Tu1561 The Performance of Pathology Trainees Compared to Non-Physician Cytotechnologists in the Assessment of EUS-FNA Specimen Adequacy

The Performance of Pathology Trainees Compared to NonPhysician Cytotechnologists in the Assessment of EUS-FNA Specimen Adequacy James L. Buxbaum*, Arthur W. Yan, Kavel H. Visrodia, Christianne J. Lane, Brett Quarto, Michael Y. Chan, Mehrdad Saliminejad Division of Gastrointestinal & Liver Diseases, Univ. of Southern California, Los Angeles, CA Background: The performance of rapid on-site evaluation (ROSE) of endoscopic ultrasound fine needle aspiration (EUS-FNA) samples by an attending cytopathologist to determine specimen adequacy has been shown to minimize additional procedures, optimize associated costs, and reduce complications. However, due to financial and manpower limitations, ROSE by an attending cytopathologists is not available at many centers and the realtime assessment of adequacy of EUS-FNA specimens is done by pathology trainees (resident or fellow) or cytotechnologists. The aim of this study is to compare the performance of pathology trainees and cytotechnologists in the determination of EUS-FNA specimen adequacy. Methods: A prospective database was developed in January 2010 following the establishment of two new academic ultrasound programs, one at Los Angeles County Hospital Medical Center (LAC), and the other at the USC Keck and Norris Hospitals (USC), a tertiary referral medical center. Among 365 consecutive patients, 221 anatomic targets were biopsied via EUS-FNA. EUS was performed at both centers by the same endosonographer and the same team of attending cytopathologists evaluated the samples after completion of the procedures. Real time adequacy of EUS-FNA samples at LAC was determined by pathology trainees, while at USC this was determined by non-physician cytotechnologists. The final assessment of the attending cytopathologist was the gold standard used to compare the performance of the trainees versus the cytotechnologists. Results: During the bedside evaluation all of the FNA samples were felt to be adequate at both institutions. However, final review of the samples by an attending pathologist determined that the adequacy of the specimens was 65.2% at LAC and 70.5% at USC (Table 1). There was no significant difference in the assessment of specimen adequacy by pathology trainees compared to experienced technologists (P 0.462). No difference in the performance of cytology trainees and the technicians was seen when the comparison was stratified by FNA target including pancreas masses, lymph nodes, or subepithelial lesions. Impression: These results suggest that there is no difference in the determination of diagnostic adequacy by a pathology trainee (resident or fellow) compared to an experienced non-physician cytology technician. Nonetheless, assessment of adequacy by both groups was suboptimal, which further underscores the need for an attending cytopathologist to determine the adequacy of EUS acquired fine needle aspirates in real-time. Other alternatives including telecytology, which allows for microscope images to be dynamically transmitted to a remotely located pathologist during EUS-FNA, are important considerations in health care systems where pathology resources are limited.