Utilization of Telecytopathology for Preliminary Diagnosis of Endoscopic Ultrasound (EUS)-Guided Fine Needle Aspiration (FNA) of Pancreas.
Rong Rong, Ajoy Roy, Kamal K Khurana. State University of New York, Upstate Medical University, Syracuse
Background: Onsite cytopathology interpretation is essential to improve the yield of EUS-guided FNA of pancreas. Distance and time constraints make onsite evaluation of EUS-guided pancreatic FNA time consuming. We evaluated a telepathology system for onsite-evaluation of EUS-guided pancreatic FNA.
Design: Real time images of Diff Quik stained cytology smears were obtained with an Olympus digital camera attached to an Olympus CX41 microscope. Cytopathologist accessing the dynamic images on a computer rendered preliminary diagnosis while communicating with the onsite operator over phone. Accuracy of preliminary diagnosis rendered via telepathology was compared with those procured by conventional on site assessment.
Results: A total of 110 EUS-guided-pancreatic FNAs were assessed for on-site preliminary diagnosis. Telecytopathology system and conventional microscopy were used to evaluate equal number of cases (55 each). Preliminary diagnoses of Negative/benign, atypical /suspicious and positive for malignancy were 69%, 7% and 24% for telecytopathology and 60%, 9% and 31% for conventional microscopy. The overall concordance between the preliminary and final diagnosis was 84% for telecytopathology and 87% for conventional microscopy. Of the nine discordant telecytopathology cases that were initially classified as benign, the final cytologic diagnosis included positive for malignancy (7 cases) and atypical cytology (2 cases). Conventional microscopy yielded 7 discordant cases with preliminary diagnosis of benign (5 cases) and atypical (2 cases). Final cytologic diagnosis on 5 benign cases included positive for malignancy (3 case) and atypical cytology (2 cases). Final cytology on 2 atypical cases was benign. Neuroendocrine neoplasms consisted of 31% of the total discrepant cases. Of the neuroendocrine neoplasms, telecytopathology missed 67% (4 of 6) of cases compared to (1 of 4) 25% missed on conventional microscopy.
Conclusions: Telecytopathology is comparable with conventional microscopy in accuracy of preliminary diagnosis during EUS-guided pancreatic FNA. Cytopathologist can make real time consultation from remote site and utilize time more efficiently. Neuroendocrine neoplasms prove to be diagnostically challenging for both telecytopathology and conventional microscopy. However the diagnostic accuracy for such cases is higher with conventional microscopy than telecytopathology.
Tuesday, March 1, 2011 2:30 PM
Platform Session: Section D, Tuesday Afternoon