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Saudi presentation with audio

  1. 1. Agreement between Rapid Onsite (ROSE) and Final Cytology in Pancreatic Cancer Ali Lankarani, MD [email_address]
  2. 2. Ali Lankarani, MD 3rd year GI fellow Allegheny General Hospital / Drexel University Pittsburgh Manish K. Dhawan, MD Disclaimer: Not an Endosonographer Ali Lankarani, MD [email_address]
  3. 3. Pancreatic Cancer <ul><li>Fourth-leading cause of cancer death in USA </li></ul><ul><li>36,800 death in 2010 (>4 life/Hr) </li></ul><ul><li>5-year survival rate = 5.5% </li></ul><ul><li>$1.5 billion is spent each year on treatment of pancreatic cancer </li></ul>Ali Lankarani, MD [email_address]
  4. 4. Pancreatic Cancer <ul><li>43,140 Americans diagnosed with Pancreatic cancer in 2010 </li></ul><ul><li>1.38% of men and women born today will be diagnosed with cancer of the pancreas at some time during their lifetime </li></ul>Ali Lankarani, MD [email_address]
  5. 5. Pancreatic Cancer Dx <ul><ul><li>Cross sectional imaging with spiral CT or MRI </li></ul></ul><ul><ul><li>Abdominal US </li></ul></ul><ul><ul><li>EUS/FNA </li></ul></ul><ul><ul><li>ERCP </li></ul></ul><ul><ul><li>Serum markers </li></ul></ul>Ali Lankarani, MD [email_address]
  6. 6. EUS in Pancreatic Cancer <ul><li>EUS is sensitive but not specific </li></ul><ul><li>EUS-FNA is the modality of choice for obtaining tissue </li></ul><ul><li>Tissue diagnosis is mandatory before chemotherapy (not surgery!) </li></ul>Ali Lankarani, MD [email_address]
  7. 7. Rapid OnSite cytologic Evaluation (ROSE) <ul><li>More than one needle pass is usually needed </li></ul><ul><li>Onsite cytopathologist, if available, can confirm the adequacy of sample </li></ul><ul><li>ROSE can helps with: </li></ul><ul><ul><li>Adequacy of sample </li></ul></ul><ul><ul><li>Presence of neoplastic changes </li></ul></ul>Ali Lankarani, MD [email_address]
  8. 8. Clinical Questions <ul><li>Evaluate the accuracy of pancreatic Rapid Onsite Cytologic Evaluation (ROSE) during EUS-FNA </li></ul><ul><li>Identify the factors that may influence the number of FNA passes needed </li></ul><ul><li>Recognize other important EUS findings that can change the management of patients with pancreatic cancer during the EUS exam </li></ul>Ali Lankarani, MD [email_address]
  9. 9. Accuracy of pancreatic Rapid Onsite Cytologic Evaluation (ROSE) <ul><li>Agreement of Rapid Onsite Cytologic Evaluation (ROSE) with final interpretation is unknown </li></ul><ul><li>ROSE over-read of neoplastic changes can result in premature termination of the exam </li></ul><ul><li>? Need for additional investigation in case of discrepancy </li></ul>Ali Lankarani, MD [email_address]
  10. 10. ROSE Accuracy <ul><li>Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer </li></ul><ul><li>Collection and analysis of: </li></ul><ul><ul><li>ROSE result </li></ul></ul><ul><ul><li>Final cytopathologic result </li></ul></ul><ul><ul><li>Name of the cytopathologist attending involve in each case </li></ul></ul><ul><li>Exams with onsite interpretation of” malignant”, “suspicious” or “atypical” were included in the study (n=200) </li></ul>Ali Lankarani, MD [email_address]
  11. 11. ROSE Accuracy <ul><li>N=200 </li></ul><ul><li>In 149 exams, ROSE and the final read were compatible (74.5%) </li></ul><ul><li>ROSE under read the neoplastic changes in 43 exams (21.5%) </li></ul><ul><li>ROSE over reads in 8 exams (4%) </li></ul>Ali Lankarani, MD [email_address] Definition of “over reading” and “under reading”. Malignant Suspicious Atypical Malignant Suspicious Final ROSE Under-reading: Atypical Benign Suspicious Suspicious Atypical Benign Malignant Final ROSE Over-reading:
  12. 12. ROSE Accuracy <ul><li>All the patients with over-read on ROSE where recommended to have repeat EUS-FNA exam </li></ul><ul><li>62% of patients with over-read on ROSE required additional endoscopic or surgical procedures </li></ul><ul><li>Incidence of ROSE over-read is cytopathologist dependent (0-7%) </li></ul>Ali Lankarani, MD [email_address]
  13. 13. Identifying the factors that may influence the number of FNA passes: <ul><li>Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer (n=188) </li></ul><ul><li>Analyze the effect of the following variations: </li></ul><ul><ul><li>FNA needle size </li></ul></ul><ul><ul><li>Location of the mass </li></ul></ul><ul><ul><li>Size of the tumor </li></ul></ul><ul><ul><li>Endosonographer’s experience </li></ul></ul>Ali Lankarani, MD [email_address]
  14. 14. Endosonographer’s experience Location of the tumor Ali Lankarani, MD [email_address] Poster # 21
  15. 15. Detection of Metastasis during Staging EUS in Pancreatic Cancer <ul><li>Resective surgery is curative only if the pancreatic cancer is localized </li></ul><ul><li>Frequency of detecting metastatic disease that was not picked on cross sectional imaging is unknown </li></ul>Ali Lankarani, MD [email_address]
  16. 16. Detection of Metastasis during Staging EUS in Pancreatic Cancer <ul><li>Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer </li></ul><ul><li>Collection and analysis of: </li></ul><ul><ul><li>location of the extra pancreatic suspicious appearing organs </li></ul></ul><ul><ul><li>Final cytopathologic result </li></ul></ul>Ali Lankarani, MD [email_address]
  17. 17. Detection of Metastasis during Staging EUS in Pancreatic Cancer <ul><li>Out of 217 patients with pancreatic cancer, in 38 (17%) patients at least one new suspicious-appearing lesion separate from the pancreatic mass was detected </li></ul><ul><li>10.1% patients were upstaged because of EUS </li></ul>Ali Lankarani, MD [email_address] Poster # 20
  18. 18. Multimedia Resources in Endoscopic Training TGIE, April 2011 Ali Lankarani, MD [email_address]
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