Multicenter, Diagnostic Study

A Deep Learning-Based Segmentation System for Rapid Onsite Cytologic Pathology Evaluation of Pancreatic Masses: A Retrospective, Multicenter, Diagnostic Study

Usefulness of the automated multiband imaging system for EUS-FNA biopsy specimen evaluation in patients with upper gastrointestinal subepithelial lesions.

Sample isolation processing by stereomicroscopy (SIPS) was recently introduced as an alternative to rapid on-site cytologic evaluation and showed high accuracy for use in pathologic diagnoses. SIPS is a useful, but slightly complicated procedure; therefore, a new, more straightforward method for the objective estimation of the core tissue amount required during the sampling is desirable. We evaluated the usefulness of the automated multiband imaging system (AMUS) for calculating whitish core amounts in EUS-FNA biopsy (EUS-FNAB) samples from patients with subepithelial lesions (SELs). Four EUS-FNAB specimens per patient were obtained from 20 patients with upper gastrointestinal SELs. The correlation between the whitish core amount calculated by AMUS, length of the manually measured whitish cores (stereomicroscopically visible white core [SVWC]), and sample suitability for pathologic evaluation were analyzed. We identified 13 patients with gastrointestinal stromal tumors, five with leiomyomas, one with a schwannoma, and one with an ectopic pancreas. The histological diagnostic accuracy was 100%, median SVWC length was 9 mm, and median whitish core area, calculated using AMUS, was 10 mm2. SVWC length correlated with whitish core amount (ρ = 0.81, P < 0.01) and adequacy score (ρ = 0.54, P < 0.01). Whitish core amount correlated with adequacy score (ρ = 0.54, P < 0.01). The area under the receiver-operating characteristic curve calculated for whitish core amount with respect to the histological diagnosis was 0.83 (P < 0.01; cutoff ≥4 mm2, sensitivity 98.4%). AMUS, a simple on-site verification instrument, is an alternative to SIPS for determining the appropriate SEL tissue sampling quantity with high diagnostic accuracy.

Diagnostic value of endobronchial ultrasound elastography combined with rapid onsite cytological evaluation in endobronchial ultrasound-guided transbronchial needle aspiration

BackgroundEndobronchial ultrasound (EBUS) elastography has been used in EBUS-guided transbronchial needle aspiration (EBUS-TBNA) to identify malignant lymph nodes based on tissue stiffness. Rapid onsite cytological evaluation (ROSE) has been widely utilized for onsite evaluation of sample adequacy and for guiding sampling during EBUS-TBNA. The aim of this study was to investigate the diagnostic value of combined EBUS elastography and ROSE in evaluating mediastinal and hilar lymph node status.MethodsRetrospective chart review was performed from December 2018 to September 2020. Patient demographics, EBUS elastography scores, and ROSE, pathologic, and clinical outcome data were collected. The EBUS elastography scores were classified as follows: Type 1, predominantly nonblue; Type 2, partially blue and partially nonblue; and Type 3, predominantly blue. A receiver operating characteristic curve was used to compare the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for evaluation of malignant lymph nodes among the EBUS elastography, ROSE, and EBUS combined with ROSE groups.ResultsA total of 245 patients (345 lymph nodes) were included. The sensitivity and specificity of the EBUS elastography group for the diagnosis of malignant lymph nodes were 90.51% and 57.26%, respectively. The sensitivity and specificity in the ROSE group were 96.32% and 79.05%, respectively. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of EBUS elastography combined with ROSE were 86.61%, 92.65%, 11.78, and 0.14, respectively, and the area under the curve was 0.942.ConclusionsCombining EBUS elastography and ROSE significantly increased the diagnostic value of EBUS-TBNA in evaluating mediastinal and hilar lymph node status compared to each method alone.