Cytotechnologist on-site evaluation of pancreas fine needle aspiration adequacy: comparison with cytopathologists and correlation with the final interpretation

Abstract

Objective: To compare on-site evaluations of adequacy (OSEA) of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of the pancreas performed by cytotechnologists and cytopathologists.

Study design: A 10-year retrospective review of 2,426 OSEA from 2,223 procedures in 1,984 patients was performed. Adequacy statistics were calculated along with the accuracy of the OSEA for each OSEA provider. The effect of other variables, including the lifetime number of EUS pancreatic OSEA, the number of years of experience at the time of each case, the institutional number of EUS FNA, and the number of smears was evaluated with ANOVA.

Results: There was no difference in the adequacy downgrade rate for cytotechnologists versus cytopathologists during this study period (38.2 vs. 32.2%, p = 0.13). Neither individual cytologist experience with EUS-guided pancreatic FNA (p = 0.25) nor years in practice (p = 0.86) was correlated with the accuracy of the OSEA. The experience of the institution with EUS-guided pancreatic FNA was correlated with both adequacy (p = 0.003) and accuracy (p = 0.000001).

Conclusion: Cytotechnologists and cytopathologists are comparably accurate in OSEA of EUS-guided pancreatic FNA. The adequacy and accuracy of the OSEA increase with institutional experience, and this increase is not solely attributable to cytologist factors.