ABSTRACT
Background: Rapid On-Site-Evaluation (ROSE) with an in-room pathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing Endoscopic Ultrasound Fine Needle Aspiration Biopsy (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and utilization of telecytology (ROSE-T) to address social distancing during the COVID-19 pandemic and to optimize clinical workflows. With ROSE-T, a technician equipped with a video conferencing capable microscope unit prepares the EUS-FNAB cytology slides, which are then examined by Cytopathologists remotely. The purpose of this study is to compare diagnostic outcomes of ROSE-P prepandemic with ROSE-T during the COVID-19 pandemic. Methods: A single-center mixed retrospective-prospective cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. All patients who underwent EUS-FNA were entered into a prospective database. The retrospective arm was patients who underwent ROSE-P pre-pandemic, whereas the prospective arm was patients who underwent ROSE-T during the pandemic. 165 patients in each group were needed to detect a 10% difference in diagnostic yield between the two groups, based on sample size calculation. An interim analysis was performed based on available data. Statistical analyses were performed using descriptive statistics and univariate analysis. Results: A total of 295 patients were enrolled in the study. 168 (57%) were in the ROSE-P group and 127 (43%) in the ROSE-T group. ROSE-T was associated with significantly more needle passes than ROSE-P (3.7 vs 3.0, p<0.0001). There was increased use of 22-gauge needle and decreased use of 25-gauge needles with ROSE-T during the pandemic (p = 0.012). There was no difference in age (63.4 vs 66.3, p=0.14), gender (43.5% vs 48.8 female gender, p=0.36), means mass size (27.2 vs 27.5 mm, p=0.14), mean procedure time (48.2 vs 46.2 minutes, p=0.92), adverse events (0.6% vs 0%, p=0.38), or diagnostic yield (97% vs 98.4%, p=0.38) between ROSEP and ROSE-T respectively. Conclusion: Rapid on-site evaluation using Telecytology was associated with more needle passes and more frequent use of 22-gauge needles as compared to ROSE-P;however, there was no difference in other important outcomes such as diagnostic yield, procedure time, and adverse events. (Table Presented)