Training endosonographers in cytopathology: improving the results of EUS-guided FNA

BackgroundAlthough on-site cytopathology services have a significant impact on efficiency and accuracy of EUS-guided FNA (EUS-FNA), the availability of this service is variable.ObjectiveTo evaluate the impact of an intensive 2-day training program to educate endosonographers in EUS-related cytopathology.DesignPilot study.SettingTertiary care medical center.SubjectsSix endosonographers (5 male, median age, 35 years) with minimal previous cytopathology exposure comprised the study cohort.MethodsPre- and posttraining testing was administered. Training commenced with a cytopathology tutorial focusing on 4 performance measures: specimen adequacy, sample interpretation, specimen processing, and preliminary diagnosis. Eight live EUS-FNA cases were then performed, and study participants independently completed 4 questions based on performance measures for each case. The ability to independently smear and stain slides and operate a microscope was additionally assessed after a hands-on tutorial.Main Outcome MeasurementsComparison of pretraining and posttraining scores, improvement in performance measures for live cases, and ability to independently handle specimens and operate a microscope.ResultsCompared with pretraining, mean posttraining test scores improved by 63% from 48 to 78 out of 100. Mean live case performance score was 95%. Performances improved from 89% on day 1 to 100% on day 2. After training, all endosonographers could independently smear/stain slides and operate a microscope.LimitationsLong-term impact is unclear.ConclusionsAn intensive 2-day program was effective in training endosonographers in the basics of EUS-related cytopathology. Incorporating basic cytopathology in EUS fellowship curriculum will likely improve diagnostic performance of tissue acquisition procedures.