False positive endoscopic ultrasound fine needle aspiration cytology: Incidence and risk factors

Ferga C. Gleeson, Benjamin R. Kipp, Jill L. Caudill, Jonathan E. Clain, Amy C. Clayton, Kevin C. Halling, Michael R. Henry, Elizabeth Rajan, Mark Topazian, Kenneth Ke Ning Wang, Maurits J. Wiersema, Jun Zhang, Michael J. Levy

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Objective: It is broadly accepted that the false positive (FP) rate for endoscopic ultrasound fine needle aspiration (EUS FNA) is 0-1%. It was hypothesised that the FP and false suspicious (FS) rates for EUS FNA are greater than reported. A study was undertaken to establish the rate and root cause of discordant interpretation. Design: Using a prospectively maintained endoscopic database, cytohistological discordant EUS FNA examinations from 30 July 1996 to 31 December 2008 were identified retrospectively. Setting: Tertiary referral centre. Main outcome measures: Discordant FNA was defined by positive or suspicious FNA cytology in the absence of malignancy or neoplasm in the subsequent surgical pathology specimen, specifically in the absence of neoadjuvant therapy. Three cytopathologists conducted a blinded review of randomised discordant and matched specimens. Results: FNA was performed in 5667/18 066 (31.4%) patients undergoing EUS, of whom 2547 had cytology results interpreted as 'positive' or 'suspicious' or 'atypical' for malignancy or neoplasm. Subsequent surgical resection without prior neoadjuvant therapy was performed in 377 patients with positive or suspicious cytology. The FP rate was 20/377 (5.3%) and increased to 27/377 (7.2%) when FS cases were included. The incidence of discordance was consistent over time (1996-2002: 10/118 (8.6%) vs 2003-2008: 17/259 (6.6%); p=0.5) and was higher in non-pancreatic FNA (15%) than pancreatic FNA (2.2%; p=0.0001). Two-thirds of the non-pancreatic FP cases involved sampling of perioesophageal or perirectal nodes in patients with luminal neoplasms or Barrett's oesophagus. Following pathological re-review, discordance was attributed to translocated cell contamination/sampling error (50%) or cytopathologist interpretive error (50%). Conclusions: These findings refute the accepted paradigm that FP cytology rarely occurs with EUS FNA. Further investigation revealed that FP FNA developed secondary to endosonographer technique or initial cytological misinterpretation, and is particularly likely when perioesophageal or perirectal nodes are aspirated in the setting of a luminal neoplasm or Barrett's oesophagus. Further study is needed to determine the significance of these findings and potential impact on the performance of FNA and patient outcomes.

Original languageEnglish (US)
Pages (from-to)586-593
Number of pages8
JournalGut
Volume59
Issue number5
DOIs
StatePublished - May 2010

Fingerprint

Fine Needle Biopsy
Cell Biology
Incidence
Neoplasms
Neoadjuvant Therapy
Barrett Esophagus
Surgical Pathology
Selection Bias
Tertiary Care Centers
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Gleeson, F. C., Kipp, B. R., Caudill, J. L., Clain, J. E., Clayton, A. C., Halling, K. C., ... Levy, M. J. (2010). False positive endoscopic ultrasound fine needle aspiration cytology: Incidence and risk factors. Gut, 59(5), 586-593. https://doi.org/10.1136/gut.2009.187765

False positive endoscopic ultrasound fine needle aspiration cytology : Incidence and risk factors. / Gleeson, Ferga C.; Kipp, Benjamin R.; Caudill, Jill L.; Clain, Jonathan E.; Clayton, Amy C.; Halling, Kevin C.; Henry, Michael R.; Rajan, Elizabeth; Topazian, Mark; Wang, Kenneth Ke Ning; Wiersema, Maurits J.; Zhang, Jun; Levy, Michael J.

In: Gut, Vol. 59, No. 5, 05.2010, p. 586-593.

