Dynamic telecytopathology for on-site preliminary diagnosis of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses

2012 ◽  
Vol 18 (5) ◽  
pp. 253-259 ◽  
Author(s):  
Kamal K Khurana ◽  
Rong Rong ◽  
Dongliang Wang ◽  
Ajoy Roy
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Neuroendocrine Neoplasms ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Preliminary Diagnosis ◽  
Site Evaluation ◽  
Conventional Microscopy

We evaluated dynamic telecytopathology for on-site-evaluation of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of the pancreas. Realtime images of stained cytology smears were assessed by a cytopathologist while communicating with the on-site operator by telephone. A total of 55 consecutive cases was assessed; preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 69%, 7% and 24%. We also reviewed 55 consecutive cases of EUS-guided FNA of pancreas which had had conventional microscopic on-site evaluation prior to the introduction of telecytopathology. Preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 60%, 9% and 31%. The overall concordance between the preliminary and final diagnosis was 84% for telecytopathology and 87% for conventional microscopy. Neuroendocrine neoplasms and well-differentiated adenocarcinoma were diagnostically challenging for both telecytopathology and conventional microscopy. Telecytopathology was similar in accuracy of preliminary diagnosis to conventional microscopy during EUS-FNA of pancreas.

Histological diagnostic ability of rapid on-site evaluation in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid lesions

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. S75
Author(s):  
Takashi Hirayama ◽  
Kazuo Hara ◽  
Nobumasa Mizuno ◽  
Susumu Hijioka ◽  
Hiroshi Imaoka ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Diagnostic Ability ◽  
Fine Needle ◽  
Site Evaluation ◽  
Solid Lesions

Gastrointestinal Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy Specimens: Adequate Diagnostic Yield and Accuracy Can Be Achieved without On-Site Evaluation

2015 ◽  
Vol 59 (4) ◽  
pp. 305-310 ◽  
Author(s):  
Kate O'Connor ◽  
Danny G. Cheriyan ◽  
Hector H. Li-Chang ◽  
Steven E. Kalloger ◽  
John Garrett ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Site Evaluation ◽  
Needle Aspiration Biopsy

Background: Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is the preferred method for biopsying the gastrointestinal tract, and rapid on-site cytological evaluation is considered standard practice. Our institution does not perform on-site evaluation; this study analyzes our overall diagnostic yield, accuracy, and incidence of nondiagnostic cases to determine the validity of this strategy. Design: Data encompassing clinical information, procedural records, and cytological assessment were analyzed for gastrointestinal EUS-FNA procedures (n = 85) performed at Vancouver General Hospital from January 2012 to January 2013. We compared our results with those of studies that had on-site evaluation and studies that did not have on-site evaluation. Results: Eighty-five biopsies were performed in 78 patients, from sites that included the pancreas, the stomach, the duodenum, lymph nodes, and retroperitoneal masses. Malignancies were diagnosed in 45 (53%) biopsies, while 24 (29%) encompassed benign entities. Suspicious and atypical results were recorded in 8 (9%) and 6 (7%) cases, respectively. Only 2 (2%) cases received a cytological diagnosis of ‘nondiagnostic'. Our overall accuracy was 72%, our diagnostic yield was 98%, and our nondiagnostic rate was 2%. Our results did not significantly differ from those of studies that did have on-site evaluation. Conclusion: Our study highlights that adequate diagnostic accuracy can be achieved without on-site evaluation.

scholarly journals Diagnostic difficulties and pitfalls in rapid on-site evaluation of endobronchial ultrasound guided fine needle aspiration

CytoJournal ◽  
2010 ◽  
Vol 7 ◽  
pp. 9 ◽  
Author(s):  
Sara E. Monaco* ◽  
Matthew J. Schuchert ◽  
Walid E. Khalbuss
Keyword(s):  
Fine Needle Aspiration ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Diagnostic Dilemma ◽  
Fine Needle ◽  
Preliminary Diagnosis ◽  
Diagnostic Difficulties ◽  
Site Evaluation ◽  
Background Material

