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Agreement between Rapid Onsite (ROSE) and
Final Cytologyin Pancreatic Cancer
Ali Lankarani, [email protected]
Ali Lankarani, MD
3rd year GI fellowAllegheny General Hospital / Drexel University
Pittsburgh
Manish K. Dhawan, MD
Disclaimer:Not an Endosonographer
Ali Lankarani, [email protected]
Pancreatic Cancer
• Fourth-leading cause of cancer death in USA
• 36,800 death in 2010 (>4 life/Hr)
• 5-year survival rate = 5.5%
• $1.5 billion is spent each year on treatment of pancreatic cancer
Ali Lankarani, [email protected]
Pancreatic Cancer
• 43,140 Americans diagnosed with Pancreatic cancer in 2010
• 1.38% of men and women born today will be diagnosed with cancer of the pancreas at some time during their lifetime
Ali Lankarani, [email protected]
Pancreatic Cancer Dx
– Cross sectional imaging with spiral CT or MRI
– Abdominal US
– EUS/FNA
– ERCP
– Serum markers
Ali Lankarani, [email protected]
EUS in Pancreatic Cancer
• EUS is sensitive but not specific
• EUS-FNA is the modality of choice for obtaining tissue
• Tissue diagnosis is mandatory before chemotherapy (not surgery!)
Ali Lankarani, [email protected]
Rapid OnSite cytologic Evaluation (ROSE)
• More than one needle pass is usually needed
• Onsite cytopathologist, if available, can confirm the adequacy of sample
• ROSE can helps with:– Adequacy of sample
– Presence of neoplastic changes
Ali Lankarani, [email protected]
Clinical Questions
• Evaluate the accuracy of pancreatic Rapid Onsite Cytologic Evaluation (ROSE) during EUS-FNA
• Identify the factors that may influence the number of FNA passes needed
• Recognize other important EUS findings that can change the management of patients with pancreatic cancer during the EUS exam
Ali Lankarani, [email protected]
Accuracy of pancreatic Rapid Onsite Cytologic Evaluation (ROSE)
• Agreement of Rapid Onsite Cytologic Evaluation (ROSE) with final interpretation is unknown
• ROSE over-read of neoplastic changes can result in premature termination of the exam
• ? Need for additional investigation in case of discrepancy
Ali Lankarani, [email protected]
ROSE Accuracy
• Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer
• Collection and analysis of:– ROSE result
– Final cytopathologic result
– Name of the cytopathologist attending involve in each case
• Exams with onsite interpretation of” malignant”, “suspicious” or “atypical” were included in the study (n=200)
Ali Lankarani, [email protected]
ROSE Accuracy
• N=200
• In 149 exams, ROSE and the final read were compatible (74.5%)
• ROSE under read the neoplastic changes in 43 exams (21.5%)
• ROSE over reads in 8 exams (4%)
Over-reading:
ROSE Final
MalignantSuspiciousAtypicalBenign
SuspiciousAtypicalBenign
Under-reading:
ROSE Final
Suspicious Malignant
AtypicalMalignantSuspicious
Definition of “over reading” and “under reading”.
Ali Lankarani, [email protected]
ROSE Accuracy
• All the patients with over-read on ROSE where recommended to have repeat EUS-FNA exam
• 62% of patients with over-read on ROSE required additional endoscopic or surgical procedures
• Incidence of ROSE over-read is cytopathologist dependent (0-7%)
YL TP ML RS JSOver Read
Same
Total
52
45
2825
50
41
35
14 18
41
9 8 12
5 92 2 2 2
0
0
10
20
30
40
50
60
Number of patients
Pathologist
Ali Lankarani, [email protected]
Identifying the factors that may influence the number of FNA passes:
• Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer (n=188)
• Analyze the effect of the following variations:– FNA needle size– Location of the mass – Size of the tumor – Endosonographer’s experience
Ali Lankarani, [email protected]
Endosonographer’s experience
0
0.5
1
1.5
2
2.5
3
3.5
25 50 75 100 125 150 175
Number of patients
Aver
age
FNA
pass
es
0
0.5
1
1.5
2
2.5
3
3.5
Numb
er of
FNA
pass
# pass head (n=34) # pass body (n=143) # pass tail (n=8)
Tumor Location
Location of the tumor
Ali Lankarani, [email protected]
Poster # 21
Detection of Metastasis during Staging EUS in Pancreatic Cancer
• Resective surgery is curative only if the pancreatic cancer is localized
• Frequency of detecting metastatic disease that was not picked on cross sectional imaging is unknown
Ali Lankarani, [email protected]
Detection of Metastasis during Staging EUS in Pancreatic Cancer
• Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer
• Collection and analysis of:– location of the extra pancreatic suspicious appearing
organs
– Final cytopathologic result
Ali Lankarani, [email protected]
Detection of Metastasis during Staging EUS in Pancreatic Cancer
• Out of 217 patients with pancreatic cancer, in 38 (17%) patients at least one new suspicious-appearing lesion separate from the pancreatic mass was detected
• 10.1% patients were upstaged because of EUS
Ali Lankarani, [email protected]
Poster # 20
