Research Article
Volume 7 Issue 2 - 2020
Experience Using Rapid On-Site Evaluation of Biopsies Obtained By EUS- Guided FNA Performed by Cytopathology-Trained Endoscopists
Dínimo José Bolívar-Saenz1*, Lázaro Antonio Arango2, Claudia Patricia Díaz Tobar3, Ricardo González4 and Edgar Julián Ferreira5
1General Surgeon of Universidad del Rosario, Fellow of the Clinical-Surgical Gastroenterology Program, University of Caldas, Manizales, Caldas, Colombia
2General Surgeon and Clinical Surgical Gastroenterologist, Chief of the Clinical-Surgical Gastroenterology Program, University of Caldas, Manizales, Caldas, Colombia
3General Surgeon and Clinical Surgical Gastroenterologist, University of Caldas, Manizales, Caldas, Colombia
4Anatomical and Clinical Pathologist, National University of Colombia. Professor at the Universidad Autónoma of Manizales. Manizales, Caldas, Colombia
5General Surgeon of Industrial University of Santander, Fellow of the Clinical-Surgical Gastroenterology Program, University of Caldas, Manizales, Caldas, Colombia
*Corresponding Author: Dínimo José Bolívar-Saenz, General Surgeon of Universidad del Rosario, Fellow of the Clinical-Surgical Gastroenterology Program, University of Caldas, Manizales, Caldas, Colombia.
Received: December 16, 2019; Published: January 18, 2020


Background: Biopsy by Fine-Needle Aspiration guided by ultrasonography (EUS-FNA) with rapid on-site evaluation (ROSE) by cytopathologists improves diagnostic capacity of the EUS. 

Objectives: To assess whether the usefulness of ROSE performed by endoscopists with cytopathology training improves the adequacy of tissue sampling obtained by EUS-FNA. 

Methodology: Between March and October 2015, 49 patients with solid or cystic lesions of the gastrointestinal tract were taken to EUS-FNA. Two endoscopists with short training in cytopathology performed the ROSE and they categorized samples obtained as adequate or not adequate; the results were compared with the evaluation of a pathologist, using the same criteria to assess concordance.

Results: A high concordance of a proper reading between the endoscopist and pathologist in first EUS-FNA (EUS-FNA 1) (Kappa agreement measure 81%, sig = 0.000) and second EUS-FNA (EUS-FNA 2) (Kappa agreement measure 78%, sig = 0.001) was found.

Conclusion: Endoscopists can acquire basic skills in cytopathology to perform the ROSE and the findings are consistent with those made by a pathologist. This strategy can contribute to obtaining adequate samples for cytopathology diagnosis and improve EUS-FNA diagnostic capacity. Basic cytopathology should be included as a subject in endosonography and endoscopy programs.

Keywords: EUS-FNA; ROSE; On-site Cytology; Endosonography


  1. Vilmann P., et al. “Endoscopic ultrasound with guided fine needle aspiration biopsy in pancreatic disease”. Gastrointestinal Endoscopy 38 (1992): 172-173.
  2. Hikichi T., et al. “Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists”. Journal of Gastroenterology 44.4 (2009): 322-328.
  3. Erickson RA., et al. “Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies”. Gastrointestinal Endoscopy 51 (2000): 184-190.
  4. Harewood GC., et al. “Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses”. Gastrointestinal Endoscopy 55 (2002): 669-673.
  5. Eloubeidi MA and Tamhane A. “EUS-guided FNA of solid pancreatic masses: a learning curve with 300 consecutive procedures”. Gastrointestinal Endoscopy 61 (2005): 700-708. 
  6. Mertz H and Gautam S. “The learning curve for EUS-guided FNA of pancreatic cancer”. Gastrointestinal Endoscopy 59 (2004): 33-37.
  7. Erickson RA. “EUS-guided FNA”. Gastrointestinal Endoscopy 60 (2004): 267-279.
  8. Yamao K., et al. “Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB): past, present, and future”. Journal of Gastroenterology 40 (2005): 1013-1023.
  9. Klapman JB., et al. “Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound guided fine needle aspiration”. The American Journal of Gastroenterology 98 (2003): 1289-1294.
  10. Logrono R and Waxman I. “Interactive role of the cytopathologists in EUS-guided fine needle aspiration: an effective approach”. Gastrointestinal Endoscopy 54 (2001): 485-490.
  11. DiMaio CJ., et al. “EUS core curriculum”. Gastrointestinal Endoscopy 76.3 (2012): 476-481.
  12. Wani S., et al. “Quality indicators for EUS”. Gastrointestinal Endoscopy 81.1 (2015): 67-80.
  13. LeBlanc JK., et al. “Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis”. Gastrointestinal Endoscopy 59 (2004): 475-481.
  14. Mehmood S., et al. “On site cytopathology evaluation and ancillary studies beneficial in EUS-FNA of pancreatic, mediastinal, intra-abdominal, and submucosal lesions”. Diagnostic Cytopathology 43.4 (2015): 278-286.
  15. Takahashi K., et al. “Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA”. Gastrointestinal Endoscopy 61 (2005): 76-79.
  16. Wakatsuki T., et al. “A comparative study of diagnostic value of cytologic sampling by endoscopic ultrasonography-guided fine-needle aspiration and that by endoscopic retrograde pancreatography for the management of pancreatic mass without biliary stricture”. Journal of Gastroenterology and Hepatology 20 (2005): 1701-1711.
  17. Hammoud GM., et al. “Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract Lesions”. World Journal of Gastrointestinal Oncology 6.11 (2014): 420-429.
  18. Wiersema MJ., et al. “Endosonography-guided real-time fine-needle aspiration biopsy”. Gastrointestinal Endoscopy 40 (1994): 700-707.
  19. Chang KJ., et al. “Endoscopic ultrasound-guided fine-needle aspiration”. Gastrointestinal Endoscopy 40 (1994): 694-699.
  20. Varadarajulu S., et al. “Training endosonographers in cytopathology: improving the results of EUS-guided FNA”. Gastrointestinal Endoscopy 81.1 (2015): 104-110.
  21. Petrone MC., et al. “Does cytotechnician training influence the accuracy of EUS-guided fine needle aspiration of pancreatic masses?” Digestive and Liver Disease 44 (2012): 311-314.
  22. Savoy AD., et al. “Can endosonographers evaluate on-site cytologic adequacy? A comparison with cytotechnologists”. Gastrointestinal Endoscopy 65 (2007): 953-957.
  23. Hayashi T., et al. “Rapid on-site evaluation by endosonographer during endoscopic ultrasound-guided fine needle aspiration for pancreatic solid masses”. Journal of Gastroenterology and Hepatology 28 (2013): 656-663.
  24. Samarasena JB., et al. “Endoscopic ultrasonography-guided fine-needle aspiration of pancreatic cystic lesions: a practical approach to diagnosis and management”. Gastrointestinal Endoscopy Clinics of North America 22.2 (2012): 169-185.
  25. Kim JH., et al. “Incremental value of cell block preparations over conventional smears alone in the evaluation of EUS-FNA for pancreatic masses”. Hepatogastroenterology 61.135 (2014): 2117-2122.
Citation: José Bolívar-Saenz., et al. “Experience Using Rapid On-Site Evaluation of Biopsies Obtained By EUS- Guided FNA Performed by Cytopathology-Trained Endoscopists”. EC Gastroenterology and Digestive System 7.2 (2020): 01-08.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

January Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before February 14, 2023.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.