title: Can endosonographers evaluate on-site cytologic adequacy? A comparison with cytotechnologists.
abstract: 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.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Pathology, Biostatistics Unit, Mayo Clinic, Jacksonville, Florida 32224, USA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Savoy
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Woodward
authors.forename: Kyung
authors.initials: K
authors.lastname: Noh
authors.forename: Surakit
authors.initials: S
authors.lastname: Pungpapong
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Jones
authors.forename: Julia
authors.initials: J
authors.lastname: Crook
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: 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