Filippo Natali1, Alessandra Cancellieri2, Carmine Tinelli3, Annalisa De Silvestri3, Vanina Livi1, Marco Ferrari1, Micaela Romagnoli1, Daniela Paioli1, Rocco Trisolini4. 1. Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy. 2. Pathology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy. 3. Clinical Epidemiology and Biometry Unit, IRCCS Policlinico San Matteo, Pavia, Italy. 4. Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy, rocco.trisolini@aosp.bo.it.
Abstract
BACKGROUND: The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials that show a lack of increase in diagnostic yield and specimen adequacy associated with its usage. OBJECTIVE: We aimed to verify whether a pulmonologist can assess endosonography-derived lymph node samples after a comprehensive and reproducible training provided by a specialist pathologist. METHODS: Prospective, observational trial structured in three phases. In the first (training) phase, a pathologist critically evaluated the smears from 150 archival endosonography cases with a pulmonologist. In the second (test) phase, the pulmonologist was asked to assess 50 archival endosonography-derived samples. In the last (real-life) phase, the pulmonologist classified the samples from 200 patients during the endosonography. The overall agreement between pulmonologist and pathologist (gold standard), assessed through κ-statistics, was the primary outcome. The agreement for the identification of specific cytological categories was the secondary outcome. RESULTS: The overallagreement between pulmonologist and pathologist was 84% (κ0.765, 95% CI 0.732-0.826) in the test phase and 89.7% (κ 0.844, 95% CI 0.799-0.881) in the real-life phase. The agreement for specific cytological categories was 92.7% (95% CI 0.824-0.980) for inadequate samples, 90.3% (95% CI 84.5-94.5%) for reactive lymphadenopathies, 90.5% (95% CI 0.845-0.946) for malignancy, and 73% (95% CI 0.515-0.897) for granulomatous samples. CONCLUSIONS: A trained pulmonologist can reliably assess adequacy and malignancy for endosonography-derived samples, which could be useful in institutions where a cytopathologist/cytotechnician is not available regularly.
BACKGROUND: The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials that show a lack of increase in diagnostic yield and specimen adequacy associated with its usage. OBJECTIVE: We aimed to verify whether a pulmonologist can assess endosonography-derived lymph node samples after a comprehensive and reproducible training provided by a specialist pathologist. METHODS: Prospective, observational trial structured in three phases. In the first (training) phase, a pathologist critically evaluated the smears from 150 archival endosonography cases with a pulmonologist. In the second (test) phase, the pulmonologist was asked to assess 50 archival endosonography-derived samples. In the last (real-life) phase, the pulmonologist classified the samples from 200 patients during the endosonography. The overall agreement between pulmonologist and pathologist (gold standard), assessed through κ-statistics, was the primary outcome. The agreement for the identification of specific cytological categories was the secondary outcome. RESULTS: The overallagreement between pulmonologist and pathologist was 84% (κ0.765, 95% CI 0.732-0.826) in the test phase and 89.7% (κ 0.844, 95% CI 0.799-0.881) in the real-life phase. The agreement for specific cytological categories was 92.7% (95% CI 0.824-0.980) for inadequate samples, 90.3% (95% CI 84.5-94.5%) for reactive lymphadenopathies, 90.5% (95% CI 0.845-0.946) for malignancy, and 73% (95% CI 0.515-0.897) for granulomatous samples. CONCLUSIONS: A trained pulmonologist can reliably assess adequacy and malignancy for endosonography-derived samples, which could be useful in institutions where a cytopathologist/cytotechnician is not available regularly.
Authors: David Fielding; Andrew J Dalley; Mahendra Singh; Lakshmy Nandakumar; Katia Nones; Vanessa Lakis; Haarika Chittoory; Kaltin Ferguson; Farzad Bashirzadeh; Michael Bint; Carl Pahoff; Jung Hwa Son; Alan Hodgson; Sowmya Sharma; David Godbolt; Kylie Coleman; Lenore Whitfield; Nicola Waddell; Sunil R Lakhani; Gunter Hartel; Peter T Simpson Journal: JTO Clin Res Rep Date: 2022-08-30