Mohanty Sambit K, Pradhan Dinesh, Sharma Shivani, Sharma Anurag, Patnaik Niharika, Feuerman Martin, Bonasara Robert, Boyd Adrienne, Friedel David, Stavropoulos Stavros, Gupta Mala
Department of Pathology, Winthrop University Hospital, Mineola, New York.
Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India.
Diagn Cytopathol. 2018 Apr;46(4):293-298. doi: 10.1002/dc.23883. Epub 2017 Dec 27.
Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) plays an important role in the diagnosis of various lesions. We sought to determine factors that influence the diagnostic yield of EUS-FNA, specifically, the presence of a cytopathologist, FNA site, and the endoscopist's skill.
The data on cytopathologist's availability, duration of procedure, number of passes made, and diagnostic material for cell block (CB) preparation was collected over an 18 months period.
230 specimens (218 patients) were obtained from pancreas (114), lymph node (64), submucosal lesions of the gastrointestinal tract (27), liver (8), and miscellaneous (17) sites. The results were classified as informative (77.8%) and non-informative (NI) (22.2%). The NI rate was significantly high, when a cytopathologist was absent (P = .0008). As the likelihood of cytopathologist's presence increased from 35.8% to 82.9%, the CB quality increased (P < .0001). In the absence of a cytopathologist, the likelihood of NI result increased more than 2-fold (P = .03) and of an inadequate CB increased 3-fold (P < .0001). The more experienced endoscopist "C" (compared to the less experienced "A + B") was less likely to get inadequate material (40.5% vs. 66.3%) (P = .0001).
The diagnostic yield of EUS-FNA is significantly related to the presence of an on-site cytopathologist and endoscopist's skill in procuring diagnostic material.
超声内镜（EUS）引导下细针穿刺抽吸活检（FNA）在各种病变的诊断中发挥着重要作用。我们试图确定影响EUS-FNA诊断率的因素，特别是细胞病理学家的在场情况、FNA部位以及内镜医师的技术水平。
在18个月的时间里，收集了关于细胞病理学家的可用性、操作持续时间、穿刺次数以及用于制备细胞块（CB）的诊断材料的数据。
从胰腺（114例）、淋巴结（64例）、胃肠道黏膜下病变（27例）、肝脏（8例）和其他（17例）部位获取了230份标本（218例患者）。结果分为有诊断价值（77.8%）和无诊断价值（NI）（22.2%）。当细胞病理学家不在场时，NI率显著升高（P = 0.0008）。随着细胞病理学家在场可能性从35.8%增加到82.9%，CB质量提高（P < 0.0001）。在没有细胞病理学家的情况下，NI结果的可能性增加了2倍多（P = 0.03），CB不足的可能性增加了3倍（P < 0.0001）。经验更丰富的内镜医师“C”（与经验较少的“A + B”相比）获取不足材料的可能性更小（40.5%对66.3%）（P = 0.0001）。
EUS-FNA的诊断率与现场细胞病理学家的在场情况以及内镜医师获取诊断材料的技术水平显著相关。
