Rapid On-site Cytologic Evaluation Research Articles

Feasibility and accuracy of rapid on-site evaluation of touch imprint cytology during transbronchial biopsy.

BackgroundRapid on-site evaluation (ROSE) of cytologic material is widely performed because it provides clinicians with instant diagnostic information. However, the utility of ROSE of touch imprint cytology (ROSE-TIC) during transbronchial biopsy (TBB) remains unclear. The aim of this study was to evaluate the feasibility and accuracy of ROSE-TIC for TBB.MethodsA retrospective study was performed on patients who underwent diagnostic bronchoscopy combined with ROSE-TIC. The results of ROSE-TIC, diagnosed as either positive or negative for malignancy, were compared with the histological findings and final diagnosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The success rate of molecular testing on TBB specimens was also assessed.ResultsOverall, 460 patients underwent bronchoscopy with ROSE-TIC. Of these, 377 cases (82.0%) were malignant and 83 cases (18.0%) were non-malignant in the final diagnosis. Compared with the histological findings, ROSE-TIC showed sensitivity, specificity, PPV, NPV, and diagnostic accuracy values of 91.1%, 90.4%, 94.8%, 84.0%, and 90.9%, respectively. Compared with the final diagnosis, ROSE-TIC showed sensitivity, specificity, PPV, NPV, and diagnostic accuracy values of 75.3%, 91.6%, 97.6%, 45.0%, and 78.3%, respectively. Seven discordant cases (1.5%) were positive on ROSE-TIC and negative on final diagnosis. The success rates for molecular analysis from TBB samples were 96.6% for EGFR mutation, 87.3% for ALK rearrangement, 93.1% for ROS1 rearrangement, and 96.2% for PD-L1 expression.ConclusionsThe accuracy of ROSE-TIC is high. It can be useful for obtaining instant diagnosis, contributing to a high success rate of molecular analysis for targeted therapy.

What's new in endobronchial ultrasound for mediastinal staging?

The essential role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in lung cancer diagnosis and staging is now well established. With a growing body of evidence seen over the last decade, the objective of this article was to review the newest findings, provide evidence-based guidance to clinicians and identify areas for future research related to EBUS-TBNA and staging in lung cancer. Recent literature regarding EBUS-TBNA for lung cancer staging was reviewed, with a focus on evidence published subsequent to the 2016 guideline on technical aspects of EBUS-TBNA by the American College of Chest Physicians (ACCP). New findings were reported for the following: role of rapid on-site cytological evaluation (ROSE), needle size, lymph node ultrasound characteristics, molecular testing, as well as practice patterns and gaps in quality of care. Significant advances in EBUS-TBNA have been realized since the publication of the 2016 ACCP guideline. Future areas of investigation have been identified and will require collaboration between centers of expertise. Additional work will be required to translate these technological advances into improved value-based care in the lung cancer population.

Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology.

The need for appropriate specimen use for ancillary testing has become more commonplace in the practice of pathology. This, coupled with improvements in technology, often provides less invasive methods of testing, but presents new challenges to appropriate specimen collection and handling of these small specimens, including thoracic small biopsy and cytology samples. To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies. The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Core needle biopsy, touch preparation, fine-needle aspiration, and effusion specimens with thoracic diseases including malignancy, granulomatous process/sarcoidosis, and infection (eg, tuberculosis) were deemed within scope. Ancillary studies included immunohistochemistry and immunocytochemistry, fluorescence in situ hybridization, mutational analysis, flow cytometry, cytogenetics, and microbiologic studies routinely performed in the clinical pathology laboratory. The use of rapid on-site evaluation was also covered. Sixteen guideline statements were developed to assist clinicians and pathologists in collecting and processing thoracic small biopsy and cytology tissue samples. Based on the systematic review and expert panel consensus, thoracic small specimens can be handled and processed to perform downstream testing (eg, molecular markers, immunohistochemical biomarkers), core needle and fine-needle techniques can provide appropriate cytologic and histologic specimens for ancillary studies, and rapid on-site cytologic evaluation remains helpful in appropriate triage, handling, and processing of specimens.

Evaluating Yield of 19 Versus 21 G EBUS-TBNA Needles: A Prospective Study.