Background: One of the novel techniques utilizing fine needle aspiration (FNA) in the diagnosis of mediastinal and lung lesions is the endobronchial ultrasound (EBUS)-guided FNA. In this study, we describe five cases which had a discrepancy between on-site evaluation and final diagnosis, or a diagnostic dilemma when rendering the preliminary diagnosis, in order to illustrate some of the diagnostic difficulties and pitfalls that can occur in EBUS FNA. Methods: A total of five EBUS FNA cases from five patients were identified in our records with a discrepancy between the rapid on-site evaluation (ROSE) and final diagnosis, or that addressed a diagnostic dilemma. All of the cases had histological confirmation or follow-up. The cytomorphology in the direct smears, cell block, and immunohistochemical stains were reviewed, along with the clinical history and other available information. Results: Two cases were identified with a nondefinitive diagnosis at ROSE that were later diagnosed as malignant (metastatic signet-ring cell adenocarcinoma and metastatic renal cell carcinoma (RCC)) on the final cytological diagnosis. Three additional cases were identified with a ROSE and final diagnosis of malignant (large cell neuroendocrine carcinoma (LCNEC) and two squamous cell carcinomas), but raised important diagnostic dilemmas. These cases highlight the importance of recognizing discohesive malignant cells and bland neoplasms on EBUS FNA, which may lead to a negative or a nondefinitive preliminary diagnosis. Neuroendocrine tumors can also be difficult due to the wide range of entities in the differential diagnosis, including benign lymphocytes, lymphomas, small and nonsmall cell carcinomas, and the lack of immunohistochemical stains at the time of ROSE. Finally, the background material in EBUS FNAs may be misleading and unrelated to the cells of interest. Conclusions: This study illustrates the cytomorphology of five EBUS FNA cases that address some of the diagnostic challenges witnessed while examining these specimens during ROSE. Many of the difficulties faced can be attributed to the baseline cellularity of the aspirates, the bronchial contamination, the difficulty identifying neoplasms with bland cytology, the wide spectrum of diseases that can occur in the mediastinum with overlapping cytomorphologic features, the mismatch between the background material and the cell populations present, and the overall unfamiliarity with these types of specimens.

scholarly journals A Pilot Randomized Crossover Trial of Wet Suction and Conventional Techniques of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Upper Gastrointestinal Subepithelial Lesions

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Mika Takasumi ◽  
Takuto Hikichi ◽  
Minami Hashimoto ◽  
Jun Nakamura ◽  
Tsunetaka Kato ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Crossover Trial ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Randomized Crossover Trial ◽  
Subepithelial Lesions ◽  
Solid Lesions

Background and Aim. A wet suction technique (“wet” technique) has been developed to improve the quality of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for sampling various solid lesions. However, no studies have reported on the wet technique for EUS-FNA for gastrointestinal (GI) subepithelial lesions (SELs). We conducted a pilot randomized crossover trial to explore whether the wet technique could be useful with regard to tissue adequacy of upper GI-SELs (UGI-SELs) compared to the conventional EUS-FNA technique (“dry” technique). Methods. Twenty-six patients with UGI-SELs indicated for EUS-FNA were randomly assigned to the dry-first arm using the dry technique for the first two passes or the wet-first arm using the wet technique for the first two passes using a cross-over design with a ratio of 1 : 1. The primary endpoint was the cellularity score of the EUS-FNA specimens rated on a 4-point scale (0-3). The secondary endpoints were the factors influencing cellularity in each suction technique. Results. The mean cellularity score was 1.65 ± 1.20 for the wet technique and 2.00 ± 0.98 for the dry technique ( p = 0.068 ). Logistic regression analysis showed that higher cellularity may be related to the final diagnosis of gastrointestinal stromal tumors in the dry technique and the SEL location in the upper stomach in the wet technique. Conclusion. The wet EUS-FNA technique failed to show a potential for improved cellularity of specimens compared to the dry technique for UGI-SELs.

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