Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses

Gastrointest Endosc. 2002 May;55(6):669-73. doi: 10.1067/mge.2002.123419.

Abstract

Background: Identification, staging, and fine needle aspiration of pancreatic mass lesions are probably the most technically demanding EUS skills. This study evaluated the effect of formal training on the diagnostic accuracy of EUS-guided fine needle aspiration (EUS-FNA) of pancreatic masses and the source of the variability in diagnostic accuracy between initial and later procedures.

Methods: Sixty-five patients with pancreatic masses underwent EUS-FNA between April 1998 (introduction of EUS-FNA) and August 1999, 20 of whom were examined by 3 endosonographers without prior experience with EUS-FNA. The initial experience of these 3 endosonographers (April to December 1998; group A patients), which included a formal training period of 2 months, and their later experience (January to August 1999; group B patients) were evaluated. Final diagnoses were determined by surgical pathology or clinical follow-up. All EUS-FNA samples were reviewed by 4 blinded pathologists to determine the contribution of pathologist interpretation to varying EUS-FNA accuracy.

Results: After a short training period, there was a significant improvement in EUS-FNA accuracy (33% vs. 91%; p = 0.004). After pathology review, good agreement was identified between original FNA interpretation and that on review (kappa = 0.78; 95% CI [0.5, 1.0]). There were differences between the mean cellularity score (2.8 vs. 1.8, p = 0.01) and mean number of passes (5.1 vs. 2.8, not significant) for correct versus incorrect FNA specimens.

Conclusion: Significant improvements in EUS-FNA accuracy can be achieved with a short period of mentored training. EUS-FNA errors during the initial learning phase are primarily due to inadequate specimens. Interpretation of pancreatic EUS-FNA specimens remained consistent before and after training.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biopsy, Needle*
  • Clinical Competence
  • Education*
  • Endosonography*
  • Female
  • Humans
  • Male
  • Mentors
  • Middle Aged
  • Pancreatic Neoplasms / diagnostic imaging*
  • Pancreatic Neoplasms / pathology*
  • Program Evaluation
  • Reproducibility of Results