Controversy remains regarding the effect of needle size on the diagnostic yield of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration. We conducted a prospective study comparing the diagnostic yield of 19 and 21 G EBUS needles and hypothesized that the 19 G have a greater EBUS-guided transbronchial needle aspiration diagnostic yield as compared with the 21 G needle. A total of 60 patients undergoing EBUS-guided transbronchial needle aspiration were enrolled with informed consent. Both 19 and 21 G needles were used at each lymph node station in alternating fashion, we randomized which needle, to begin with. Two rapid on-site cytology evaluation stations were present and assigned to one of the 2 needles. They reported sample adequacy and prepared a separate cell block per lymph node sampled for their assigned needle. A total of 141 lymph nodes were analyzed. Diagnosis included 69 benign lymph nodes, 47 malignant lymph nodes, 22 noncaseating granulomas, and 3 infected lymph nodes. Five hundred seventy-three passes (average: 4.1 passes/lymph node) were done with 19 G and 581 passes with 21 G needles (average: 4.1 passes/lymph node). Diagnostic yield was similar between 19 and 21 G needles overall (89.4% vs. 88.7%, P=0.71). The 19 G needles showed higher smear cellularity (32.6% vs. 13.0%, P=0.05), and rapid on-site cytology evaluation adequacy (84.8% vs. 63.0%, P=0.004) in lymph nodes with cancer diagnosis. In 7 of the 141 lymph nodes, samples from only one of the needles provided the final diagnosis. There is no difference in the overall diagnostic yield between 19 and 21 G needles. Further studies are needed to confirm the trend of the superiority of 19 G in cancerous lymph nodes.

Rapid on-site cytologic evaluation by pulmonologist improved diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy

Rapid on-site cytologic evaluation (ROSE) has been shown to improve the diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB). However, ROSE by a cytopathologist or cytotechnologist is not always available during the procedure. The purposes of this study were to verify that a pulmonologist, after receiving training in cytology, could accurately assess an EBUS-TBB specimen on-site, and to evaluate the contribution of ROSE to EBUS-TBB. A retrospective chart review of patients who underwent EBUS-TBB for diagnosis of peripheral pulmonary lesions (PPLs) from January 2014 to June 2017 was performed. PPLs without a malignant diagnosis were excluded. The ROSE result determined by a pulmonologist was compared to the formal imprint cytologic report and pathologic report. The diagnostic accuracy of EBUS-TBB was also compared between those with and without ROSE. Two hundred ninety-three patients who underwent 336 EBUS-TBB procedures for PPL diagnosis and were found to have proven malignancy were enrolled. Eighty-six procedures were performed with ROSE. With the formal imprint cytologic diagnosis as the standard, ROSE had 96.9% sensitivity, 68.2% specificity, 89.9% positive predictive value (PPV), 88.2% negative predictive value (NPV), and 89.5% diagnostic accuracy. With the formal pathologic result as the standard, ROSE had 88.2% sensitivity, 80% specificity, 97.1% PPV, 47.1% NPV, and 87.2% diagnostic accuracy, respectively. The diagnostic accuracy was significantly higher when ROSE was performed during EBUS-TBB (88.4% vs 68.0%, P<0.001). A trained pulmonologist can interpret adequately cytologic smears on-site and effectively improve the accuracy of EBUS-TBB in the diagnosis of PPLs.

Introduction to Pancreatic Pathology and Fine-Needle Aspiration Cytology.

This introductory chapter discusses the demographics of pancreatic tumors and the risk factors associated with pancreatic neoplasms. The WHO 2019 classification of pancreatic epithelial tumors and WHO 2017 classification of pancreatic neuroendocrine neoplasms is provided. The current role of fine-needle aspiration (FNA) in the pancreatic lesions, different radiographic modalities and their evolution in the FNA of pancreatic lesions, and utility of rapid on-site evaluation of pancreatic cytology is also discussed. Guidelines on pancreatic pathology provided by the Papanicolaou Society of Cytopathology (PSC) in 2014 are summarized. These guidelines, which are provided by experts in the field, establish recommendations for clinical follow-up, indications, and preprocedural studies for pancreatic FNA, different techniques of pancreatic FNA, postprocedural follow-up, treatment options for different pancreatobiliary lesions, and utilization of ancillary studies for cytological diagnosis of pancreatic lesions. Standardization of the terminology and nomenclature and the diagnostic categories provided by the PSC are also discussed. Lastly, an algorithmic approach to cytological evaluation of pancreatic masses is provided.