Research output: Contribution to journalArticle

Gleeson, FC, Kipp, BR, Caudill, JL, Clain, JE, Clayton, AC, Halling, KC, Henry, MR, Rajan, E, Topazian, M, Wang, KKN, Wiersema, MJ, Zhang, J & Levy, MJ 2010, 'False positive endoscopic ultrasound fine needle aspiration cytology: Incidence and risk factors', Gut, vol. 59, no. 5, pp. 586-593. https://doi.org/10.1136/gut.2009.187765
Gleeson FC, Kipp BR, Caudill JL, Clain JE, Clayton AC, Halling KC et al. False positive endoscopic ultrasound fine needle aspiration cytology: Incidence and risk factors. Gut. 2010 May;59(5):586-593. https://doi.org/10.1136/gut.2009.187765
Gleeson, Ferga C. ; Kipp, Benjamin R. ; Caudill, Jill L. ; Clain, Jonathan E. ; Clayton, Amy C. ; Halling, Kevin C. ; Henry, Michael R. ; Rajan, Elizabeth ; Topazian, Mark ; Wang, Kenneth Ke Ning ; Wiersema, Maurits J. ; Zhang, Jun ; Levy, Michael J. / False positive endoscopic ultrasound fine needle aspiration cytology : Incidence and risk factors. In: Gut. 2010 ; Vol. 59, No. 5. pp. 586-593.
@article{c43d27c4d6ea42868301d32fd958d2e8,
title = "False positive endoscopic ultrasound fine needle aspiration cytology: Incidence and risk factors",
abstract = "Objective: It is broadly accepted that the false positive (FP) rate for endoscopic ultrasound fine needle aspiration (EUS FNA) is 0-1{\%}. It was hypothesised that the FP and false suspicious (FS) rates for EUS FNA are greater than reported. A study was undertaken to establish the rate and root cause of discordant interpretation. Design: Using a prospectively maintained endoscopic database, cytohistological discordant EUS FNA examinations from 30 July 1996 to 31 December 2008 were identified retrospectively. Setting: Tertiary referral centre. Main outcome measures: Discordant FNA was defined by positive or suspicious FNA cytology in the absence of malignancy or neoplasm in the subsequent surgical pathology specimen, specifically in the absence of neoadjuvant therapy. Three cytopathologists conducted a blinded review of randomised discordant and matched specimens. Results: FNA was performed in 5667/18 066 (31.4{\%}) patients undergoing EUS, of whom 2547 had cytology results interpreted as 'positive' or 'suspicious' or 'atypical' for malignancy or neoplasm. Subsequent surgical resection without prior neoadjuvant therapy was performed in 377 patients with positive or suspicious cytology. The FP rate was 20/377 (5.3{\%}) and increased to 27/377 (7.2{\%}) when FS cases were included. The incidence of discordance was consistent over time (1996-2002: 10/118 (8.6{\%}) vs 2003-2008: 17/259 (6.6{\%}); p=0.5) and was higher in non-pancreatic FNA (15{\%}) than pancreatic FNA (2.2{\%}; p=0.0001). Two-thirds of the non-pancreatic FP cases involved sampling of perioesophageal or perirectal nodes in patients with luminal neoplasms or Barrett's oesophagus. Following pathological re-review, discordance was attributed to translocated cell contamination/sampling error (50{\%}) or cytopathologist interpretive error (50{\%}). Conclusions: These findings refute the accepted paradigm that FP cytology rarely occurs with EUS FNA. Further investigation revealed that FP FNA developed secondary to endosonographer technique or initial cytological misinterpretation, and is particularly likely when perioesophageal or perirectal nodes are aspirated in the setting of a luminal neoplasm or Barrett's oesophagus. Further study is needed to determine the significance of these findings and potential impact on the performance of FNA and patient outcomes.",
author = "Gleeson, {Ferga C.} and Kipp, {Benjamin R.} and Caudill, {Jill L.} and Clain, {Jonathan E.} and Clayton, {Amy C.} and Halling, {Kevin C.} and Henry, {Michael R.} and Elizabeth Rajan and Mark Topazian and Wang, {Kenneth Ke Ning} and Wiersema, {Maurits J.} and Jun Zhang and Levy, {Michael J.}",
year = "2010",
month = "5",
doi = "10.1136/gut.2009.187765",
language = "English (US)",
volume = "59",
pages = "586--593",
journal = "Gut",
issn = "0017-5749",
publisher = "BMJ Publishing Group",
number = "5",

}

TY - JOUR

T1 - False positive endoscopic ultrasound fine needle aspiration cytology

T2 - Incidence and risk factors

AU - Gleeson, Ferga C.

AU - Kipp, Benjamin R.

AU - Caudill, Jill L.

AU - Clain, Jonathan E.

AU - Clayton, Amy C.

AU - Halling, Kevin C.

AU - Henry, Michael R.

AU - Rajan, Elizabeth

AU - Topazian, Mark

AU - Wang, Kenneth Ke Ning

AU - Wiersema, Maurits J.

AU - Zhang, Jun

AU - Levy, Michael J.

