Original article
General thoracic
A Prospective Clinical Trial of Telecytopathology for Rapid Interpretation of Specimens Obtained During Endobronchial Ultrasound–Fine Needle Aspiration

Presented at the Sixty-first Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 5–8, 2014.
https://doi.org/10.1016/j.athoracsur.2015.02.090Get rights and content

Background

Cytopathologic interpretation of endobronchial ultrasound with fine needle aspiration (EBUS-FNA) samples by a pathologist can be time-consuming and costly, and an onsite cytopathologist may not always be readily available. A telecytopathology system was instituted and evaluated to examine the effect on operative time for EBUS.

Methods

A prospective study was performed of sequential patients undergoing EBUS-FNA for the evaluation of mediastinal lymphadenopathy. Specimens for the control group were transported to the pathology laboratory, followed by remote cytologic interpretation. In a subsequent cohort, a telecytopathology system was used with intraoperative transmission of real-time live video microscopy to a remote cytopathologist (TCP group). The primary outcome was time to confirmation of cytology results.

Results

Of 46 patients entered into the study, 23 underwent traditional analysis (control group), and 20 were analyzed using telecytopathology (TCP group). Lung cancer was the most common malignancy in both groups (12 TCP, 12 control). There was no difference in mean number of lymph node stations sampled (1.3 TCP vs 1.8 control, p = 0.76). Use of TCP was associated with fewer needle passes (4.9 vs 7.3, p = 0.02) and fewer slides for interpretation (8.4 vs 13.5, p = 0.01) per procedure. Time to result confirmation was significantly shorter in the TCP group (19.0 vs 46.7 minutes, p < 0.001). A diagnostic specimen was obtained in 70% of patients in the TCP group compared with 65% in the control group (p = 0.5). False-negative rates in patients undergoing EBUS-FNA and mediastinoscopy were similar between the two groups (0 in TCP vs 2 in control, p = 0.49). Mean procedural costs (excluding cost of the telecytology system and operating room time) were equivalent between the two groups ($888 TCP vs $887 control).

Conclusions

Telecytopathology provides rapid interpretation of EBUS-FNA samples with diagnostic accuracy comparable to traditional methods, shortens procedure time, and is a more efficient model for delivery of on-site EBUS-FNA interpretation.

Section snippets

Material and Methods

We designed a single-center, prospective nonrandomized trial at Barnes-Jewish Hospital–Washington University in St. Louis School of Medicine. Following Investigational Review Board approval, we identified eligible patients in our patient clinics or from in-hospital consultations. For inclusion in the study, patients must have fulfilled all of the following criteria: mediastinal or nodal pathology, or both, requiring EBUS-FNA for diagnosis or staging, ability to tolerate general anesthesia, age

Results

From May through August 2013, 23 patients were evaluated using the conventional method (control group). The transitional phase was occurred from September through mid-October 2013 and included 17 patients to familiarize the cytology team and operating room staff with the telecytology equipment (Fig 1A and B). These patients were not included in the data analysis. The TCP phase of the study involved an additional 20 patients (TCP group) and was carried out from late October 2013 through the end

Comment

EBUS-FNA has become an important tool for the staging of lung cancer and for the evaluation and diagnosis of other intrathoracic pathology. Institutional practices regarding the evaluation of EBUS-FNA specimens obtained during these procedures vary widely. Pathologic interpretation of the specimens is provided by a cytopathologist and is the preferred method at our institution. This is particularly important if additional procedures are planned based on the biopsy results. This applies not only

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