Design of a prospective, multicenter, and cohort study of an innovative electromagnetic navigation bronchoscopy in diagnosing pulmonary nodules among Chinese population.

Electromagnetic navigation bronchoscopy (ENB) has been demonstrated to increase the diagnostic yield of peripheral pulmonary lesions. We designed two prospective clinical trials using an innovative ENB system that can combine with both thick and thin bronchoscope, including a randomized controlled clinical study to assess the usefulness of the ENB system and a real-world study to explore the optimal way to use this system. Patients with peripheral pulmonary nodules (PPNs) suspicious of lung cancer with the long diameter more than 8 mm and no more than 30 mm will be enrolled in the study. A total of 400 patients will be enrolled in the randomized controlled clinical study and randomly divided into two groups, endobronchial ultrasound (EBUS) combined with guide sheath (GS) with or without ENB. The real-world study is a single arm and observational study, at least 750 subjects will be enrolled in the study. ENB combined with or without other guided bronchoscopy techniques, fluoroscopy, and rapid on-site cytologic evaluation (ROSE) will be performed according to the judgment of the operator. The primary endpoint of the two studies is the diagnostic yield of ENB in diagnosing PPNs. The secondary endpoint includes the diagnostic yields for malignant and benign diseases, navigation time, time for finding lesions, total operation time, complication rate, etc. Enrollment for the study began in July 2018 and is currently in progress. With up to 1,150 subjects estimated to be enrolled, the study will provide evidence on the usage of the novel ENB system in diagnosing PPNs.

Feasibility of rapid on-site cytological evaluation of lung cancer by a trained pulmonologist during bronchoscopy examination.

Rapid on-site cytological evaluation (ROSE) in bronchoscopy is a useful ancillary technique. ROSE is usually performed by a cytopathologist or cytotechnologist. However, because of staff shortages and reduced availability, ROSE cannot be performed in every hospital. We aimed to evaluate the accuracy of ROSE when performed by a trained pulmonologist, comparing the diagnosis results with the final diagnosis of cytopathologists. We performed a retrospective cohort study on 125 patients who underwent bronchoscopy with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary lesions by conventional bronchoscopy at Sapporo Medical University Hospital between March 2012 and September 2018. ROSE was performed by a pulmonologist who was trained by a cytotechnologist for a total of 1 month. DiffQuik® staining for ROSE was used to prepare cytology slides. The results of ROSE were compared with the final diagnosis obtained using Papanicolaou staining by cytopathologists. In all procedures, the sensitivity, specificity and diagnostic accuracy of ROSE were 88.5%, 83.0% and 86.4%, respectively. There was no significant difference in the sensitivity, specificity, positive predictive value, negative predictive value or accuracy between EBUS-TBNA and EBUS-GS. ROSE of lung cancer by a trained pulmonologist can be highly accurate and deemed as feasible and useful for not only EBUS-TBNA but also EBUS-GS.

2165 Endoscopic Ultrasound-Guided Fine-Needle Biopsy (FNB) of a Liver Lesion Demonstrating Metastatic Esophageal Adenocarcinoma

INTRODUCTION: The role of biopsy in determining the etiology of hepatic lesions is crucial in determining pathology and potential therapy. Liver biopsies are often accomplished with the aid of interventional radiology with a percutaneous approach. However, there are instances when a percutaneous approach is not feasible. Here, we present a patient who underwent an endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) of a left lobe hepatic lesion which demonstrated metastatic esophageal adenocarcinoma. CASE DESCRIPTION/METHODS: A 76 year-old man with a history of esophageal adenocarcinoma, who previously underwent treatment with neoadjuvant chemoradiation and surgical resection 3 years earlier, was found on routine surveillance CT imaging to have a lesion within the left lobe of his liver. He subsequently underwent a PET CT that demonstrated this lesion to be FDG avid without any other evidence of FDG avidity (Figure 1). Interventional radiology was initially consulted for liver biopsy, however due to a poor window for access this could not be performed. He subsequently was referred for an EUS-guided FNB. EUS demonstrated a round to oval shaped, irregular mass within the left lobe of the liver. The mass was hypoechoic and heterogeneous with central spiculation. The mass measured 43 mm by 33 mm in maximal cross-sectional diameter. Color Doppler imaging was used prior to needle puncture to confirm a lack of significant vascular structures within the needle path. Fine needle aspiration for cytology was performed. Three passes were made with a 22-gauge FNB needle (Acquire™ 22ga) using a trans-gastric approach (1 pass for cytology touch prep, and 2 core biopsy samples for surgical pathology) (Figure 2). Preliminary rapid on-site cytological evaluation (ROSE) was suspicious for malignancy, with final specimen demonstrating adenocarcinoma. Surgical pathology from the core biopsy was reviewed and a diagnosis of metastatic adenocarcinoma, moderately differentiated, morphologically compatible with esophageal adenocarcinoma was rendered (Figure 3). DISCUSSION: This case demonstrates the utility and feasibility of an EUS-guided liver biopsy when a percutaneous approach is not possible to help make a diagnosis and direct therapy.

