Gastrointestinal Endoscopy
Volume 69, Issue 7 , Pages 1264-1270, June 2009

Reliability of gross visual assessment of specimen adequacy during EUS-guided FNA of pancreatic masses

Current affiliations: Gastroenterology Division (Y.P.N., S.S.J., D.S.E., S.A.E., R.R.A.), Department of Pathology (L.R.Y., J.Z.), Biostatistics (Q.Z.), Washington University School of Medicine, St. Louis, Missouri, Digestive Diseases and Nutrition Division (J.T.M.), University of Oklahoma Health, Sciences Center, Oklahoma City, Oklahoma, USA

Received 3 April 2008; accepted 21 August 2008. published online 25 February 2009.

St. Louis, Missouri, USA

Background

In many centers, on-site cytopathologists are not available during EUS-guided FNA (EUS-FNA) examinations. Often, endosonographers request that technologists assess the adequacy of FNA by gross inspection of the slides. To date, there has not been a study that assessed the accuracy of experienced technologists in predicting tissue sampling adequacy by gross inspection before cytologic staining.

Objectives

To assess a grading system used by cytotechnologists and EUS technologists during gross inspection of FNA slides in reliably predicting specimen adequacy compared with the final cytologic diagnoses.

Design

Prospective, double-blind, controlled study.

Setting

Academic tertiary-referral center with a high-volume EUS practice.

Patients

Fifty-one patients with a suspected solid pancreatic mass who were undergoing planned EUS-FNA.

Main Outcome Measurements

The degree of correlation in the assessment of specimen adequacy as exhibited by a weighted kappa statistic between 2 groups of technologists and a board-certified cytopathologist.

Results

FNA was performed in 37 cases with 234 individual slide specimens available for analysis. Only fair agreement was observed between cytotechnologists and EUS technologists versus final cytopathologic assessment of adequacy (kappa 0.20 and 0.19, respectively). The routine practice of 6 to 7 FNA passes yielded adequate tissue for assessment in 36 of 37 patients (97%).

Limitations

Interobserver variability, single center, and findings applicable only to solid pancreatic lesions.

Conclusions

Neither trained EUS technologists nor cytotechnologists were able to provide a reliable assessment of pancreatic-mass FNA adequacy by using gross visual inspection of the specimen on a slide. Rapid on-site cytopathology reduced the number of passes, ensured specimen adequacy, provided definitive diagnosis, and should be used in centers where available.

Abbreviations: EUS-FNA, EUS-guided FNA, EUS-TCB, EUS tru-cut biopsy

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 DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

 If you want to chat with an author of this article, you may contact him at razar@im.wustl.edu.

PII: S0016-5107(08)02485-1

doi:10.1016/j.gie.2008.08.030

Gastrointestinal Endoscopy
Volume 69, Issue 7 , Pages 1264-1270, June 2009

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