ORLANDO – Having a cytopathologist on hand during an ultrasound-guided biopsy of the pancreas can increase the likelihood of getting it right on the first try, according to results from a randomized controlled trial reported at the annual Digestive Disease Week.
Among 131 patients at three clinical centers who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic masses, those randomized to procedures with on-site cytopathology (CyP+) had a significantly higher proportion of biopsies deemed suspicious or malignant than did those randomized to biopsies with no cytopathologist immediately at hand.
Patients with on-site cytopathology also were significantly more likely to have adequate specimens taken, and to require fewer EUS-FNA passes per procedure, reported Dr. Sachin Wani, of the University of Colorado Anschutz Medical Center in Aurora, and his colleagues.
Biopsies performed with cytopathologists present took about 4 minutes longer to perform, however.
Investigators in three tertiary care centers in Missouri and Colorado randomly assigned patients with pancreatic masses to undergo EUS-FNA with cytopathology on-site, with the number of needle passes determined by the judgment of the adequacy of the sample by the pathologist (maximum of 10) or the same procedure with 7 passes, with cytopathology performed later.
At each center, all final pathology slides were reviewed by cytopathologists using standard criteria for both cytologic characteristics and final cytologic diagnosis.
Cytologic criteria include adequacy of the sample, amount of blood, cellularity, and contamination. The final diagnosis categories were benign, atypical, suspicious, malignant, or inadequate.
Although more patients in the CyP+ group were diagnosed with a malignancy (80.3% vs. 67.7%), this difference was not significant. However, when samples deemed to be suspicious were included, on-site cytopathologists identified significantly more samples than pathologists who examined samples after the fact (87.9% vs. 70.8%; P = .01).
In addition, more patients in the CyP+ group had adequate specimens (93.9% vs. 81.5%; P = .03), and these specimens were acquired with significantly fewer median needle passes (three vs. seven; P less than .001).
CyP+ biopsies took an average of 23.4 minutes, compared with 19.1 minutes for biopsies with later pathology review (P = .04). But the time to review slides was significantly shorter when the cytopathologist was present (16.4 vs. 27.7 minutes; P less than .001).
Dr. Wani noted that his presentation was based on an interim analysis of an ongoing study, and that pathology readings were left to the individual treatment centers, with no central pathology performed.
The study was supported by a clinical research award from the American College of Gastroenterology. Dr. Wani reported having no financial disclosures.
