BACKGROUND: The effectiveness of endoscopic ultrasound-guided fine-needle aspiration increases with the number of needle passes but needle passes are also associated with increased risk of adverse events. The trade-off between needle passes and adequacy has not been well-characterized. AIMS: The purpose of this study was to compare the risk-benefit tradeoff of different sampling protocols with and without rapid onsite evaluation (ROSE). PATIENTS AND METHODS: We used a discrete-event simulation model to compare eight different sampling protocols. Each sampling protocol was simulated 10,000 times to obtain the average performance for each scenario. The per-pass adequacy rates, ROSE, accuracy of the assessor and sampling limits were varied to determine the impact of these factors on the number of needle passes and adequacy rates. RESULTS: Increasing per-class adequacy can be achieved at a cost of increased needle passes. Sampling with ROSE achieved higher adequacy with fewer needle passes than policies using a fixed number of needle passes without ROSE. CONCLUSIONS: Variable sampling policies using ROSE generally achieve greater per-case adequacy with fewer needle passes than non-ROSE sampling policies using a fixed number of passes.
BACKGROUND: The effectiveness of endoscopic ultrasound-guided fine-needle aspiration increases with the number of needle passes but needle passes are also associated with increased risk of adverse events. The trade-off between needle passes and adequacy has not been well-characterized. AIMS: The purpose of this study was to compare the risk-benefit tradeoff of different sampling protocols with and without rapid onsite evaluation (ROSE). PATIENTS AND METHODS: We used a discrete-event simulation model to compare eight different sampling protocols. Each sampling protocol was simulated 10,000 times to obtain the average performance for each scenario. The per-pass adequacy rates, ROSE, accuracy of the assessor and sampling limits were varied to determine the impact of these factors on the number of needle passes and adequacy rates. RESULTS: Increasing per-class adequacy can be achieved at a cost of increased needle passes. Sampling with ROSE achieved higher adequacy with fewer needle passes than policies using a fixed number of needle passes without ROSE. CONCLUSIONS: Variable sampling policies using ROSE generally achieve greater per-case adequacy with fewer needle passes than non-ROSE sampling policies using a fixed number of passes.
Authors: Robert L Schmidt; Michal A Kordy; Kirsten Howard; Lester J Layfield; Brian J Hall; Douglas G Adler Journal: Am J Clin Pathol Date: 2013-03 Impact factor: 2.493
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