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

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.