Yield of biliary stent cytology: Is it time to think lean?

Abstract Background and study aims During evaluation of pancreaticobiliary strictures, it is common practice to send biliary stents for cytologic analysis. However, in recent years, complementary tissue acquisition techniques ranging from cholangioscopy to fine-needle biopsy have improved the ability to acquire tissue and diagnose malignancy. Data are limited on the current diagnostic yield and cost effectiveness of biliary stent analysis. Patients and methods We performed a retrospective study of all pancreaticobiliary stents sent for analysis in a tertiary care academic medical center from June 2013 to September 2016. Patient demographics, stent information, and final diagnosis history were collected through chart review. Costs were determined using published reimbursement rates for Medicare. Results Two hundred thirty-one stents from 175 patients were sent for cytologic analysis during the study period. Of the 62 stents obtained from patients ultimately diagnosed with malignancy, only one (1.6 %) had positive cytology for malignant cells, while the others were acellular/non-diagnostic (2/62, 3.2 %), negative (48/62, 77.4 %), or atypical (11/62, 17.7 %). The sensitivity of stent cytology for diagnosis of malignancy was 1.6 % (1/62). No cases were identified in which stent cytology changed clinical management. From a payer perspective, the mean estimated cost for each stent cytologic analysis is greater than $ 70.00. Conclusions While stent cytologic analysis is a common clinical practice, the diagnostic yield and cost effectiveness of the practice must be reevaluated. With the rise of newer diagnostic technologies such as digital cholangioscopy and endoscopic ultrasound-guided fine-needle biopsy, it may be time to “think lean” and acknowledge a sunset for biliary stent cytology.

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Su1322 COMPARING DIAGNOSTIC YIELD OF EUS GUIDED FINE NEEDLE ASPIRATION(FNA) VERSUS FINE NEEDLE BIOPSY(FNB) IN THE DIAGNOSIS OF SOLID LESIONS: RETROSPECTIVE REVIEW STUDY IN A COMMUNITY HOSPITAL

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.2168 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB331

Author(s):

Rupinder Mann ◽

Neilinder S. Behniwal ◽

Inderbir Baadh ◽

Abhishek Gulati

Keyword(s):

Fine Needle Aspiration ◽

Retrospective Review ◽

Needle Biopsy ◽

Community Hospital ◽

Diagnostic Yield ◽

Fine Needle Biopsy ◽

Needle Aspiration ◽

Fine Needle ◽

Review Study ◽

Solid Lesions

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Sa1450 YIELD OF PANCREATIC FINE-NEEDLE BIOPSY NOT AFFECTED BY PRIOR BILIARY STENT PLACEMENT

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.1246 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB196

Author(s):

Roberto Trasolini ◽

Natasha K. Klemm ◽

David Farnell ◽

Fergal Donnellan

Keyword(s):

Stent Placement ◽

Needle Biopsy ◽

Fine Needle Biopsy ◽

Biliary Stent ◽

Fine Needle

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Ultrasound-Guided Fine-Needle Biopsy of First 1000 Consecutive Thyroid Nodules: Single-Surgeon Experience

OTO Open ◽

10.1177/2473974x20929008 ◽

2020 ◽

Vol 4 (2) ◽

pp. 2473974X2092900

Author(s):

Jagdish K. Dhingra

Keyword(s):

Learning Curve ◽

Needle Biopsy ◽

Thyroid Nodules ◽

Diagnostic Yield ◽

Statistical Significance ◽

Fine Needle Biopsy ◽

Ultrasound Guided ◽

Fine Needle ◽

Surgeon Experience ◽

Chi Square Analysis

Objective To study the feasibility, safety, and learning curve of ultrasound-guided fine-needle biopsy (USGFNB) performed by a newly trained otolaryngologist in a community office in a setting. Study Design Collect USGFNB data of all thyroid nodules in a prospective manner. Setting A dedicated ultrasound clinic in a large community-based practice, operated by a single surgeon with the purpose of providing office-based point-of-care diagnostic ultrasonography and USGFNB. Subjects and Methods Data on the first 1000 unselected consecutive thyroid nodules that underwent USGFNB over a 3-year period were analyzed. Chi-square analysis was used to assess the statistical significance of characteristics of diagnostic vs nondiagnostic nodules. A multivariate regression analysis was conducted to determine nodule characteristics predictive of adequate sampling. Diagnostic yield and time efficiency data were plotted over a 3-year period to study the learning curve for the USGFNB procedure performed by an operator with no previous experience. Results A total of 1000 nodules in 734 patients including 142 males and 592 females (age range, 17-87 years) were studied. Of the patients, 188 of 734 had more than 1 nodule biopsied, with a maximum of 4 nodules biopsied in 1 setting. The procedure was successfully completed in all patients, with no major complications. A steep learning curve was observed, and adequate samples were obtained in 91.9% of the patients on the first attempt. The cystic nature of the nodule was the biggest predictor of a nondiagnostic yield. Conclusions Otolaryngologist-performed USGFNB of the thyroid is safe, effective, and desirable.

