Telecytology for On-Site Adequacy Evaluation Decreases the Nondiagnostic Rate in Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Lesions
Bella Graber, Ajoy Roy, Ronald D Szyjkowski, Kamal K Khurana. SUNY Upstate Medical University, Syracuse, NY
Background: In the recent years, the advances in digital methods in pathology have resulted in use of telecytology in the immediate assessment of fine needle aspiration specimens. We retrospectively compared the unsatisfactory rate for endoscopic ultrasound-guided (EUS) fine-needle aspiration (FNA) of pancreatic lesions in 2 situations: 1 with onsite telecytopathology evaluation and 1 without on-site evaluation.
Design: 216 consecutive adult patients underwent EUS FNA of pancreatic lesions. 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 2 groups - one with telecytopathology on-site adequacy evaluation and other without any onsite adequacy evaluation. For the group with telecytopathology on-site evaluation, real time images of Diff Quik stained cytology smears were obtained with an Olympus Digital camera attached to an Olympus CX41 microscope and transmitted via ethernet to a pathologist who rendered preliminary diagnosis while communicating with the on-site operator over the Vocera system. The cytologic diagnoses were reviewed and the nondiagnostic rates for each group were calculated.
Results: Telecytopathology on-site evaluation was provided for 95 cases with a nondiagnostic rate of 4.1% (4 of 95 cases). On-site evaluation was not provided for 121 cases with a nondiagnostic rate of 19.8% (24 of 121 cases). Final cytologic diagnosis of unsatisfactory, negative/benign, atypical /suspicious and positive for malignancy were 4.1%, 40%, 17.8% and 37.9% for telecytopathology group and 19.8%, 62.8%, 9% and 8.2% for the group without on-site adequacy evaluation. The nondiagnostic rates and the percentage yield of malignant and suspicious lesions between the two groups were statistically significant (P<0.005).
Conclusions: Telecytopathology onsite evaluation of EUS FNA of pancreatic lesions reduces the non-diagnostic rate and yields higher percentage of malignant and suspicious lesions compared with the group without any onsite evaluation.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 273, Wednesday Afternoon