Rapid on-site cytopathological examination (ROSE) performed by endosonagraphers and its improvement in the diagnosis of pancreatic solid lesions

Abstract

PURPOSE:To evaluate the diagnosis improvement of EUS-FNA when using ROSE performed by the endosonographer. METHODS:A retrospective study was conducted. A total of 48 pancreatic solid masses EUS-FNA were divided into two groups according to the availability of on-site cytology (ROSE) -the first 24 patients (group A-without ROSE) and the latter 24 cases (group B-with ROSE). Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, complications and inadequacy rate of EUS-FNA were determined and compared. RESULTS:Among the 48 EUS-FNA, the overall performance was: sensitivity 82%; specificity 100%; positive predictive value (PPV) 100%; negative predictive value (NPV) 70% and accuracy 87%. The sensitivity of the Group A was 71%, versus 94% in-group B (p=0.61). Moreover, the negative predictive value was 58% versus 87% (p=0.72). The accuracy rate increased from 79% to 96% (p=0.67) in the ROSE group. The number of punctures was similar between the groups. No major complications were reported. CONCLUSION:Rapid on-site cytopathological examination, even when performed by the endosonographer, may improve the diagnostic performance in the diagnosis of solid pancreatic lesions, regardless of the slight increase in the number of punctures.

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

“…A total of 1299 individuals were included, in which 3 studies enrolled over 200 individuals[ 8 , 10 , 15 ], 3 studies enrolled 100–200 individuals[ 9 , 21 , 22 ], and the other one study enrolled <100 individuals[ 16 ]. Of the 7 studies, one was randomized trial [ 15 ] and the other six were non-randomized comparative studies [ 8 – 10 , 16 , 21 , 22 ].…”

“…Meta-analyses revealed that on-site cytopathology evaluation could improve diagnostic adequacy and accuracy for malignancy detection [ 12 – 14 ]. However, new and high quality studies published recently reported convertible conclusions [ 15 , 16 ]. Design inadequacies of previous meta-analysis limited their capacity in completely addressing this clinical question and left the benefits of ROSE remained controversial.…”

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

“…Many studies have shown improved diagnostic yield and accuracy with ROSE [18][19][20]; however, more recent observational data on the impact of ROSE have yielded conflicting results [10,21]. A meta-analysis and systematic review by Kong et al showed that the use of ROSE did not improve the diagnostic yield and accuracy, nor did it improve the pooled sensitivity and specificity for EUS-FNA of pancreatic masses [22].…”

A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation

“…Gastrointestinal endosonographers, confronted with the above-mentioned problem, have endeavored to evaluate the possibility of performing the on-site review of EUS-derived samples themselves since 2007 [25]. Although encouraging results have been presented in some studies, these have been conducted almost exclusively on patients undergoing investigation for pancreatic solid masses rather than for lymphadenopathy [25-28]. …”