title: Reliability of gross visual assessment of specimen adequacy during EUS-guided FNA of pancreatic masses.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Prospective, double-blind, controlled study.
  
  
  METHODS
  Academic tertiary-referral center with a high-volume EUS practice.
  
  
  METHODS
  Fifty-one patients with a suspected solid pancreatic mass who were undergoing planned EUS-FNA.
  
  
  METHODS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Gastroenterology Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Yume P
authors.initials: YP
authors.lastname: Nguyen
authors.forename: John T
authors.initials: JT
authors.lastname: Maple
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhang
authors.forename: Lourdes R
authors.initials: LR
authors.lastname: Ylagan
authors.forename: Jing
authors.initials: J
authors.lastname: Zhai
authors.forename: Cara
authors.initials: C
authors.lastname: Kohlmeier
authors.forename: Sreenivasa
authors.initials: S
authors.lastname: Jonnalagadda
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Early
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: Riad R
authors.initials: RR
authors.lastname: Azar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D004311:Double-Blind Method; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013048:Specimen Handling