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Telecytology versus in-room Cytopathologist for Endoscopic Ultrasound Fine Needle Aspiration or Biopsy of Solid Pancreatic Lesions

Published:October 13, 2022DOI:https://doi.org/10.1016/j.gie.2022.10.015
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      Abstract

      Background and Aims

      Rapid On-Site-Evaluation (ROSE) with an in-room pathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing Endoscopic Ultrasound fine needle aspiration or biopsy (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and utilization of Telecytology (ROSE-T) to optimize clinical workflows, and to address social distancing mandates created during the COVID-19 pandemic. The purpose of this study is to compare diagnostic outcomes of ROSE-P and ROSE-T.

      Methods

      A single center cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. The primary outcome was overall diagnostic yield of cancer. All patients who underwent EUS-FNA were entered into a prospectively maintained database. Statistical analyses were performed using descriptive statistics and univariate analysis.

      Results

      There were 165 patients in each arm. There was no difference in diagnostic yield between ROSE-P and ROSE-T (96.4% vs 94.5%, p=.428). ROSE-T was associated with increased use of 22-gauge needles (p=.006) and more needle passes (p<.001). There was no significant difference in age, gender, lesion size, needle type, procedure times, or adverse events between the two groups (p<.05 for all). There were more pancreatic tail lesions sampled in the ROSE-P group (p<.001).

      Conclusion

      Rapid on-site evaluation using Telecytology was not associated with any difference in final histologic diagnosis for EUS-FNAB of solid pancreatic masses. This has important implications for optimizing clinical workflows.

      Keywords

      Acronyms:

      ROSE (Rapid On-Site Evaluation), ROSE-P (Rapid On-Site Evaluation with an in-room Cytopathologist), EUS-FNAB (Endoscopic Ultrasound Fine Needle Aspiration or Biopsy), ROSE-T (Rapid On-Site Evaluation utilizing Telecytology (remote Cytopathologist)), CT (Computed tomography), UCSF (University of California, San Francisco), ED (Emergency department), EHR (Electronic health record)
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