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, CT(ASCP) N Context.-Little has been reported on changes in pancreatic pathology practice after implementation of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).Objectives.-We assessed the impact of EUS-FNA on cytologic diagnosis replacing histologic diagnosis for pancreatic disease and determined whether it fulfills Christensen criteria of a disruptive innovation effect.Design.-Pattern of utilization during 20 years, diagnostic categories, and diagnostic accuracy of pancreatic cytology were compared before and after implementation of EUS-FNA. The disruptive effect of cytology relevant to biopsy was assessed by comparing the utilization trends and the accuracy of diagnosis over time.Results.-The mean annual volume (standard deviation) of cytologic specimens increased from 24 (11) to 231 (10) after implementation of EUS-FNA, and that of histologic specimens increased from 97 (42) to 377 (148). The average percentage of annual cases managed by following cytology alone was 19% (10) before versus 51% (8) after implementation. The percentage managed by histology alone was 56% before versus 23% after implementation. Non-endoscopic ultrasound-guided fine-needle aspiration cytology decreased from 36% to 1%. Needle biopsies decreased from 7% to 1%, and other biopsy types from 29% to 9%. Unsatisfactory (7% versus 1%), atypical (16% versus 4%), and suspicious (16% versus 3%) diagnoses were significantly reduced. The accuracy of cytologic diagnosis significantly improved: the sensitivity (confidence interval) and specificity (confidence interval) for cancer diagnosis were 55% (38%-70%) and 78% (58%-89%) before versus 88% (84%-91%) and 96% (93%-98%) after implementation, respectively.Conclusions.-Endoscopic ultrasound-guided fine-needle aspiration improved the accuracy of cytologic diagnosis, reduced the number of indeterminate diagnoses, and replaced the need for tissue biopsy. Given its cost and simplicity as compared with tissue biopsy, this trend represents a disruptive innovation effect.

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been anticipated to improve communication between pathologists and clinicians and thereby patient outcomes. In the current study, the impact of TBSRTC on various quality and outcome measures was assessed. METHODS: The current study included all patients who underwent fine‐needle aspiration (FNA) of the thyroid between April 2006 and April 2009. Before implementation, the authors used generic diagnostic categories; after implementation, TBSRTC was used. Quality of reporting, diagnostic categories, rate of surgery, rates of frozen section, the “risk” of malignancy after a cytologic diagnosis, and errors before and after implementation of TBSRTC were compared using the chi‐square and Fisher exact tests. Multilevel likelihood ratios and the receiver operating characteristic were used to compare the accuracy of FNA before and after implementation. RESULTS: A total of 1671 FNAs (957 obtained before and 714 obtained after implementation of TBSRTC) were obtained from 1339 patients. Of these, 301 patients (191 before and 110 after implementation) underwent subsequent surgical resection. Before implementation, the reports were more ambiguous (3.7% vs 0.5%; P < .05) and implicit (5.1% vs 2.7%; P < .05) than after implementation. The overall rate of surgery decreased after implementation of TBSRTC (24.5% vs 19.6%; P < .05). The overall risk of malignancy did not appear to be affected by implementation of TBSRTC, but it decreased significantly after a benign FNA diagnosis compared with a diagnosis of an atypical lesion or follicular neoplasm. The rate of frozen section remained unchanged. The diagnostic accuracy was not found to be significantly different before compared with after implementation of TBSRTC. CONCLUSIONS: Implementation of TBSRTC appears to improve the quality of reporting by lowering the number of ambiguous and implicit diagnoses and decreases the overall surgery rates, particularly for benign lesions, but it does not appear to have any effect on the accuracy of FNA of the thyroid, false‐positive rates, or the frequency of intraoperative consultations. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.

We compared the histologic follow-up of 368 smears or slides with an interpretation of "atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion" (ASC-H) based on conventional and liquid-based preparations and age groups in a high-risk population. Patients with an ASC-H interpretation were 17 to 87 years old (mean, 36.8 years). The specimens were 52 liquid-based preparations and 316 conventional smears. For 218 cases (59.2%), including 28 liquid-based preparations (65%) and 190 conventional smears (58%), histologic follow-up was available. In 20 liquid-based preparations (71%) and 152 conventional smears (80.0%), cervical intraepithelial neoplasia (CIN) or higher was revealed on subsequent biopsy. Other results were as follows: liquid-based preparations, CIN1, 11 (55%); CIN2/3, 9 (45%); conventional smears, CIN1, 78 (51.3%); CIN2/3, 70 (46.1%); squamous cell carcinoma, 4 (2.6%). There was no statistically significant difference in the incidence of CIN or higher on subsequent biopsy after an interpretation of ASC-H based on preparation types. The incidences of CIN in patients 40 years old or older and patients younger than 40 years were 66% and 84%, respectively, a statistically significant difference. Because of the high incidence of clinically significant lesions noted on subsequent follow-up, patients with an interpretation of ASC-H should be observed closely and referred for colposcopic examination regardless of their age.