What I need to know and what I need to do if I do not have a cytopathologist present for the procedure

摘要

INTRODUCTIONThere is evidence enough in the literature to assert that on-site cytopathologic interpretation of the sample improves the diagnostic yield of EUS-guided FNA (EUS-FNA). Moreover, it is known that the presence of an attending cytopathologist during the procedure is cost effective,3'4 although this point may vary among different countries and institutions. Unfortunately, an on-site cytopathologist is not always available and increases the cost of the procedure. An alternative strategy could be to have an on-site cytotechnologist (able to interpret adequacy) who would submit difficult cases to the cytologist or bring the sample to the laboratory for immediate review while the endosonographer is waiting to know if more passes are necessary. Because pancreatic lesions are the most difficult to diagnose, a theoretically useful approach could be to concentrate them within the week and try to have an attendant cytopathologist for this specific group of patients. However, none of these strategies has been formally tested or compared with the others. Also, some devices consisting of a microscope provided with a digital camera can transmit the images to the cytopathologist's desktop. In this case, what is necessary to do in the EUS room is only to prepare the smears and drive the microscope.If none of the different options mentioned above is available, then the endosonographer must prepare the smears and be able to recognize the adequacy of the sample. Therefore, what do we need to know and what do we need to do when a cytopathologist is not present for the procedure?