Providing on-site diagnosis of malignancy on endoscopic-ultrasound-guided fine-needle aspirates: should it be done?

Jhala, Nirag C.; Eltoum, Isam A.; Eloubeidi, Mohamad A.; Meara, Regina; Chhieng, David C.; Crowe, D. Ralph; Jhala, Darshana

doi:10.1016/j.anndiagpath.2006.03.005

« Previous Next »Annals of Diagnostic Pathology
Volume 11, Issue 3 , Pages 176-181, June 2007

Providing on-site diagnosis of malignancy on endoscopic-ultrasound-guided fine-needle aspirates: should it be done?

Nirag C. Jhala, MD, MIAC
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
- Corresponding author. Division of Anatomic Pathology, KB 531, University of Alabama at Birmingham, Birmingham, AL 35249, USA. Tel.: +1 205 975 8898; fax: +1 205 975 7286.
Isam A. Eltoum, MD, MBA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
Mohamad A. Eloubeidi, MD, MHS
- Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
Regina Meara, MD
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
David C. Chhieng, MD, MBA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
D. Ralph Crowe, MD
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
Darshana Jhala, BMUS, MD
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA

Abstract

Background

Rapid and accurate tissue diagnosis for a deep-seated malignancy would allow treating physicians to provide disease-specific interventions and help patients make early informed management decisions. Providing on-site tissue diagnosis for fine-needle aspirate samples obtained with endosonography would help develop such efficient patient management issues. Here we report our experience of prospectively providing on-site diagnosis on 485 endoscopic ultrasound fine-needle aspirate samples.

Methods

Four hundred eighty-five endoscopic ultrasound fine-needle aspirates from the pancreas (n= 305), lymph nodes (n = 91), biliary tree (n = 47), liver (n = 15), gastrointestinal tract (n = 19), and adrenal gland (n = 8) were reviewed. For all aspirates, the cytologic diagnoses, both preliminary and final, were categorized into the following: positive for malignancy, positive for neoplastic process, suspicious for malignancy, atypical cells, reactive process, and nondiagnostic.

Results

Of the 485 cases, 163 (33.6%) were diagnosed as benign, 43 (8.8%) as atypical, 21 (4.3%) as suspicious, 18 (3.7%) as positive for neoplasm, and 230 (47.4%) as malignant after final cytologic interpretation. A significantly (P < .001) higher degree of concordance was noted for unequivocal diagnosis of malignancy (196/198, 98.9%) vs nonmalignancy (200/250, 67.2%) between on-site and final cytologic diagnosis. Of the 52 discordant cases, 12 (2.6%) diagnoses were downgraded and 40 (8.9%) were upgraded from preliminary on-site diagnosis. Our overall sensitivity (87 vs 92), specificity (95% vs 100%), and accuracy (90% vs 94%) improved for final cytologic diagnosis.

Conclusion

On-site diagnosis of malignancy could be used to initiate informed patient management decisions. Cases where a diagnosis of malignancy is not rendered at on-site interpretation need further cytologic evaluation.

Keywords: Endoscopic ultrasound, Fine-needle aspiration, Pancreas, Lymph node, Bile duct, Adrenal gland, Liver, Gastrointestinal tract, Diagnosis