Role of Rapid Onsite Evaluation (ROSE) of EUS-FNAC in Diagnostic Yield of Solid Mass Lesions

Abstract

Introduction: Endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNA) is a preferred minimally invasive modality with low complication rates for cytological diagnosis of various gastrointestinal and mediastinal lesions.The present study was conducted to determine whether rapid on-site evaluation (ROSE) of cytology smears by cytopathologist improves the diagnostic yield of solid mass lesions on EUS-FNA. Material and Methods: Total 112 patients from June 2014 through October 2015 referred for EUS-FNA of solid mass lesions were prospectively enrolled in this single center study out of which 56 were in group-I (without onsite cytopathologist) and 56 in group-II (with onsite cytopathologist). In group-Ι patients cytology slides were prepared by endoscopy nurse. In group-ΙΙ patients cytology slides were prepared, stained and assessed for adequacy of sampling by onsite cytopathologist. The final cytopathological diagnosis (definitely positive, definitely negative or inadequate) was compared between the two groups. Results: A total of 61 EUS-FNA procedures in group I and 59 in group II were performed. Abdominal lymph nodes were the most common target sites in both the groups. A significantly higher number of needle passes were performed without onsite cytopathologist (3.59 vs 2.88; P=0.0001). The final cytopathological diagnosis was definite in 71.4% in group I compared with 87.5% in group II. (P = 0.035) The percentage of inadequate diagnosis was 23.2%, in group I and 8.9% in group II. (P= 0.035) Conclusion: ROSE by cytopathologist and interpretation significantly improves the diagnostic yield of EUS-FNA.