Telepathology Assisted Immediate Assessment of EBUS-FNA Has Equivalent Accuracy to Cytopathologist On-Site Examination
Jena B Hudson, Benjamin A Murray, Alexander C Chen, Brian T Collins, Jeff F Wang. Washington University School of Medicine, Saint Louis, MO; Barnes-Jewish Hospital, Saint Louis, MO
Background: Performing immediate assessment (IA) has become the standard of care for Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) specimens. Despite the benefits of aiding interventional pulmonologists to achieve higher adequacy rates and fewer unnecessary passes, the time required by attending cytopathologists to be present for on-site assessments is significant and impacts other clinical responsibilities. At our institution, it is a brisk 9 minute walk from the cytology department to the EBUS-FNA suite. Telepathology, as implemented here, consists of a cytotechnologist or trainee driven microscope attached to a Nikon DS-Fi1 Camera and DS-L2 controller that displays dynamic microscopic images in real-time on the attending pathologist's office computer.
Design: Preliminary assessment results, final diagnoses, and corresponding surgical pathology diagnoses, when available, were compared between consecutive EBUS-FNA specimens acquired before and after implementation of telepathology assisted IA. Cases were divided into three categories: satisfactory for evaluation (SFI), indeterminate for evaluation (IND), and unsatisfactory for evaluation (UNSAT).
Results: 105 EBUS-FNA specimens that were evaluated by conventional on-site examination were compared to the first 116 cases using telepathology assisted IA. The IAs for the conventional on-site cases were 60/105 (57%) SFI; 34/105 (32%) IND; 11 (10%) UNSAT. The telepathology assisted cases were 58/116 (50%) SFI; 47/116 (40%) IND; 11/116 (10%) UNSAT. A 3x2 Fisher's exact test showed no significant difference in adequacy assessment distribution between the two methods (p=0.45). Conventional on-site IA and telepathology assisted IA had similar abilities to predict which samples would be diagnostic on final cytologic examination. 59/60 (98%) and 57/58 (98%) of SAT cases (p=1), 29/34 (85%) and 44/47 (94%) of IND cases (p=0.27) and 4/11 (36%) and 8/11 (73%) of UNSAT cases were diagnostic on final examination, for conventional on-site exam and telepathology assisted, respectively. 26 of the conventional on-site cases and 25 telepathology assisted on-site cases had corresponding tissue diagnoses with a single discrepant result in each group.
Conclusions: Telepathology assisted IA of EBUS-FNA allowed for the same diagnostic accuracy as traditional on-site IA with the added advantage of eliminating travel time for attending pathologists.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 51, Monday Morning