A Prospective Clinical Trial of Telecytopathology for Rapid Interpretation of Specimens Obtained During Endobronchial Ultrasound–Fine Needle Aspiration

Abstract

Background Cytopathologic interpretation of EBUS-FNA samples by a pathologist can be time-consuming and costly, and an onsite cytopathologist may not always be readily available. A telecytopathology system was instituted and evaluated to examine the impact on operative time for EBUS. Methods A prospective study was performed of sequential patients undergoing EBUS-FNA for the evaluation of mediastinal lymphadenopathy. The control group involved transportation of specimens to the pathology lab followed by remote cytologic interpretation. A subsequent cohort utilized a telecytopathology system with intra-op transmission of real-time live video microscopy to a remote cytopathologist (TCP group). The primary outcome was time to confirmation of cytology results. Results Of 46 patients entered into the study, 23 underwent traditional analysis (Control group) while 20 were analyzed using telecytopathology (TCP group). Lung cancer was the most common malignancy in both groups (12 TCP, 12 Control). There was no difference in mean number of lymph node stations sampled (1.3 TCP vs. 1.8 Control, p=0.76). Use of TCP was associated with fewer needle passes (4.9 vs. 7.3, p=0.02) and fewer slides for interpretation (8.4 vs. 13.5, p=0.01) per procedure. Time to result confirmation was significantly shorter in the TCP group (19.0 vs. 46.7 minutes, p<0.001). A diagnostic specimen was obtained in 70% of patients in the TCP group compared with 65% in the control group (p=0.5). False negative rates in patients undergoing both EBUS-FNA and mediastinoscopy were similar between the two groups (0 in TCP vs. 2 in Control, p=0.49). Mean procedural costs (excluding cost of the telecytology system and OR time) were equivalent between the two groups ($888 TCP vs. $887 Control). Conclusions Telecytopathology provides rapid interpretation of EBUS-FNA samples with diagnostic accuracy comparable to traditional methods, shortens procedure time, and is a more efficient model for delivery of on-site EBUS-FNA interpretation.

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International telecytology: Current applications and future potential

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