Enhancing Diagnostic Yield of EUS-Guided FNA Through On-site Cytopathology

Abstract

Objective: The diagnostic yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) can vary according to many factors. We aimed to determine the predictors that optimize the diagnostic yield of EUS-FNA, particularly the role of on-site cytopathologists. Methods: A total of 175 patients who underwent EUS-FNA were retrospectively enrolled in this study. Lesion localization, size, characteristics, and the presence of a cytopathologist during the examination were evaluated. A standard endoscope and a Cook Medical Echo Tip 22G needle were used to view, evaluate, and perform FNA on the lesions using the Standard Suction Technique. Results: The most common lesion location was the pancreas, accounting for 70% of cases. The average lesion size was 3.2 ± 1.7 cm. Rapid on-site pathological evaluations (ROSE) were performed for 64 patients (37%), significantly improving diagnostic rates to 78% compared to 63% without ROSE (OR 2.09, 95% CI 1-4.2, P=.039). The diagnostic yield was higher for solid lesions compared to cystic ones (OR 2.2, 95% CI 1-4.7, P=.03). A positive correlation was found between lesion size and diagnostic yield (R 0.18, P=.017). ROC analysis showed that lesions larger than 2.4 cm had a diagnostic specificity of 73% and sensitivity of 45% (AUC 0.61, P=.019). Conclusion: Our findings clearly revealed that ROSE enhances the diagnostic yield and procedural efficiency of EUS-FNA. This may be related to the high quality of smears prepared by the cytopathologist. Furthermore, larger lesion sizes were associated with higher diagnostic accuracy, particularly in pancreatic lesions.