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Utilization and Diagnostic Yield of Neurogenetic Testing at a Tertiary Care Facility

Clinical Chemistry ◽

10.1373/clinchem.2006.083360 ◽

2007 ◽

Vol 53 (6) ◽

pp. 1016-1022 ◽

Cited By ~ 8

Author(s):

Kerstin L Edlefsen ◽

Jonathan F Tait ◽

Mark H Wener ◽

Michael Astion

Keyword(s):

Positive Result ◽

Diagnostic Yield ◽

Medical Center ◽

Care Center ◽

Academic Medical Center ◽

Molecular Genetic ◽

Tertiary Care ◽

Care Facility ◽

Utilization Review ◽

Tertiary Care Facility

Abstract Background: Institutions face increasing charges related to molecular genetic testing for neurological diseases. The literature contains little information on the utilization and performance of these tests. Methods: A retrospective utilization review was performed to determine the diagnostic yield of neurogenetic tests ordered during calendar year 2005 at a large academic medical center in the western United States. Results: Overall, a relevant mutation was identified in 30.2% of the 162 patients tested and in 21.5% of the 121 probands, defined as patients for whom no mutation has been previously identified in a family member. Patients with muscle weakness (n = 65) had a mutation detected in 26.2% of all patients and 23.5% of probands (n = 51), with an estimated testing cost per positive result of $3190. Patients tested for neuropathy (n = 36) had a mutation detected in 27.8% of patients and 22.6% of probands (n = 31), with an estimated cost per positive result of $5955. Patients with chorea (n = 25) had a positive result obtained in 68% of patients and 71.4% of probands (n = 7); the estimated cost per positive test was $440. Other diagnostic categories evaluated include ataxias (n = 18; yield, 11.1%; $7620 per positive), familial stroke or dementia syndromes (n = 8; yield, 12.5%; $6760 per positive), and multisystem mitochondrial disorders (n = 10; yield, 20%; $6485 per positive). Conclusions: Expert clinicians at a tertiary care center who ordered neurogenetic tests obtained a positive result in 21.5% of patients without previously identified familial mutations. These results can be used for comparison and to help establish utilization guidelines for neurogenetic testing.

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S998 Endoscopic Ultrasound (EUS) Guided Fine-Needle Biopsy (FNB) Has Higher Diagnostic Yield but Similar Accuracy Than EUS Fine Needle Aspirate (FNA) for Pancreatic Neuroendocrine Tumor Grading: A Meta-Analysis

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000777524.06680.5e ◽

2021 ◽

Vol 116 (1) ◽

pp. S476-S476

Author(s):

Manik Aggarwal ◽

Prabhat Kumar ◽

Rajat Garg ◽

Dheera Grover ◽

Amandeep Singh ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Meta Analysis ◽

Pancreatic Neuroendocrine Tumor ◽

Fine Needle Biopsy ◽

Fine Needle Aspirate ◽

Tumor Grading ◽

Fine Needle ◽

Similar Accuracy

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Prospective comparative study of endoscopic ultrasonography-guided fine-needle biopsy and unroofing biopsy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.38 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 38-38 ◽

Cited By ~ 1

Author(s):

Sung Kwan Shin ◽

Jun Chul Park ◽

Eun Hye Kim ◽

Sang Kil Lee ◽

Yong Chan Lee

Keyword(s):

Comparative Study ◽

Endoscopic Ultrasonography ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Fine Needle Biopsy ◽

Histological Diagnosis ◽

Fine Needle ◽

Significant Difference ◽

Prospective Comparative Study ◽

The Mean

38 Background: Adequate tissue acquisition is important in making treatment decisions for patients with upper gastrointestinal subepithelial tumors (SETs). This study aimed to compare the outcomes of endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) with those of the unroofing biopsy technique. Methods: This study was a single-center, prospective comparative study conducted at Severance Hospital, Yonsei University College of Medicine. A total of 39 patients with SETs ≥15 mm were enrolled between January 2016 and August 2017. Results: Of the 39 patients, 28 underwent biopsy with both techniques (4 underwent only unroofing and 7 underwent only EUS-FNB). The mean tumor size was 21.0 mm (median, 19.0 mm; 15.0–45.0 mm). Histological diagnosis was made with EUS-FNB in 64.3% and with unroofing biopsy in 78.6% (p = 0.344), and immunohistochemical diagnosis was made with EUS-FNB in 46.4% and unroofing biopsy in 67.9% (p = 0.180). In the subgroup analysis (28 patients), there was no significant difference in diagnostic yield between the 2 methods. The mean procedural time with EUS-FNB was shorter than that with unroofing biopsy (p < 0.001). The larger SET (≥ 20 mm) (p = 0.035) and satisfaction of procedure (p = 0.019) were positively associated with successful histological diagnosis by EUS-FNB. No complications were reported with both methods. Conclusions: There was no significant difference in the histological diagnostic yield for SETs between the EUS-FNB and unroofing biopsy techniques. Further study is needed to confirm the efficacy of EUS-FNB and unroofing biopsy in a larger study population. Clinical trial information: NCT02646241.

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