On-site stereomicroscope quality evaluations to estimate white core cutoff lengths using EUS-FNA biopsy sampling with 22-gauge needles

Although rapid on-site cytologic evaluation (ROSE) during EUS-guided FNA biopsy (EUS-FNAB) sampling may improve accuracy of pathologic analyses, cytopathologists are not widely available. We calculated the cutoff lengths required for accurate pathologic diagnoses from stereomicroscopically visible white cores (SVWCs) sampled using 22-gauge needles. Overall, 118 patients with mediastinal or upper abdominal solid masses requiring pathologic diagnoses were included. EUS-FNAB sampling was performed using 22-gauge needles. SVWCs were isolated and measured using stereomicroscopy, and the utility of calculated cutoff lengths in diagnosis was investigated. The procedure success and SVWC sampling rates were both 100%, and the median SVWC length was 10mm. Pathologic examination identified 75, 31, and 12 patients with pancreatic neoplasms (PNs), subepithelial lesions (SELs), and other lesions, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosing malignancy using EUS-FNAB sampling were 93.1%, 100%, 100%, 69.6%, and 94%, respectively. The final diagnostic accuracy in the entire cohort, PNs, and SELs was 92.4%, 90.7%, and 93.5%, respectively. Receiver operating characteristic curves demonstrated the overall SVWC cutoff length to be 11mm (11mm for PNs, 3.5mm for SELs). The overall sensitivity according to SVWC cutoff length was 91.4% (87.6% for PNs, 98.8% for SELs). Compared with cutoff length, multivariate analysis confirmed SVWC length to be a stronger independent factor for tissue diagnosis in both groups. Diagnosis improved significantly with SVWC cutoff lengths≥11mm. This may be a useful index forendoscopists, particularly where ROSE is unavailable. (Clinical trial registration number: UMIN000023013.).

Diagnostic Yield and Therapeutic Advantages of Rapid On-site Cytological Evaluation (ROSE) for Renal Masses

Diagnostic Yield and Therapeutic Advantages of Rapid On-site Cytological Evaluation (ROSE) for Renal Masses

Metagenomic next-generation sequencing diagnosis of peripheral pulmonary infectious lesions through virtual navigation, radial EBUS, ultrathin bronchoscopy, and ROSE.

ObjectiveTo evaluate the efficacy of combined rapid on-site evaluation of cytology (ROSE), ultrathin bronchoscopy, virtual bronchoscopic navigation, radial endobronchial ultrasound (EBUS), and metagenomic next-generation sequencing (mNGS) for diagnosis of peripheral pulmonary infectious lesions.MethodsSpecimens from patients with peripheral lung infection were obtained by transbronchial lung biopsy (TBLB) and bronchoalveolar lavage (BAL), and mNGS was used to detect pathogenic microorganisms. The sensitivity and specificity of mNGS were compared between TBLB tissue and BAL fluid.ResultsThe most common pathogens of pulmonary infectious lesions in this study were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. The specificity of mNGS was higher in TBLB tissue than in BAL fluid, but mNGS of BAL fluid had higher sensitivity.ConclusionsThe combination of ROSE, ultrathin bronchoscopy, virtual bronchoscopic navigation, radial EBUS, and mNGS technology yielded high efficacy for the diagnosis of peripheral pulmonary infectious lesions. TBLB and BAL specimens have respective advantages in specificity and sensitivity for mNGS analysis.

