Dynamic telecytology compares favorably to rapid onsite evaluation of endoscopic ultrasound fine needle aspirates.
OBJECTIVE
Rapid onsite evaluation (ROSE) has been demonstrated to correlate with final cytologic interpretations and improves the diagnostic yield of endoscopic ultrasound (EUS)-fine needle aspiration (FNA); however, its availability is variable across centers. The aim of this prospective study was to evaluate whether remote telecytology can substitute for ROSE.


METHODS
Consecutive patients who underwent EUS-FNA for diverse indications at a high volume referral center were enrolled and all samples were prospectively evaluated by three methods. ROSE was performed by a cytopathologist in the procedure room; simultaneously dynamic telecytology was done by a different cytopathologist in a remote location at our institution. The third method, final cytologic interpretation in the laboratory, was the gold standard. Telecytology was performed using an Olympus microscope system (BX) which broadcasts live images over the Internet. Accuracy of telecytology and agreement with other methods were the principle outcome measurements.


RESULTS
Twenty-five consecutive samples were obtained from participants 40-87 years old (median age 63, 48 % male). There was 88 % agreement between telecytology and final cytology (p < 0.001) and 92 % agreement between ROSE and final cytology (p < 0.001). There was consistency between telecytology and ROSE (p value for McNemar's χ(2) = 1.0). Cohen's kappa for agreement for telecytology and ROSE was 0.80 (SE = 0.11), confirming favorable correlation.


CONCLUSIONS
Dynamic telecytology compares favorably to ROSE in the assessment of EUS acquired fine needle aspirates. If confirmed by larger trials, this system might obviate the need for onsite interpretation of EUS-FNA specimens.
Division of Gastroenterology, The University of Southern California, Los Angeles, CA, USA.
James L
JL
Buxbaum
Mohamad A
MA
Eloubeidi
Christianne J
CJ
Lane
Shyam
S
Varadarajulu
Ami
A
Linder
Amanda E
AE
Crowe
Darshana
D
Jhala
Nirag C
NC
Jhala
David R
DR
Crowe
Isam A
IA
Eltoum
D000307:Adrenal Gland Diseases / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003584:Cytological Techniques / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged