title: Rapid on-site evaluation of endoscopic ultrasound core biopsy specimens has excellent specificity and positive predictive value for gastrointestinal lesions.
abstract: BACKGROUND
  Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) is a safe and effective way to sample lesions in the gastrointestinal tract. Rapid on-site specimen evaluation (ROSE) improves the accuracy of EUS-FNA. While data suggests that EUS with fine-needle biopsy (EUS-FNB) is effective, it remains unclear if ROSE is predictive of a final diagnosis when obtaining core specimens.
  
  
  OBJECTIVE
  The aim of this study was to investigate the utility of ROSE in achieving a final diagnosis for EUS-FNB core specimens.
  
  
  METHODS
  We evaluated 60 consecutive patients referred for EUS guided sampling of lesions within or adjacent to the gastrointestinal tract. All patients underwent EUS-FNB to evaluate the additive value of ROSE to the diagnostic accuracy of specimens obtained using a core biopsy needle. EUS-FNA was also performed in a majority of cases.
  
  
  RESULTS
  EUS-FNB was feasible in all 60 cases; on-site specimen adequacy and final diagnostic accuracy was 58 % [95 % confidence intervals (CI) 45.1-71.2] and 83 % (95 % CI 71.9-91.5), respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of ROSE for core biopsies were 65, 100, 100, and 39 %, respectively. On-site adequacy and diagnostic accuracy for EUS-FNA was 38 % (95 % CI 22.2-53.5) and 63 % (95 % CI 50.1-75.8), respectively. There were no significant complications.
  
  
  CONCLUSIONS
  EUS-FNB is safe, feasible, and effective. ROSE of the core biopsy provides excellent PPV; however, an inadequate ROSE appears to be of limited value. Further prospective studies are needed to assess the optimal handling and onsite processing of core specimens to determine whether ROSE is beneficial for EUS-FNB.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St. Claire, Chicago, IL 60611, USA.
authors.forename: Kumar
authors.initials: K
authors.lastname: Krishnan
authors.forename: Sharvari
authors.initials: S
authors.lastname: Dalal
authors.forename: Ritu
authors.initials: R
authors.lastname: Nayar
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000295:instrumentation; D015331:Cohort Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D016591:Histocytological Preparation Techniques; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity