Ecka Ruth Shifa, Sharma Malay
Department of Pathology and Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, 250001, India.
Diagn Cytopathol. 2013 Dec;41(12):1075-80. doi: 10.1002/dc.23047. Epub 2013 Oct 25.
Endoscopic ultrasound-guided-fine-needle aspiration (EUS-FNA) is the preferred modality nowadays for the cytological diagnosis of various mediastinal and gastrointestinal lesions. Onsite cytopathology interpretation is not available in most centers. The objective of this study is to assess whether rapid on-site evaluation (ROSE) by cytopathologist of the tissue samples improves the diagnostic accuracy of EUS-FNA. This study is a retrospective review of all 646 patients undergoing EUS-FNA between January 2009 and October 2012 in our hospital. Patients in group I had cytology slides prepared by an endoscopy nurse. Patients in group II had cytology slides prepared, stained and assessed for adequacy of tissue sampling by a cytopathologist onsite. The adequacy of the samples and the final cytopathological diagnosis (definitely positive, definitely negative, inconclusive, or inadequate) was compared between the two groups. A total of 425 EUS-FNA procedures were performed in 375 patients in group I and 271 EUS-FNA procedures in 271 patients in group II. The mean of needle passes in group I was 3.12 passes per patient and 3.24 passes in group II. The difference in the number of needle passes was not statistically significant (P = 0.30). The final diagnosis was definite in 64.8% in group I compared with 97.7 % in group II (P = 0.001). The percentage of inconclusive and inadequate diagnoses was 5.6% and 29.3%, respectively in group I and 0% and 2.3% in group II (P = 0.001). In conclusion, ROSE by cytopathologist and interpretation significantly improves the diagnostic yield of EUS-FNA.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）是目前用于各种纵隔和胃肠道病变细胞学诊断的首选方法。大多数中心无法进行现场细胞病理学解读。本研究的目的是评估细胞病理学家对组织样本进行快速现场评估（ROSE）是否能提高EUS-FNA的诊断准确性。本研究是对2009年1月至2012年10月期间在我院接受EUS-FNA的所有646例患者进行的回顾性研究。第一组患者的细胞学玻片由内镜护士制备。第二组患者的细胞学玻片由细胞病理学家在现场制备、染色并评估组织采样的充分性。比较两组样本的充分性和最终细胞病理学诊断（明确阳性、明确阴性、不确定或不充分）。第一组375例患者共进行了425次EUS-FNA操作，第二组271例患者共进行了271次EUS-FNA操作。第一组患者的平均穿刺次数为每人3.12次，第二组为3.24次。穿刺次数的差异无统计学意义（P = 0.30）。第一组的最终诊断明确率为64.8%，而第二组为97.7%（P = 0.001）。第一组不确定和不充分诊断的百分比分别为5.6%和29.3%，第二组为0%和2.3%（P = 0.001）。总之，细胞病理学家进行的ROSE和解读显著提高了EUS-FNA的诊断率。
