Читать книгу Pancreatic Tumors - Группа авторов - Страница 36

For FNA of solid pancreatic lesions, rapid on-site evaluation (ROSE) has become an integral part of the procedure in many hospitals. Some studies recommend that a cytopathologist/cytotechnologist be present during the procedure for ROSE [2]. There have been several studies suggesting that there is an increase in diagnostic yield and a decreased need for repeat endoscopic ultrasound-guided (EUS)-FNA with ROSE [3–8]. ROSE is said to reduce the probability of false negative and unsatisfactory aspirations. ROSE with EUS-FNA has been reported to provide more accurate diagnoses than EUS-FNA alone [9–11]. ROSE is useful for three different reasons: (i) it helps in the assessment of the adequacy of aspirates to ensure that the lesion is appropriately sampled, (ii) it helps triage the specimen acquired appropriately, based on the initial impression after examining the slides, for additional studies such as flow cytometry, microbiology, or cell block for immunohistochemical stains, and (iii) it provides a provisional diagnosis to the echoendoscopists [11]. Based on this information, a decision is made as to whether additional passes are required or the material collected is sufficient for diagnosis. However, in recent years there have been many studies which have questioned the added benefit of ROSE. Few studies have concluded that the diagnostic yield in unassisted EUS-FNA is not inferior to ROSE-assisted EUS-FNA if at least seven passes are made from the pancreatic lesion [12–15]. A meta-analysis review concluded that ROSE does not improve EUS-FNA adequacy in pancreatic masses [16]. Hence, routine use of ROSE in EUS-FNA at tertiary cancer centers may not change clinical outcomes. This study also concluded that, since ROSE is a time-consuming service with poor reimbursement and is not available in many centers, it should not be strongly recommended for all EUS-FNA procedures for pancreatic lesions [16]. Non-assisted EUS-FNA procedures incur lower costs and a comparable rate of complications.