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.

Keywords:
Pancreatic cancer, Gastrointestinal tract, Endoscopic ultrasound, Fine-needle aspiration biopsy, Accuracy, On-site cytopathology evaluation
1.
Klapman JB, Logrono R, Dye CE, Waxman I: Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol 2003;98:1289-1294.
2.
Bellizi AM, Stewlow EB: Pancreatic cytopathology. Arch Pathol Lab Med 2009;133:388-404.
3.
Ylagen LR, Edmundowicz S, Kasal K, Walsh D, Lu DW: Endoscopic ultrasound fine-needle aspiration cytology of pancreatic carcinoma: a 3-year experience and review of the literature. Cancer Cytopathol 2002;96:362-369.
4.
Turner BG, Cizginer S, Agarwal D, Yang J, Bishop Pitman M, Brugge WR: Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy. Gastrointest Endosc 2010;71:91-98.
5.
Eloubeidi MA, Jhala D, Chhieng DC, et al: Yield of endoscopic ultrasound guided fine needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer Cytopathol 2003;99:285-292.
6.
Leiman G: My approach to pancreatic fine needle aspiration. J Clin Pathol 2007;60:43-49.
7.
Storch I, Jorda M, Thurer R: Advantage of EUS Trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination. Gastrointest Endosc 2006;64:505-511.
8.
Schmidt RL, Witt BL, Matynia AP, Barraza G, Layfield LJ, Adler DG: Rapid on-site evaluation increases endoscopic ultrasound-guided fine-needle aspiration adequacy for pancreatic lesions. Dig Dis Sci 2013;58:872-882.
9.
Nguyen YP, Maple JT, Zhang Q, et al: Reliability of gross visual assessment of specimen adequacy during EUS-guided FNA of pancreatic masses. Gastrointest Endosc 2009;69:1264-1270.
10.
Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I, et al: Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol 2011;106:1705-1710.
11.
Kim J, Ryu JK, Park JM, et al: Clinical factors associated with accuracy of EUS-FNA for pancreatic or peripancreatic solid mass without on-site cytopathologists. J Gastroenterol Hepatol 2014;29:887-892.
12.
Afify AM, al-Khafaji BM, Kim B, Scheiman JM: Endoscopic ultrasound - guided fine needle aspiration of the pancreas: diagnostic utility and accuracy. Acta Cytol 2003;47:341-348.
13.
Raut CP, Grau AM, Staerkel GA, et al: Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg 2003;7:118-126.
14.
Volmar KE, Vollmer RT, Jowell PS, Nelson RC, Xie HB: Pancreatic FNA in 1,000 cases: a comparison of imaging modalities. Gastrointest Endosc 2005;61:854-861.
15.
Wilson JL, Kalade A, Prasad S, et al: Diagnosis of solid pancreatic masses by endoscopic ultrasound-guided fine-needle aspiration. Intern Med J 2009;39:32-37.
16.
Hewitt MJ, McPhail MJ, Possamai L, Dhar A, Vlavianos P, Monohan KJ: EUS- guided FNA for diagnosis of solid pancreatic neoplasms: a meta analysis. Gastrointest Endosc 2012;75:319-331.
17.
Jhala NC, Jhala DN, Chhieng DC, Eloubeidi MA, Eltoum IA: Endoscopic ultrasound-guided fine needle aspiration: a cytopathologist's perspective. Am J Clin Pathol 2003;120:351-367.
18.
Itoi T, Tsuchiya T, Itokawa F, et al: Histological diagnosis by EUS-guided fine-needle aspiration biopsy in pancreatic solid masses without on-site cytopathologist: a single center experience. Dig Endosc 2011;23:34-38.
19.
Cermak TS, Wang B, De Brito P, Carroll J, Haddad N, Sidawy MK: Does on-site adequacy evaluation reduce the non-diagnostic rate in endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions? Cancer Cytopathol 2012;120:319-325.
20.
LeBlanc JK, Ciaccia D, Al-Assi MT, et al: Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc 2004;59:475-481.
21.
Erickson RA, Sayage-Rabie L, Beissner RS: Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc 2000;51:184-190.
22.
Chhieng DC, Jhala D, Jhala N, et al: Endoscopic ultrasound-guided fine-needle aspiration biopsy: a study of 103 cases. Cancer Cytopathol 2002;96:232-239.
23.
Shin HJC, Lahoti S, Sneige N: Endoscopic ultrasound-guided fine-needle aspiration in 179 cases. Cancer Cytopathol 2002;96:174-180.
24.
Hayashi T, Ishiwatari H, Yoshida M, et al: Rapid on-site evaluation by endosonographer during endoscopic ultrasound-guided fine needle aspiration for pancreatic solid masses. J Gastroenterol Hepatol 2013;28:656-663.
25.
Hikichi T, Irisawa A, Bhutani MS, et al: Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists. J Gastroenterol 2009;44:322-328.
26.
de Luna R, Eloubeidi MA, Sheffield MV, et al: Comparison of ThinPrep and conventional preparations in pancreatic fine-needle aspiration biopsy. Diagn Cytopathol 2004;30:71-76.
27.
Michael CW, Hunter B: Interpretation of fine-needle aspirates processed by the ThinPrep technique: cytologic artifacts and diagnostic pitfalls. Diagn Cytopathol 2000;23:6-13.
28.
Belsley NA, Pitman MB, Lauwers GY, Brugge WR, Deshpande V: Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer Cytopathol 2008;114:102-110.
© 2015 S. Karger AG, Basel
2015
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