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

Abstract

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.

Endoscopic ultrasound guided fine‐needle aspiration: What variables influence diagnostic yield?

“…Although this study revealed comparable diagnostic yield and inadequate specimen during EUS–FNA with and without ROSE, the on‐site evaluation group required fewer passes as compared to the EUS–FNA without on‐site evaluation. Another study by O'Connor et al revealed similar finding although they compared their data of EUS–FNA without on‐site evaluation with the published literature's data of EUS–FNA with on‐site evaluation which incorporates bias into the study.…”

Endoscopic ultrasound-guided tissue acquisition with or without macroscopic on-site evaluation: randomized controlled trial

“…Similarly, a Dutch group studied the impact of ROSE during EUS-FNA of mediastinal and abdominal lymph nodes; the multicenter, randomized trial showed that EUS-FNA with and without ROSE were comparable in terms of diagnostic yield and accuracy [23]. When EUS-FNA is performed by a skilled endosonographer in a center with a high diagnostic rate, ROSE may offer no benefit to the standard approach [24][25][26][27].…”

Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review

“…The pooled sensitivity and specificity of two cohorts (ROSE and non-ROSE) were compared using the bivariate approach. In addition, a summary receiver operating characteristic (SROC) curve was constructed using the DerSimonian–Laird random-effects model[ 17 ] Statistical analyses were executed by Review manager5.3 (The Cochrane Collaboration, Oxford, UK) and Meta-DiSc version 1.4 statistical software (Meta-DiSc, Unit of Clinical Biostatistics team of the Ramony Cajal Hospital, Madrid, Spain).…”