Can endosonographers evaluate on-site cytologic adequacy? A comparison with cytotechnologists.
BACKGROUND
On-site determination of cytologic adequacy increases the accuracy of EUS-guided FNA (EUS-FNA); however, on-site cytotechnologists are not available to all endosonographers. We hypothesize that experienced endosonographers can accurately assess whether an on-site FNA specimen is adequate.


OBJECTIVE
To determine the accuracy of on-site cytopathology interpretation of EUS-FNA specimens by comparing endosonographers with a cytotechnologist.


METHODS
Prospective double-blind controlled trial.


METHODS
Academic medical center with a high-volume EUS practice.


METHODS
Consecutive patients undergoing EUS-FNA of lymph nodes or pancreas tumors.


METHODS
Accuracy, sensitivity, and specificity of 3 endosonographers and 1 cytotechnologist for interpretation of cytologic specimen adequacy and diagnosis compared with a criterion standard of a board-certified cytopathologist.


RESULTS
There were 59 lymph node, 49 pancreas, and 9 liver specimens (117 total). For determination of adequacy, none of the endosonographers were statistically equivalent to the cytotechnologist (P=.004). For determination of suspicious/malignant versus benign specimens, all 3 endosonographers were inferior (P<.001) to the cytotechnologist.


CONCLUSIONS
This study represents a small group of trained endosonographers in a high-volume practice and may not be applicable to other settings. The sample size does not allow an accurate evaluation of different biopsy sites (eg, pancreas vs lymph node).


CONCLUSIONS
Even trained endosonographers have variable and, in some cases, inferior abilities to interpret on-site cytologic adequacy compared with cytotechnologists.
Savoy
Alan D
AD
Division of Gastroenterology and Hepatology, Department of Pathology, Biostatistics Unit, Mayo Clinic, Jacksonville, Florida 32224, USA.
Raimondo
Massimo
M
Woodward
Timothy A
TA
Noh
Kyung
K
Pungpapong
Surakit
S
Jones
Arthur D
AD
Crook
Julia
J
Wallace
Michael B
MB
D044963:Biopsy, Fine-Needle / Q000379:methods; D002983:Clinical Competence; D003584:Cytological Techniques / Q000379:methods; D003937:Diagnosis, Differential; D004311:Double-Blind Method; D019160:Endosonography / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity