A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation

Filippo Natali, Alessandra Cancellieri, Carmine Tinelli, Annalisa De Silvestri, Vanina Livi, Marco Ferrari, Micaela Romagnoli, Daniela Paioli, Rocco Trisolini

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalRespiration
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Endosonography
Lymph Nodes
Pulmonologists
Neoplasms
Pathologists

Keywords

  • Endobronchial ultrasound
  • Lung cancer
  • Lymphadenopathy
  • Rapid on-site evaluation
  • Sarcoidosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation. / Natali, Filippo; Cancellieri, Alessandra; Tinelli, Carmine; De Silvestri, Annalisa; Livi, Vanina; Ferrari, Marco; Romagnoli, Micaela; Paioli, Daniela; Trisolini, Rocco.

In: Respiration, 01.01.2019.

Research output: Contribution to journalArticle

Natali, Filippo ; Cancellieri, Alessandra ; Tinelli, Carmine ; De Silvestri, Annalisa ; Livi, Vanina ; Ferrari, Marco ; Romagnoli, Micaela ; Paioli, Daniela ; Trisolini, Rocco. / A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation. In: Respiration. 2019.
@article{7ce531b140ba4d7eb6441403143195bc,
title = "A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation",
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.",
keywords = "Endobronchial ultrasound, Lung cancer, Lymphadenopathy, Rapid on-site evaluation, Sarcoidosis",
author = "Filippo Natali and Alessandra Cancellieri and Carmine Tinelli and {De Silvestri}, Annalisa and Vanina Livi and Marco Ferrari and Micaela Romagnoli and Daniela Paioli and Rocco Trisolini",
year = "2019",
month = "1",
day = "1",
doi = "10.1159/000496549",
language = "English",
journal = "Respiration; international review of thoracic diseases",
issn = "0025-7931",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation

AU - Natali, Filippo

AU - Cancellieri, Alessandra

AU - Tinelli, Carmine

AU - De Silvestri, Annalisa

AU - Livi, Vanina

AU - Ferrari, Marco

AU - Romagnoli, Micaela

AU - Paioli, Daniela

AU - Trisolini, Rocco

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Endobronchial ultrasound

KW - Lung cancer

KW - Lymphadenopathy

KW - Rapid on-site evaluation

KW - Sarcoidosis

UR - http://www.scopus.com/inward/record.url?scp=85064901890&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064901890&partnerID=8YFLogxK

U2 - 10.1159/000496549

DO - 10.1159/000496549

M3 - Article

C2 - 30982053

AN - SCOPUS:85064901890

JO - Respiration; international review of thoracic diseases

JF - Respiration; international review of thoracic diseases

SN - 0025-7931

ER -