Rapid On-Site Evaluation by Endosonographer of Endoscopic Ultrasound Fine-Needle Aspiration of Solid Pancreatic Lesions

Abstract

Objectives: Rapid on-site evaluation (ROSE) by cytopathologists during endoscopic ultrasound-fine-needle aspiration (EUS-FNA) of solid pancreatic lesions (SPLs) improves adequacy and diagnostic accuracy while reducing the number of needle passes. We evaluated the usefulness of ROSE performed by the endosonographer.Methods: Patients with an SPL were randomly assigned to EUS-FNA with ROSE or non-ROSE. Procedure duration, number of needle passes, specimen adequacy, and adverse event rates were compared.Results: Sixty-five patients were enrolled (33 in the ROSE vs 32 in the non-ROSE group). Both groups were similar in terms of age, sex, size, and location of the lesion. Specimen adequacy rates were high and similar between groups. Mean (standard deviation) procedure duration was shorter in the ROSE versus non-ROSE group (30.0 [11.3] vs 37.0 [7.2] minutes, P < 0.005), as well as the mean (standard deviation) number of needle passes (2.6 [0.8] vs 3.5 [0.8], P < 0.005). Accuracy parameters as sensitivity and accuracy of ROSE by the endosonographer for malignancy were 93% and 88%, respectively.Conclusions: After specific training, the endosonographer can accurately evaluate samples during EUS-FNA of SPL, allowing for a shorter procedure duration and a lower number of needle passes.

A deep learning-based segmentation system for rapid onsite cytologic pathology evaluation of pancreatic masses: A retrospective, multicenter, diagnostic study

“… 25 Several studies assessed the performance of endoscopists or endosonographers in assessing the diagnostic adequacy of EUS-FNA samples and demonstrated a higher diagnostic adequacy among these endoscopists or endosonographers. 21 , 26 , 27 However, the training curriculums varied in different studies, leading to a considerable inconsistency between endoscopists and cytopathologists. 28 To the best of our knowledge, no studies have implemented deep learning in assessing the diagnostic adequacy of EUS-FNA.…”

A morphological and immunohistochemical study of the endoscopic ultrasound–fine-needle biopsy samples from solid pancreatic masses: a single center study

“…Traditionally, HP diagnosis of solid pancreatic tumors was performed by EUS–FNA, through cytological examination, direct smears, cytospin [ 14 ]. Rapid on-site evaluation (ROSE) was also proposed to faster analyze the smears and repeat the EUS–FNA if necessary [ 15 ]. However, randomized studies have shown that this approach may not be so efficient, and it does not significantly improve EUS sampling resultant [ 16 ].…”

Rapid on‐site evaluation by endoscopists: Another option to improve the diagnostic yield of EUS‐FNA of solid pancreatic lesions

“…However, data are limited, being mainly retrospective studies [2][3][4] with only two randomized trials that did not directly assess clinical outcomes. 5,6 In this issue of Journal of Gastroenterology and Hepatology, Zhang et al reported the results of a single center randomized trial that compared the diagnostic performance of EUS-FNA with and without self-ROSE. 7 The endoscopists underwent a 1 month training in sample adequacy assessment and cytopathological diagnosis of EUS-FNA pancreas cytology in the pathology department.…”

“…Self-ROSE resulted in significantly shorter mean procedure time (30 vs 37 min, P < 0.005) and fewer mean number of needle passes (2.6 vs 3.5, P < 0.005). 6 The structure of a valid training curriculum for self-ROSE and the minimum level of expertise to be achieved and maintained are two very important issues that need to be addressed. The definitive cytological diagnosis must always be provided by a pathologist as it is unreasonable to expect endoscopists to have equivalent level of proficiency.…”