Comparison of tissue and molecular yield between fine-needle biopsy (FNB) and fine-needle aspiration (FNA): a randomized study

Background and study aims Recently, a new Franseen design endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle was developed with the goal of providing more tissue for histology. We compared the tissue adequacy rate and nucleic acid yield of 22G EUS-FNB vs. 22G endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), in solid gastrointestinal and extra-intestinal lesions. Patients and methods We conducted a randomized crossover study and recruited 36 patients. We performed three passes for pancreatic lesions and two passes for other lesions, using each needle. We blinded the pathologist to needle assignment. We assessed the diagnostic tissue adequacy rate and compared the total tissue area, diagnostic tissue area, and desmoplastic stroma (DS) area in cases of carcinoma. We also examined the nucleic acid yield of the two needles in pancreatic lesions. Results The lesions included 20 pancreatic masses (55 %), six gastric subepithelial lesions (17 %), five lymph nodes (14 %) and five other abdominal masses (14 %). Mean ± SD lesion size was 3.8 ± 2.0 cm. The final diagnosis was malignant in 27 lesions (75 %) and benign in nine lesions (25 %). We found EUS-FNB procured significantly more median total tissue area (5.2 mm 2 vs. 1.9 mm 2 , P < 0.001), diagnostic tissue area (2.2 mm 2 vs. 0.9 mm 2 , P = 0.029), and DS area (2 mm 2 vs. 0.1 mm 2 , P = 0.001) in lesions diagnosed as carcinoma (n = 23), as compared to EUS-FNA. In pancreatic lesions, EUS-FNB obtained significantly more nucleic acid than EUS-FNA (median; 4,085 ng vs. 2912 ng, P = 0.02). There was no difference in the cellblock or rapid on-site cytological evaluation (ROSE) diagnostic yield between the needles. Conclusion The 22G EUS-FNB provides more histological core tissue and adequate nucleic acid yield compared to 22G EUS-FNA. In this study, the diagnostic performance was similar between the needles

The impact of macroscopic on-site evaluation using filter paper in EUS-guided fine-needle biopsy.

Background and Objectives:EUS-guided tissue acquisition with rapid on-site cytologic evaluation (ROSE) has been used to increase the diagnostic yield. However, ROSE is not available in many centers. To date, only a few studies have assessed the adequacy of histologic cores in macroscopic on-site evaluation (MOSE) during EUS-guided fine-needle biopsy (EUS-FNB). Blood contamination of histologic core specimens lowers the sample quality and the diagnostic yield. Therefore, we evaluated the efficacy of MOSE using filter paper to increase the adequacy of histologic core specimens while minimizing blood contamination.Materials and Methods:Seventy-nine consecutive patients with an intraabdominal mass underwent EUS-FNB between March 2017 and October 2018. Histologic specimens obtained using EUS-FNB were expelled onto filter paper, and the histologic procurement rate on MOSE was evaluated.Results:EUS-FNB using a 20-gauge Procore needle or a 22-gauge Acquire needle was successful in all patients. The mean number of needle passes was 2.8 ss0.8. Visible histologic cores were observed in 94.9% (75/79) of the patients. Blood-contaminated specimens with scanty histologic cores were obtained in 5.1% (4/79) of the patients. On microscopic examination, 92.4% (73/79) of the histologic samples were graded as optimal. The diagnostic accuracy, sensitivity, and specificity were 94.5%, 94.3%, and 100%, respectively. Mild postprocedural adverse events occurred in 2 patients (2.5%: n = 1, transient fever; n = 1, acute pancreatitis).Conclusions:MOSE using filter paper provided adequate histologic samples while minimizing blood contamination. MOSE can also increase the diagnostic accuracy when ROSE is not available.

Utility of rapid on-site cytologic evaluation with endoscopic ultrasound-guided fine needle aspiration for pancreatic solid tumors and the role of cytotechnologists in this diagnostic method

Utility of rapid on-site cytologic evaluation with endoscopic ultrasound-guided fine needle aspiration for pancreatic solid tumors and the role of cytotechnologists in this diagnostic method

Diagnostic Yield of a Conventional Endoscopic Ultrasound-Fine Needle Aspiration (EUS-FNA) and Two Endoscopic Ultrasound-Fine Needle Biopsy (EUS-FNB) Needles: A Single-Center, Retrospective Study

