Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses.
BACKGROUND
Identification, staging, and fine needle aspiration of pancreatic mass lesions are probably the most technically demanding EUS skills. This study evaluated the effect of formal training on the diagnostic accuracy of EUS-guided fine needle aspiration (EUS-FNA) of pancreatic masses and the source of the variability in diagnostic accuracy between initial and later procedures.


METHODS
Sixty-five patients with pancreatic masses underwent EUS-FNA between April 1998 (introduction of EUS-FNA) and August 1999, 20 of whom were examined by 3 endosonographers without prior experience with EUS-FNA. The initial experience of these 3 endosonographers (April to December 1998; group A patients), which included a formal training period of 2 months, and their later experience (January to August 1999; group B patients) were evaluated. Final diagnoses were determined by surgical pathology or clinical follow-up. All EUS-FNA samples were reviewed by 4 blinded pathologists to determine the contribution of pathologist interpretation to varying EUS-FNA accuracy.


RESULTS
After a short training period, there was a significant improvement in EUS-FNA accuracy (33% vs. 91%; p = 0.004). After pathology review, good agreement was identified between original FNA interpretation and that on review (kappa = 0.78; 95% CI [0.5, 1.0]). There were differences between the mean cellularity score (2.8 vs. 1.8, p = 0.01) and mean number of passes (5.1 vs. 2.8, not significant) for correct versus incorrect FNA specimens.


CONCLUSIONS
Significant improvements in EUS-FNA accuracy can be achieved with a short period of mentored training. EUS-FNA errors during the initial learning phase are primarily due to inadequate specimens. Interpretation of pancreatic EUS-FNA specimens remained consistent before and after training.
Harewood
Gavin C
GC
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Wiersema
Lisa M
LM
Halling
Amy C
AC
Keeney
Gary L
GL
Salamao
Diva R
DR
Wiersema
Maurits J
MJ
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002983:Clinical Competence; D004493:Education; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008611:Mentors; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015397:Program Evaluation; D015203:Reproducibility of Results