title: Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists.
abstract: BACKGROUND
  Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with rapid on-site evaluation (ROSE) has been reported to provide a more accurate diagnosis than EUS-FNA without such evaluation. However, even endosonographers can evaluate ROSE regarding sample adequacy. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers compared to ROSE by cytopathologists in patients with solid pancreatic masses.
  
  
  METHODS
  Between September 2001 and October 2005, of the 73 EUS-FNA procedures with the final diagnoses, 38 procedures after the introduction of ROSE by endosonographers (September 2001-September 2003, period 1), and 35 procedures after the introduction of ROSE by cytopathologists (October 2003-October 2005, period 2) were included. The specimens were stained with Diff-Quik stain and assessed. When the on-site assessors (endosonographers or cytopathologists) indicated that the amounts of cell samples were adequate, the procedure was stopped.
  
  
  RESULTS
  Results are presented with 95% confidence limits. The average numbers of needle passes were 4.0 +/- 1.6 and 3.4 +/- 1.5 in periods 1 and 2, respectively (P = 0.06). The specimen collection rates were 97.4 and 97.1% in periods 1 and 2, respectively (P = 0.51). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy and benign were 92.9, 100, 100, 83.3, and 94.7%, respectively, in period 1, and 93.1, 100, 100, 75.0, and 94.3%, respectively, in period 2 (P = 0.97, P = 1.0, P = 1.0, P = 0.65, P = 0.93, respectively). No complications were seen.
  
  
  CONCLUSIONS
  For accurate diagnosis, ROSE should be performed during EUS-FNA by the endosonographer, if no cytopathologist is available.
authors.affiliation: Department of Internal Medicine II, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
authors.forename: Takuto
authors.initials: T
authors.lastname: Hikichi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Irisawa
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Takagi
authors.forename: Goro
authors.initials: G
authors.lastname: Shibukawa
authors.forename: Go
authors.initials: G
authors.lastname: Yamamoto
authors.forename: Takeru
authors.initials: T
authors.lastname: Wakatsuki
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Imamura
authors.forename: Yuta
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Ai
authors.initials: A
authors.lastname: Sato
authors.forename: Masaki
authors.initials: M
authors.lastname: Sato
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Ikeda
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tasaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Watanabe
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Ohira
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Obara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D003581:Cytodiagnosis / Q000379:methods; D016208:Databases, Factual; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity