On‐site adequacy evaluations performed by cytotechnologists

Abstract

BACKGROUND: Practice patterns regarding on‐site assessment of the adequacy of image‐guided fine‐needle aspiration biopsies (FNABs) vary among laboratories, but in many laboratories primary responsibility rests with the cytotechnologists. On‐site evaluation provides feedback on the need for additional passes and facilitates triaging of the specimen for time‐sensitive ancillary studies. Prior studies have suggested that cytotechnologists can assess the initially obtained specimens correctly, but they are few in number and limited by small size. The purpose of this study was to assess the frequency with which our cytotechnologists were able to correctly assess specimens as adequate using a large‐scale database that included a wide range of image‐guided FNABs. METHODS: The frequency that on‐site adequacy assessments of 5241 image‐guided FNABs were correct was determined by correlating the cytotechnologists' assessments of adequacy with the final cytologic interpretation. An adequacy assessment was considered correct if the FNAB was ultimately reported as satisfactory and unequivocally benign or malignant. An adequate reading on a case that was ultimately reported as unsatisfactory, atypical, or suspicious was deemed “incorrect.” The effect of imaging modality was also analyzed. RESULTS: Of 5241 FNABs, 2784 (53%) were interpreted as adequate on site. Of these, 2637 (95%) were correctly considered adequate. Of the common biopsy sites sampled, the adequacy assessments for liver FNABs demonstrated the highest frequency for being correctly considered adequate (97%) and those for kidney FNABs showed the lowest (90%). Imaging modality had no effect on accuracy. CONCLUSIONS: Cytotechnologists are almost always correct when assessing initial FNAB samples as adequate. Cancer (Cancer Cytopathol) 2012;. © 2011 American Cancer Society.

Accuracy of Cytotechnologist Evaluation of Specimen Adequacy and Screening Interpretation of Malignancy in Fine-Needle Aspiration of the Liver

“…The cost is justified easily on an institutional scale when the decreased rebiopsy rate and efficient use of a cytopathologist's time are considered [17], but few medical delivery systems are integrated well enough to allocate resources so holistically. As such, the practice remains the domain of large academic centers [11,12,13,14,18]. This is likely to change, given the emergence of telecytology and the growth of accountable care organizations.…”

Cytotechnologist On-Site Evaluation of Pancreas Fine Needle Aspiration Adequacy: Comparison with Cytopathologists and Correlation with the Final Interpretation

“…The largest study of cytotechnologists as OSEA providers demonstrated highly desirable results [20] although the number of pancreas biopsies was small, and there was no comparison with the performance of cytopathologists in the same role at the same institution. In contrast, in this study we examine the accuracy of both cytotechnologists and cytopathologists in performing OSEA during EUS-guided FNA of the pancreas.…”

Cytotechnologist-Attended On-Site Evaluation of Adequacy for Metastatic Disease Involving Bone and Soft Tissue

“…This is probably the case because in order for institutions to engage in un-reimbursed cytotechnologist-performed OSEA, they have to evaluate the cost-effectiveness on a macro-scale institutional level [12]. Large academic centers, for example, have been quick to give cytotechnologists these duties [13,14,15]. While a randomized clinical trial has yet to be performed and published, the data shown here and elsewhere [13,14,15] have shown sufficient performance of cytotechnologists for OSEA and form a sufficient basis for pursuing this level of evidence as part of the evidence needed to request the addition to the current medical services fee schedule.…”

“…Given the time constraints on practicing cytopathologists, divesting them from other clinical functions in order to perform OSEA presents a significant logistical challenge. Alternatives have been proposed including non-cytologist-performed OSEA [10,11] and cytotechnologist-performed OSEA [12,13,14,15]. Our own experience has shown that cytotechnologists perform similarly to cytopathologists in OSEA of thyroid [14] and endoscopic ultrasound (US)-guided pancreas FNA [15].…”