Endoscopic ultrasonography-guided fine needle aspiration:Relatively low sensitivity in the endosonographer population

AIM:To assess the characteristics and quality of endoscopic ultrasonography-guided fine needle aspiration(EUS-FNA) in a large panel of endosonographers.METHODS:A survey was conducted during the 13th annual live course of endoscopic ultrasonography(EUS) held in Amsterdam,Netherlands.A 2-page questionnaire was developed for the study.Content validity of the questionnaire was determined based on input by experts in the field and a review of the relevant literature.It contained 30 questions that pertained to demographics and the current practice for EUS-FNA of responders,including sampling technique,sample processing,cytopathological diagnosis and sensitivity of EUS-FNA for the diagnosis of solid mass lesions.One hundred and sixty-one endosonographers who attended the course were asked to answer the survey.This allowed assessing the current practice of EUS-FNA as well as the self-reported sensitivity of EUS-FNA for the diagnosis of solid mass lesions.We also examined which factors were associated with a self-reported sensitivity of EUS-FNA for the diagnosis of solid mass lesions > 80%.RESULTS:Completed surveys were collected from 92(57.1%) of 161 endosonographers who attended the conference.The endosonographers had been practicing endoscopy and EUS for 12.5 ± 7.8 years and 4.8 ± 4.1 years,respectively;one third of them worked in a hospital with an annual caseload > 100 EUS-FNA.Endoscopy practices were located in 29 countries,including 13 countries in Western Europe that totaled 75.3% of the responses.Only one third of endosonographers reported a sensitivity for the diagnosis of solid mass lesions > 80%(interquartile range of sensitivities,25.0%-75.0%).Factors independently associated with a sensitivity > 80% were(1) > 7 needle passes for pancreatic lesions or rapid on-site cytopathological evaluation(ROSE)(P < 0.0001),(2) a high annual hospital caseload(P = 0.024) and(3) routine isolation of microcores from EUS-FNA samples(P = 0.042).ROSE was routinely available to 27.9% of respondents.For lymph nodes and pancreatic masses,a maximum of three needle passes was performed by approximately two thirds of those who did not have ROSE.Microcores were routinely harvested from EUS-FNA samples by approximately one third(37.2%) of survey respondents.CONCLUSION:EUS-FNA sensitivity was considerably lower than reported in the literature.Low EUS-FNA sensitivity was associated with unavailability of ROSE,few needle passes,absence of microcore isolation and low hospital caseload.

AIM： To assess the characteristics and quality of endoscopic ultrasonography-guided fine needle aspiration （EUS-FNA） in a large panel of endosonographers. METHODS： A survey was conducted during the 13th annual live course of endoscopic ultrasonography （EUS） held in Amsterdam, Netherlands. A 2-page question- naire was developed for the study. Content validity of the questionnaire was determined based on input by experts in the field and a review of the relevant literature. It contained 30 questions that pertained to demographics and the current practice for EUS-FNA of responders, including sampling technique, sample processing, cytopathological diagnosis and sensitivity of EUS-FNA for the diagnosis of solid mass lesions. One hundred and sixty-one endosonographers whoattended the course were asked to answer the survey. This allowed assessing the current practice of EUS-FNA as well as the self-reported sensitivity of EUS-FNA for the diagnosis of solid mass lesions. We also examined which factors were associated with a self-reported sensitivity of EUS-FNA for the diagnosis of solid mass lesions 〉 80%. RESULTS： Completed surveys were collected from 92 （57.1%） of 161 endosonographers who attended the conference. The endosonographers had been practio ing endoscopy and EUS for 22.5 4. 7.8 years and 4.8 4- 4.1 years, respectively; one third of them worked in a hospital with an annual caseload 〉 100 EUS-FNA. Endoscopy practices were located in 29 countries, in- cluding 13 countries in Western Europe that totaled 75.3% of the responses. Only one third of endosonog raphers reported a sensitivity for the diagnosis of solid mass lesions 〉 80% （interquartile range of sensitivities, 25.0%-75.0%）. Factors independently associated with a sensitivity 〉 80% were （1） 〉 7 needle passes for pancreatic lesions or rapid on-site cytopathological evaluation （ROSE） （P 〈 0.0001）, （2） a high annual hospital caseload （P = 0.024） and （3） routine isolation of microcores from EUS-FNA samples （P = 0.042）. ROSE was routinely available to 27.9% of respondents. For lymph nodes and pancreatic masses, a maximum of three needle passes was performed by approximately two thirds of those who did not have ROSE. Microcores were routinely harvested from EUS-FNA samples by approximately one third （37.2%） of survey respondents. CONCLUSION： EUS-FNA sensitivity was considerably lower than reported in the literature. Low EUS-FNA sensitivity was associated with unavailability of ROSE, few needle passes, absence of microcore isolation and low hospital caseload.