[346] Rapid On-Site Cytologic Evaluation (ROSE) of Endoscopic Ultrasound-Guided Fine Needle Aspirations (EUS-FNAs): A Tale of Two Institutions

Kathriel J Brister, Kavitha Rao, VanderLaan Paul, Marotti Jonathan, Wang Helen. Beth Israel Deaconess Medical Center, Boston, MA; Dartmouth-Hitchcock Medical Center, Lebanon, NH

Background: ROSE is generally considered to improve diagnostic yield of EUS-FNAs. We investigated the use of ROSE on EUS-FNA procedures at two academic medical centers (“MCA” and “MCB”). At MCA, ROSE is rarely performed on EUS-FNAs, while ROSE is performed on almost all EUS-FNAs at MCB. The purpose of this study is to determine the impact of ROSE on EUS-FNA outcome by comparing experiences at MCA and MCB.
Design: A retrospective review of all EUS-FNAs accessioned between 8/2011-8/2012 at MCA and MCB was performed. Electronic medical records were reviewed for performance of ROSE, procedure time, number of repeat procedures, and final diagnoses. Statistical significance of difference was determined by t test for continuous variables and by chi-square for categorical variables.
Results:

Data
VariableInstitutionP-value
 MCAMCB 
Procedure #302114 
Repeat procedures31 (10%)5 (4%)0.06
Patient #271109 
Lesion Sampled <0.001
Pancreas only159 (53%)94 (82%) 
Lymph nodes only111 (37%)12 (11%) 
Both31 (10%)8 (7%) 
ROSE done16 (5%)106 (93%)<0.001
Average procedure time in minutes37 (2-80)53 (22-137)<0.0001
Average procedure time if pancreas only was sampled36 (2-80)51 (22-127)<0.0001
Average procedure time if lymph node only was sampled38 (13-67)60 (42-137)<0.0001
Average procedure time if both were sampled40 (22-80)66 (47-89)0.0002
Average procedure time if 1 site was sampled37 (2-80)51 (22-137)<0.0001
Average procedure time if ≥ 2 sites were sampled40 (22-80)66 (37-89)<0.0001
Final diagnosis of each procedure  <0.001
Non-diagnostic/negative124 (42%)19 (17%) 
Atypical42 (14%)3 (3%) 
Suspicious25 (8%)2 (2%) 
Positive111 (37%)90 (79%) 


While only 5% of all procedures at MCA underwent ROSE, 69% of MCA's ROSEs were performed on repeat procedures (35% of repeat procedures at MCA underwent ROSE). However, upon repeat procedure at MCA, the positive rate was approximately the same as the overall rate (35% vs 37%). The positive rate of those procedures with ROSE at MCA was 44% vs 36% without ROSE (P = 0.55). This indicates that the relatively low overall positive rate at MCA (37%) is not likely due to lack of ROSE.
Conclusions: Although it is unclear whether ROSE significantly affects diagnostic yield, ROSE appears to significantly increase procedure time of EUS-FNA but is associated with fewer repeat procedures. The overall cost effectiveness of ROSE needs further investigation to determine if lower repeat rates are an adequate trade-off for significantly longer procedure times and personnel commitment.
Category: Cytopathology

Monday, March 4, 2013 1:00 PM

Poster Session II # 65, Monday Afternoon

 

Close Window