Introduction: EUS-FNA is considered to be the standard approach to sample solid lesions adjacent to the gastrointestinal tract. EUS-FNB needles have been gaining widespread popularity due to the increase in diagnostic yield associated with these needles. Aim: To evaluate and compare the diagnostic yield of the solid lesions sampled using an FNA (Echtotip Ultra® (EC), Cook Medical, IN, USA) and two FNB (Acquire ® (AC), Boston Scientific, MA, USA and Shark-Core (SC), Medtronic, CA, USA) needles. Methods: A retrospective review of consecutive patients undergoing an index EUS procedure for evaluation of a solid lesion by single provider with experience of over 1000 EUS procedures was performed. Demographic and procedure related data including location, lesion size, anesthesia type, needle type number of passes, presence of rapid onsite cytologic evaluation (ROSE), diagnostic yield, adverse events and final diagnosis was collected. Statistical analysis of the obtained data set was performed using Stata 15.1. Chi square and Logistic regression analysis was performed. Results: A total of 329 lesions were sampled between July 2016 and May 2018 (Table 1). The overall diagnostic yield was 93.6%. The diagnostic yield of the EC needle was significantly lower than both the SC and AC needles (86.2 vs 96 and 94.9% respectively). The diagnostic yield for lesions assessed using more than one needle in the same procedure (due to non-diagnostic yield with the first needle) was 100% however statistical significance. The odds of obtaining a higher yield with SC compared to EC was 3.7 (p=0.034) however the odds did not reach statistical significance for the AC needle compared to the EC needle. (OR 3.4, p=0.053). Conclusion: EUS-FNB needles had an overall better diagnostic yield than the EUS-FNA needle however only the diagnostic yield with the SharkCore ® EUS-FNB needle reached statistical significance while there was a trend towards a higher diagnostic yield with the Acquire ® EUS-FNB. There was no difference in diagnostic yield between the two EUS-FNB needles. Although not statistically significant due to a small sample size, an approach of switching to a second needle was associated with a diagnostic yield of 100%.796_A Figure 1. Demographic and procedure related data796_B Figure 2. Diagnostic yield based on needle type and site of lesion

EUS-Guided FNA Biopsy of Solid Pancreatic Lesions: A Review of 111 Cases and Comparative Study of Diff-Quik/PAP/Thin Prep Staining Techniques

Background: Pancreatic cancer is the fourth leading cause of cancer associated deaths in the United States and ranks ninth in its incidence. EUS-guided FNA cytology has emerged as an important diagnostic tool since Vilman and Grimm (1992) made the first reports of endoscopic guided fine needle aspiration. Currently, EUS-guided FNA biopsy of the pancreas is a standard practice for the diagnosis and staging of pancreatic malignancy. Aim: The current study was carried out with the following objectives. 1. To find out the diagnostic accuracy, sensitivity, and specificity of EUS-guided FNA of the pancreatic malignancy by correlating cytologic diagnosis with histologic diagnosis and other investigations. 2. To know the diagnostic accuracy of air-dried smears using Diff-Quik Stain. 3. To compare the diagnosis obtained by Diff-Quik, conventional PAP Stain smears/cytospin preparation and Thin Prep (liquid-based media). Methods: 111 cases of EUS-guided FNA biopsy of the pancreas performed during the year January 2008 to December 2009 having solid pancreatic mass/lesion on the USG/CT and suspicious for the malignancy or malignant on clinical and radiologic investigations were reviewed in August 2011 at the Department of Pathology and Laboratory Medicine, Hospital of University of Pennsylvania. Results: There was an 83.9% correlation between Diff-Quick diagnosis and the final cytologic diagnosis. The overall diagnostic accuracy for the malignancy was 89.7%, sensitivity 90.6%, and specificity 100% of the cases where the cytologic diagnosis was correlated with histologic diagnosis and the other investigations. The positive predictive value for the malignancy was 100%. The false negative diagnosis was encountered in 10.3% cases. 51% of the cases showed intranuclear vacuoles, in the malignant cases on Diff-Quik stain. Conclusion: EUS FNA of the pancreas is a safe and reliable technique with high diagnostic accuracy, sensitivity, and specificity. The Diff-Quik stain smear is a useful technique for the rapid on-site cytologic evaluation for the detection of malignancy of the pancreas. Thin Prep was found superior to the PAP/Diff-Quik stain for the diagnosis of the malignancy. The EUS FNA samples processed by multiple staining techniques help to improve the diagnostic accuracy and sensitivity.

