When Is Rapid On-Site Evaluation Cost-Effective for Fine-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.

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Breast fine needle aspiration biopsy cytology: the potential impact of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology and the use of rapid on-site evaluation

Journal of the American Society of Cytopathology ◽

10.1016/j.jasc.2019.10.004 ◽

2020 ◽

Vol 9 (2) ◽

pp. 103-111

Author(s):

Andrew S. Field ◽

Wendy A. Raymond ◽

Mary Rickard ◽

Fernando Schmitt

Keyword(s):

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Aspiration Biopsy Cytology ◽

Site Evaluation ◽

Potential Impact ◽

Needle Aspiration Biopsy ◽

International Academy

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Improved laboratory resource utilization and patient care with the use of rapid on-site evaluation for endobronchial ultrasound fine-needle aspiration biopsy

Cancer Cytopathology ◽

10.1002/cncy.21320 ◽

2013 ◽

Vol 121 (10) ◽

pp. 544-551 ◽

Cited By ~ 47

Author(s):

Brian T. Collins ◽

Alexander C. Chen ◽

Jeff F. Wang ◽

Cory T. Bernadt ◽

Souzan Sanati

Keyword(s):

Patient Care ◽

Resource Utilization ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Endobronchial Ultrasound ◽

Fine Needle ◽

Site Evaluation ◽

Needle Aspiration Biopsy

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Fine-Needle Aspiration Biopsy Cytopathology of Breast Lesions Using the International Academy of Cytology Yokohama System and Rapid On-Site Evaluation: A Single-Institute Experience

Acta Cytologica ◽

10.1159/000518375 ◽

2021 ◽

pp. 1-15

Author(s):

Neha Agrawal ◽

Kanchan Kothari ◽

Santosh Tummidi ◽

Prashant Sood ◽

Mona Agnihotri ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Breast Lesions ◽

Fine Needle ◽

Site Evaluation ◽

Malignant Lesions ◽

Needle Aspiration Biopsy ◽

International Academy

Introduction: Breast cancer is rapidly emerging as the leading cause of cancer in Indian women. Robust cytopathology and histopathology services are required to tackle this growing burden. The use of rapid on-site evaluation (ROSE) and the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy (FNAB) Cytopathology, which offers structured protocols, are expected to improve breast cytopathology reporting. Methods: We retrieved the cytopathology slides, categorized them by the IAC Yokohama System and histopathology data of all the patients who had been investigated for breast lesions from September 2016 to December 2018, and compared the cytopathology and histopathology. Risk of malignancy (ROM) and performance metrics, like sensitivity, specificity, predictive values, accuracy, and area under the curve were computed. Results: A total of 1,147 FNABs were evaluated, of which 442 (38.5%) underwent ROSE and 624 (54.4%) histopathology. Reported using IAC categories, our cohort recorded 4.9% inadequate, 65.3% benign, 7.8% atypical, 3.3% suspicious for malignancy, and 18.7% malignant lesions. The overall sensitivity and specificity for identifying in situ and malignant lesions were 99.1% and 99.3%, respectively, and were substantially improved by ROSE. ROSE improved the concordance between cytopathology and histopathology from 76.9% to 90.2%, by reducing inadequate (p < 0.001) cases. The ROM increased along a gradient from inadequate to malignant categories, with the gradient being sharpened by ROSE. The false negativity rate was 0.7% and false positivity rate 0%. Conclusion: Incorporating ROSE and the IAC Yokohama System for breast cytopathology reporting improves accurate diagnosis of breast lesions, prevents missed diagnoses, and provides reliable estimates of ROM. These protocols also aid in standardizing a reproducible system for monitoring and auditing of breast pathology services, identify areas that need strengthening, and improve training at pathology centers.

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