PY - 2010/5

Y1 - 2010/5

N2 - Objective: It is broadly accepted that the false positive (FP) rate for endoscopic ultrasound fine needle aspiration (EUS FNA) is 0-1%. It was hypothesised that the FP and false suspicious (FS) rates for EUS FNA are greater than reported. A study was undertaken to establish the rate and root cause of discordant interpretation. Design: Using a prospectively maintained endoscopic database, cytohistological discordant EUS FNA examinations from 30 July 1996 to 31 December 2008 were identified retrospectively. Setting: Tertiary referral centre. Main outcome measures: Discordant FNA was defined by positive or suspicious FNA cytology in the absence of malignancy or neoplasm in the subsequent surgical pathology specimen, specifically in the absence of neoadjuvant therapy. Three cytopathologists conducted a blinded review of randomised discordant and matched specimens. Results: FNA was performed in 5667/18 066 (31.4%) patients undergoing EUS, of whom 2547 had cytology results interpreted as 'positive' or 'suspicious' or 'atypical' for malignancy or neoplasm. Subsequent surgical resection without prior neoadjuvant therapy was performed in 377 patients with positive or suspicious cytology. The FP rate was 20/377 (5.3%) and increased to 27/377 (7.2%) when FS cases were included. The incidence of discordance was consistent over time (1996-2002: 10/118 (8.6%) vs 2003-2008: 17/259 (6.6%); p=0.5) and was higher in non-pancreatic FNA (15%) than pancreatic FNA (2.2%; p=0.0001). Two-thirds of the non-pancreatic FP cases involved sampling of perioesophageal or perirectal nodes in patients with luminal neoplasms or Barrett's oesophagus. Following pathological re-review, discordance was attributed to translocated cell contamination/sampling error (50%) or cytopathologist interpretive error (50%). Conclusions: These findings refute the accepted paradigm that FP cytology rarely occurs with EUS FNA. Further investigation revealed that FP FNA developed secondary to endosonographer technique or initial cytological misinterpretation, and is particularly likely when perioesophageal or perirectal nodes are aspirated in the setting of a luminal neoplasm or Barrett's oesophagus. Further study is needed to determine the significance of these findings and potential impact on the performance of FNA and patient outcomes.

AB - Objective: It is broadly accepted that the false positive (FP) rate for endoscopic ultrasound fine needle aspiration (EUS FNA) is 0-1%. It was hypothesised that the FP and false suspicious (FS) rates for EUS FNA are greater than reported. A study was undertaken to establish the rate and root cause of discordant interpretation. Design: Using a prospectively maintained endoscopic database, cytohistological discordant EUS FNA examinations from 30 July 1996 to 31 December 2008 were identified retrospectively. Setting: Tertiary referral centre. Main outcome measures: Discordant FNA was defined by positive or suspicious FNA cytology in the absence of malignancy or neoplasm in the subsequent surgical pathology specimen, specifically in the absence of neoadjuvant therapy. Three cytopathologists conducted a blinded review of randomised discordant and matched specimens. Results: FNA was performed in 5667/18 066 (31.4%) patients undergoing EUS, of whom 2547 had cytology results interpreted as 'positive' or 'suspicious' or 'atypical' for malignancy or neoplasm. Subsequent surgical resection without prior neoadjuvant therapy was performed in 377 patients with positive or suspicious cytology. The FP rate was 20/377 (5.3%) and increased to 27/377 (7.2%) when FS cases were included. The incidence of discordance was consistent over time (1996-2002: 10/118 (8.6%) vs 2003-2008: 17/259 (6.6%); p=0.5) and was higher in non-pancreatic FNA (15%) than pancreatic FNA (2.2%; p=0.0001). Two-thirds of the non-pancreatic FP cases involved sampling of perioesophageal or perirectal nodes in patients with luminal neoplasms or Barrett's oesophagus. Following pathological re-review, discordance was attributed to translocated cell contamination/sampling error (50%) or cytopathologist interpretive error (50%). Conclusions: These findings refute the accepted paradigm that FP cytology rarely occurs with EUS FNA. Further investigation revealed that FP FNA developed secondary to endosonographer technique or initial cytological misinterpretation, and is particularly likely when perioesophageal or perirectal nodes are aspirated in the setting of a luminal neoplasm or Barrett's oesophagus. Further study is needed to determine the significance of these findings and potential impact on the performance of FNA and patient outcomes.

UR - http://www.scopus.com/inward/record.url?scp=77951723494&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951723494&partnerID=8YFLogxK

U2 - 10.1136/gut.2009.187765

DO - 10.1136/gut.2009.187765

M3 - Article

C2 - 20427392

AN - SCOPUS:77951723494

VL - 59

SP - 586

EP - 593

JO - Gut

JF - Gut

SN - 0017-5749

IS - 5

ER -