Utility of Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Malignant and Nonmalignant Disease

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate procedure to sample mediastinal tissue. Rapid on-site cytologic evaluation (ROSE) has been advocated to improve the performance of this procedure, but its benefit remains controversial. Our objective is to assess the utility of ROSE for EBUS-TBNA diagnostic accuracy among unselected patients. Methods: We prospectively collected data from all consecutive EBUS-TBNA procedures performed between 2008 and 2014. ROSE was introduced since 2011 in our daily practice. The accuracy of EBUS-TBNA with and without ROSE was compared in a univariate and multivariate model accounting for confounding factors. The impact of ROSE was then analyzed according to the etiology and size of the lesions. Results: Among 348 EBUS-TBNA procedures analyzed, 213 were performed with ROSE. The overall accuracy tended to be better with ROSE than without (90.6 vs. 84.4%; p = 0.082). After adjustment in a multivariate model, the benefit of ROSE still did not reach statistical significance (adjusted odds ratio 1.86; 95% confidence interval 0.79–4.41). Similar results were obtained in subgroups of patients with malignant disease or sarcoidosis. The size of the lesion did not influence the impact of ROSE on accuracy. Conclusions: ROSE was associated with a moderate increase in the accuracy of EBUS-TBNA, but the difference was not statistically significant. The same effect of ROSE was observed in malignant and nonmalignant lesions and this effect was not influenced by the lesion’s size.

Utility of rapid onsite evaluation of touch imprint cytology from endoscopic and cholangioscopic forceps biopsy sampling (with video)

Rapid onsite evaluation of touch imprint cytology (ROSE-TIC) is a simple and rapid method used for the diagnosis of benign and malignant lesions. We evaluated the diagnostic accuracy of ROSE-TIC for advanced intestinal luminal and indeterminate pancreatobiliary lesions during endoscopy. This is a retrospective descriptive study of patients who underwent endoscopy or ERCP between January 1, 2014 and December 31, 2016. It included patients who were referred for the treatment of intestinal luminal lesions or evaluation of indeterminate pancreatobiliary lesions. The slides were prepared by gently touching the specimen onto a glass slide and were examined under the microscope. The main outcome measure was to determine the diagnostic accuracy of ROSE-TIC by comparing the onsite cytology findings with the corresponding off-site histologic diagnosis. All 222 patients (106 pancreatobiliary and 116 GI lesions) had a prior benign diagnosis of intestinal luminal lesions or indeterminate diagnosis of pancreatobiliary lesions. The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ROSE-TIC were 97%, 85%, 83%, 97.2%, and 90%, respectively. The accuracy varied with the site of the biopsy sample. The accuracy was lowest for upper GI tract, where it was 85.2% but was 95% for lower GI tract lesions. By establishing a rapid onsite diagnosis, ROSE-TIC expedites decision-making on patient management. Prospective studies are needed to confirm these preliminary findings.

A multicenter evaluation of a new EUS core biopsy needle: Experience in 200 patients

Background and Objectives:We present a multicenter study of a new endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle (Acquire, Boston Scientific, Natick, MA). The aim of the study was to analyze the needle's clinical performance when sampling solid lesions and to assess the safety of this device.Methods:We performed a multicenter retrospective study of patients undergoing EUS-FNB during July 1–November 15, 2016.Results:Two hundred patients (121 males and 79 females) underwent EUS-FNB of solid lesions with the Acquire needle. Lesions included solid pancreatic masses (n = 109), adenopathy (n = 45), submucosal lesions (n = 34), cholangiocarcinoma (n = 8), liver lesions (n = 6), and other (n = 8). Mean lesion size was 30.6 mm (range: 3–100 mm). The mean number of passes per target lesion was 3 (range: 1–7). Rapid onsite cytologic evaluation (ROSE) by a cytologist was performed in all cases. Tissue obtained by EUS-FNB was adequate for evaluation and diagnosis by ROSE in 197/200 cases (98.5%). Data regarding the presence or absence of a core of tissue obtained after EUS-FNB were available in 145/200 procedures. In 131/145 (90%) of cases, a core of tissue was obtained. Thirteen out of 200 patients (6.5%) underwent some form of repeat EUS-based tissue acquisition after EUS-FNB with the Acquire needle. There were no adverse events.Conclusion:Overall, this study showed a high rate of tissue adequacy and production of a tissue core with this device with no adverse events seen in 200 patients. Comparative studies of different FNB needles are warranted in the future to help identify which needle type and size is ideal in different clinical settings.