title: Telecytopathology for on-site adequacy evaluation decreases the nondiagnostic rate in endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions.
abstract: OBJECTIVE
  Advances in digital imaging methods have resulted in use of telecytology in the immediate assessment of fine-needle aspiration (FNA) specimens. We retrospectively compared the nondiagnostic rate for endoscopic ultrasound-guided (EUS) FNA of pancreatic lesions in two groups: one with on-site evaluation for adequacy via telecytopathology and the other without on-site adequacy evaluation.
  
  
  METHODS
  All patients undergoing EUS-FNA of pancreatic lesions over a 2-year period were included. Direct smears were immediately wet-fixed or air-dried, and any residual material was rinsed in saline for cell block or cytospin preparation. Patients were divided into two groups: Group 1 had on-site telecytopathology evaluation for adequacy by a cytopathologist, and Group 2 had no on-site adequacy evaluation. The cytologic diagnoses were reviewed, and the nondiagnostic rates for each group were calculated. The age, sex, and characteristics of pancreatic lesions (solid versus cystic) between the two groups were compared.
  
  
  RESULTS
  In total, 217 patients were included. Telecytopathology on-site evaluation was provided for 95 (43.8%) cases. There was no difference between the groups in terms of age and sex. Pancreatic lesions were predominantly solid in the group that underwent telecytopathology on-site evaluation (p<0.005). The nondiagnostic rates for solid lesions in Group 1 and Group 2 were 3.7% and 25.6%, respectively (p<0.0001). Although the nondiagnostic rate for cystic lesion was higher in Group 2, it did not reach a level of statistical significance (16.5% versus 7.1%; p=0.249). After adjusting for the effects of sex and lesion characteristics (solid versus cystic lesion) with multivariate logistic regression, the odds of having a nondiagnostic specimen in Group 2 was 6.9 times greater than in Group 1, and the result was statistically significant (p=0.0013).
  
  
  CONCLUSIONS
  Telecytopathology on-site evaluation of EUS-FNA of pancreatic lesions reduces the nondiagnostic rate, especially in lesions with solid characteristics, and may serve as an effective substitute for on-site evaluation by a cytopathologist.
authors.affiliation: 1 Department of Pathology, State University of New York , Syracuse, New York.
authors.forename: Kamal K
authors.initials: KK
authors.lastname: Khurana
authors.forename: Bella
authors.initials: B
authors.lastname: Graber
authors.forename: Dongliang
authors.initials: D
authors.lastname: Wang
authors.forename: Ajoy
authors.initials: A
authors.lastname: Roy
mesh_terms: D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000473:pathology*; D012189:Retrospective Studies; D019113:Telepathology / Q000379:methods*; D014584:User-Computer Interface
keywords: cytology; pancreas; telemedicine; telepathology