title: Back to the roots - should gastroenterologists perform their own cytology?
abstract: BACKGROUND
  Onsite cytology is widely recommended to improve cytological results in endoscopic ultrasound fine-needle punctures. The question is how well a gastroenterologist can be trained to perform an immediate bedside cytology.
  
  
  METHODS
  From September 2008 to May 2011 157 endosonographic fine-needle punctures with a 22 G needle where performed in a municipal hospital. A medium amount of 26 loaded slides resulted from every puncture and air drying was used to preserve the specimen. 2 promising slides were kept whereas the remaining slides were sent on to a professional laboratory for final examination. The preliminary diagnosis was compared with the results from the professional cytologist for final evaluation.
  
  
  RESULTS
  152/157 fine-needle punctures were evaluable. In 6 cases the final result was regarded as uncertain. 73 malignant specimens and 73 benign specimens could be used for comparison. The gastroenterologist's evaluation achieved a sensitivity of 87.7 % and specificity of 90.4 % when the decision between a benign and malignant specimen was made. The specification of the tumour could not be done reliably by the gastroenterologist.
  
  
  CONCLUSIONS
  Doing a delayed onsite diagnosis of the specimen by a gastroenterologist can help to speed up the diagnostic process with reasonable certainty. However, it cannot replace a professional cytological diagnosis because of the possible misevaluation and the uncertainty in tumour specification. Additionally, advanced methods like immunocytology cannot be performed in an onsite hospital setting.
authors: Department of Internal Medicine II, Friedrich Schiller University, Jena, Germany. Michael.hocke@klinikummeiningen.de
authors: M
authors: M
authors: Hocke
authors: A
authors: A
authors: Ignee
authors: T
authors: T
authors: Topalidis
authors: C F
authors: CF
authors: Dietrich
mesh_terms: D044963:Biopsy, Fine-Needle; D003585:Cell Biology / Q000193:education*; D003299:Cooperative Behavior; D057210:Delayed Diagnosis; D004526:Efficiency; D016099:Endoscopy, Gastrointestinal; D005240:Feasibility Studies; D005762:Gastroenterology / Q000193:education*; D005767:Gastrointestinal Diseases / Q000473:pathology*; D005858:Germany; D006801:Humans; D007318:Inservice Training; D033183:Interdisciplinary Communication; D019095:Point-of-Care Systems; D018084:Ultrasonography, Interventional