The usefulness of visual assessment for adequacy of endosonography-guided fine needle aspiration cytology

Backgrounds:

Endosonography-guided fine needle aspiration (EUS-FNA) is useful in the diagnosis and staging of pancreatobiliary or gastrointestinal malignancy. It has been reported that on-site cytopathologic interpretation improves sample adequacy. However, it is difficult to get support from on-site cytopathologists in general practice. Thus, we conducted this study to find out whether simple visual assessment is useful enough to predict the adequacy of EUS-FNA.

Methods:

From May 2010, patients who received EUS-FNA in Asan Medical Center to confirm histology were included prospectively. At the time of EUS-FNA & specimen collection, visual assessment was performed and four morphologic criteria (non-bloody white core, bloody core with white spots, bloody core and gelatinous white material) were applied to each sample slide. Then each slide was processed to be stained at the department of cytopathology and reviewed by cytopathologists to assess the specimen adequacy.

Results:

Sixty-five specimens were collected from 25 patients. Aspirated lesions were as follows: 39 pancreas (61.9%), 13 intra-abdominal lymph nodes (20.6%), other intra-abdominal organ (12.7%) and mediastinal lymph node (4.8%). Of these, malignancies were 65.1%, borderline malignancies 3.2% and benign lesions 31.7%.

The positive predictive value (PPV) of non-bloody white core for prediction of specimen adequacy was 90.6% and the PPV of bloody core with white spots was 94.4%. Among adequate sample slides, non-bloody white core was observed in 53.7% and bloody core with white spots were observed only in 31.5%.

Conclusions:

Visual assessment of specimen adequacy seems to be very useful during EUS-FNA.

Non-bloody white core and bloody core with white spots showed very high PPV. By using morphologic criteria with high PPV, it may be possible to reduce the number of needle pass and procedural time in general fields of practice.