Does On-Site Evaluation Improve the Diagnostic Yield of Fine Needle Aspiration Specimens?
William Shi, Pil Gyu Hwang, Norge Vergara, Gordon H Yu, Zubair W Baloch. Hospital of the University of Pennsylvania, Philadelphia, PA
Background: Fine-needle aspiration (FNA) has proven to be a safe, economical, accurate, and rapid diagnostic technique. Rapid on-site evaluation (ROSE) of FNA samples has been advocated as a guide for assessing the adequacy of FNA samples and to provide an effective triaging mechanism for additional studies. The intention of this study was to explore whether ROSE is effective in procuring adequate specimen for ancillary studies and improving the final diagnostic yield.
Design: The computerized pathology files at our institution were searched for all FNA cases performed between July 2011 and December 2011; the thyroid FNA cases were excluded as ROSE is performed in ≥99% of these cases. The collected data points included:location of site(s) sampled, on-site evaluation performed, preliminary on-site diagnosis rendered, final cytologic diagnosis, cell blocks, and ancillary studies performed.
Results: A total of 554 FNA specimens were reviewed and included in the study; of these 56 (10%) were lung FNA, 387 (70 %) lymph nodes, 51 (9 %) pancreas and 60 (11%) were from miscellaneous sites. ROSE was performed in 300 of 554 (54%) cases. A final diagnosis of malignancy was rendered in 137 of 300 (46%) and 48 of 254 (19%) cases with and without ROSE respectively. Adequate material for cell blocks and/or any necessary ancillary studies was obtained in 200 of 300 (61%) cases with ROSE (cell blocks 171, immunostains 51, flow cytometry 31; special stains 1, Molecular studies 13) and 201 of 254 (79 %) cases without ROSE (cell blocks 197, immunostains 18, flow cytometry 4; special stains 4; molecular studies 3). On final review, 5 of 300 ROSE cases (2 %) and 5 of 254 non-ROSE cases (2%) were non-diagnostic due to the lack of adequate specimen. Among the 29 cases considered inadequate by ROSE (29/300, 10%), only 4 were deemed non-diagnostic on final review; 1 case considered as adequate on ROSE was found to be non-diagnostic on final review.
Conclusions: ROSE can be beneficial in providing a preliminary diagnosis in cases with high clinical suspicion for malignancy which may lead to immediate management decisions; however, in cases with low clinical suspicion for malignancy it may be of minimal or no value in providing specimen adequacy assessment and improving diagnostic yield.
Category: Quality Assurance
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 292, Tuesday Morning