Can endosonographers evaluate on-site cytologic adequacy? A comparison with cytotechnologists

Alan D. Savoy, Massimo Raimondo, Timothy A. Woodward, Kyung Noh, Surakit Pungpapong, Arthur D. Jones, Juliana Crook, Michael B. Wallace

Research output: Contribution to journalArticle

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Abstract

Background: On-site determination of cytologic adequacy increases the accuracy of EUS-guided FNA (EUS-FNA); however, on-site cytotechnologists are not available to all endosonographers. We hypothesize that experienced endosonographers can accurately assess whether an on-site FNA specimen is adequate. Objective: To determine the accuracy of on-site cytopathology interpretation of EUS-FNA specimens by comparing endosonographers with a cytotechnologist. Design: Prospective double-blind controlled trial. Setting: Academic medical center with a high-volume EUS practice. Patients: Consecutive patients undergoing EUS-FNA of lymph nodes or pancreas tumors. Main Outcome Measurements: Accuracy, sensitivity, and specificity of 3 endosonographers and 1 cytotechnologist for interpretation of cytologic specimen adequacy and diagnosis compared with a criterion standard of a board-certified cytopathologist. Results: There were 59 lymph node, 49 pancreas, and 9 liver specimens (117 total). For determination of adequacy, none of the endosonographers were statistically equivalent to the cytotechnologist (P = .004). For determination of suspicious/malignant versus benign specimens, all 3 endosonographers were inferior (P < .001) to the cytotechnologist. Limitations: This study represents a small group of trained endosonographers in a high-volume practice and may not be applicable to other settings. The sample size does not allow an accurate evaluation of different biopsy sites (eg, pancreas vs lymph node). Conclusions: Even trained endosonographers have variable and, in some cases, inferior abilities to interpret on-site cytologic adequacy compared with cytotechnologists.

Original languageEnglish (US)
Pages (from-to)953-957
Number of pages5
JournalGastrointestinal Endoscopy
Volume65
Issue number7
DOIs
StatePublished - Jun 2007

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Pancreas
Lymph Nodes
Sample Size
Biopsy
Sensitivity and Specificity
Liver
Neoplasms

ASJC Scopus subject areas

  • Gastroenterology

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Can endosonographers evaluate on-site cytologic adequacy? A comparison with cytotechnologists. / Savoy, Alan D.; Raimondo, Massimo; Woodward, Timothy A.; Noh, Kyung; Pungpapong, Surakit; Jones, Arthur D.; Crook, Juliana; Wallace, Michael B.

In: Gastrointestinal Endoscopy, Vol. 65, No. 7, 06.2007, p. 953-957.

Research output: Contribution to journalArticle

Savoy, Alan D. ; Raimondo, Massimo ; Woodward, Timothy A. ; Noh, Kyung ; Pungpapong, Surakit ; Jones, Arthur D. ; Crook, Juliana ; Wallace, Michael B. / Can endosonographers evaluate on-site cytologic adequacy? A comparison with cytotechnologists. In: Gastrointestinal Endoscopy. 2007 ; Vol. 65, No. 7. pp. 953-957.
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abstract = "Background: On-site determination of cytologic adequacy increases the accuracy of EUS-guided FNA (EUS-FNA); however, on-site cytotechnologists are not available to all endosonographers. We hypothesize that experienced endosonographers can accurately assess whether an on-site FNA specimen is adequate. Objective: To determine the accuracy of on-site cytopathology interpretation of EUS-FNA specimens by comparing endosonographers with a cytotechnologist. Design: Prospective double-blind controlled trial. Setting: Academic medical center with a high-volume EUS practice. Patients: Consecutive patients undergoing EUS-FNA of lymph nodes or pancreas tumors. Main Outcome Measurements: Accuracy, sensitivity, and specificity of 3 endosonographers and 1 cytotechnologist for interpretation of cytologic specimen adequacy and diagnosis compared with a criterion standard of a board-certified cytopathologist. Results: There were 59 lymph node, 49 pancreas, and 9 liver specimens (117 total). For determination of adequacy, none of the endosonographers were statistically equivalent to the cytotechnologist (P = .004). For determination of suspicious/malignant versus benign specimens, all 3 endosonographers were inferior (P < .001) to the cytotechnologist. Limitations: This study represents a small group of trained endosonographers in a high-volume practice and may not be applicable to other settings. The sample size does not allow an accurate evaluation of different biopsy sites (eg, pancreas vs lymph node). Conclusions: Even trained endosonographers have variable and, in some cases, inferior abilities to interpret on-site cytologic adequacy compared with cytotechnologists.",
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N2 - Background: On-site determination of cytologic adequacy increases the accuracy of EUS-guided FNA (EUS-FNA); however, on-site cytotechnologists are not available to all endosonographers. We hypothesize that experienced endosonographers can accurately assess whether an on-site FNA specimen is adequate. Objective: To determine the accuracy of on-site cytopathology interpretation of EUS-FNA specimens by comparing endosonographers with a cytotechnologist. Design: Prospective double-blind controlled trial. Setting: Academic medical center with a high-volume EUS practice. Patients: Consecutive patients undergoing EUS-FNA of lymph nodes or pancreas tumors. Main Outcome Measurements: Accuracy, sensitivity, and specificity of 3 endosonographers and 1 cytotechnologist for interpretation of cytologic specimen adequacy and diagnosis compared with a criterion standard of a board-certified cytopathologist. Results: There were 59 lymph node, 49 pancreas, and 9 liver specimens (117 total). For determination of adequacy, none of the endosonographers were statistically equivalent to the cytotechnologist (P = .004). For determination of suspicious/malignant versus benign specimens, all 3 endosonographers were inferior (P < .001) to the cytotechnologist. Limitations: This study represents a small group of trained endosonographers in a high-volume practice and may not be applicable to other settings. The sample size does not allow an accurate evaluation of different biopsy sites (eg, pancreas vs lymph node). Conclusions: Even trained endosonographers have variable and, in some cases, inferior abilities to interpret on-site cytologic adequacy compared with cytotechnologists.

AB - Background: On-site determination of cytologic adequacy increases the accuracy of EUS-guided FNA (EUS-FNA); however, on-site cytotechnologists are not available to all endosonographers. We hypothesize that experienced endosonographers can accurately assess whether an on-site FNA specimen is adequate. Objective: To determine the accuracy of on-site cytopathology interpretation of EUS-FNA specimens by comparing endosonographers with a cytotechnologist. Design: Prospective double-blind controlled trial. Setting: Academic medical center with a high-volume EUS practice. Patients: Consecutive patients undergoing EUS-FNA of lymph nodes or pancreas tumors. Main Outcome Measurements: Accuracy, sensitivity, and specificity of 3 endosonographers and 1 cytotechnologist for interpretation of cytologic specimen adequacy and diagnosis compared with a criterion standard of a board-certified cytopathologist. Results: There were 59 lymph node, 49 pancreas, and 9 liver specimens (117 total). For determination of adequacy, none of the endosonographers were statistically equivalent to the cytotechnologist (P = .004). For determination of suspicious/malignant versus benign specimens, all 3 endosonographers were inferior (P < .001) to the cytotechnologist. Limitations: This study represents a small group of trained endosonographers in a high-volume practice and may not be applicable to other settings. The sample size does not allow an accurate evaluation of different biopsy sites (eg, pancreas vs lymph node). Conclusions: Even trained endosonographers have variable and, in some cases, inferior abilities to interpret on-site cytologic adequacy compared with cytotechnologists.

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