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DOES AN ON-SITE CYTOTECHNOLOGIST IMPROVE THE ACCURACY OF ENDOSCOPIC ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION?
F Alsohaibani*, S Girgis**, G Sandha*
Departments of Medicine* and Pathology**, University of Alberta, Edmonton
BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the preferred modality for the cytological diagnosis of various cancers. On-site cytopathology interpretation is not available in most centres. The aim of this study was to determine whether the adequacy of tissue sampling assessed by an on-site cytotechnologist improves the diagnostic yield of EUS-FNA.
METHODS: This is a retrospective review of solid-mass EUS-FNA from 09/2005 - 08/2007. Group I (09/2005 – 08/2006) had cytology slides prepared by an endoscopy nurse. Group II (09/2006 – 08/2007) had cytology slides prepared, stained and assessed for adequacy of tissue sampling by a cytotechnologist in the endoscopy suite. The final cytopathological diagnosis (definitely positive, definitely negative or inconclusive) was compared between the two groups.
RESULTS: A total of 49 EUS-FNA were performed in 48 patients in Group I and 60 EUS-FNA in 56 patients in Group II. There were 50% females in both groups. Mean age was 65 years (range 23-84 years) in Group I and 61 years (range 26-86 years) in Group II. Pancreatic masses were the most common FNA target site in both groups (45% in Group I vs. 37% in Group II) followed by mediastinal lymph nodes and abdominal masses (25% and 18% in Group I vs. 27% and 22% in Group II, respectively). The total number of needle passes in Group I was 105 (mean 2.14/pt, range 1-5) vs. 158 in Group II (mean 2.63/pt, range 1-4). Final cytopathology was definite in 53% in Group I compared with 77% in Group II (p=0.01). The percentage of inconclusive diagnoses was 47% in Group I and 23% in Group II (p=0.001).
CONCLUSION: On-site cytotechnologist interpretation of adequacy of tissue sampling significantly improves the diagnostic yield of EUS-FNA. This appears independent of the total number of needle passes undertaken for tissue sampling.