P1361 - The Utility of ROSE-TIC (Touch Imprint Cytology) in ...

5/25/2018

https://www.eventscribe.com/2017/wcogacg2017/ajaxcalls/PosterInfo.asp?efp=S1lVTUxLQVozODMy&PosterID=116079&rnd=0.9733847

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P1361 - The Utility of ROSE-TIC (Touch Imprint Cytology) in Expediting the Diagnosis of Intestinal and Pancreatobiliary Lesions During Endoscopic Procedures Monday, Oct 16 10:30 AM – 4:00 PM

Category: Interventional Endoscopy Saeed Ali, MD, MBBS1, Robert Hawes, MD, FACG2, Shantel Hebert-Magee, MD2, Udayakumar Navaneethan, MD, FACG3, Ji Young Bang, MD, MPH2, Konrad W. Krall, CT(ASCP)2, Shyam Varadarajulu, MD2, Muhammad Khalid Hasan, MD2 1Florida

Hospital, Orlando, FL; 2Center for Interventional Endoscopy, Florida Hospital, Orlando, FL; 3Florida Hospital, University of Central Florida College of Medicine, Orlando, FL

Introduction: Rapid onsite evaluation of touch imprint cytology (ROSE-TIC) is a simple, rapid and inexpensive technique used in the diagnosis of benign and malignant lesions. Itâ€™s utility and efficacy is well proven in guiding the extent of surgical resection margins and to assess imaging-guided biopsy specimens. However, its role in diagnosing gastrointestinal (GI) lesions during endoscopy has not been explored. The objective of this study was to evaluate the diagnostic accuracy of ROSE-TIC in diagnosing GI lesions during endoscopy. Methods: ROSE-TIC was obtained for a total of 222 cases. It involved taking biopsy (Bx) specimens and exfoliating cells by gently rubbing the tissue onto a glass slide. The slide was prepared and examined as is done with endoscopic ultrasound-fine needle aspiration (EUS-FNA) specimens. The main outcome measure was to determine the diagnostic accuracy of ROSE-TIC by comparing the cytological findings with the corresponding final off-site histological diagnosis. Results: All 222 (106 pancreatobiliary and 116 intestinal lesions) patients had a prior indeterminate diagnosis, inconclusive biopsies or benign Bx where malignancy was suspected. The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ROSE-TIC was 96.8, 83.33, 81.58, 97.22, and 89.18%, respectively. The accuracy varied with the site of Bx. The accuracy for duodenal lesions was 80% whereas it was 94% for the colorectal lesions (Table 1-2). Discussion: The overall accuracy of ROSE-TIC in this study is 89.18%. The management of benign GI lesions is different than early malignancy. Endoscopic mucosal resection (EMR) can be effectively applied to benign lesions. Whereas either endoscopic submucosal dissection (ESD) or surgery is a better option for cancers. Endoscopy is not always accurate in making this differentiation. Our study shows that the simple technique of ROSE-TIC very accurately determines the true nature of intestinal lesions, especially in the colon (94%), where it is most applicable in the U.S. allowing for an optimal treatment. ROSE-TIC can give a rapid on-site diagnosis in cases of a suspected malignancy where routine biopsy would take 2-7 days thus expediting the patient care. ROSE-TIC can help eliminate inadequate specimen procurement and sampling error thus significantly reducing the need for repeated endoscopic procedures that will reduce cost and prevent delays in patient care. https://www.eventscribe.com/2017/wcogacg2017/ajaxcalls/PosterInfo.asp?efp=S1lVTUxLQVozODMy&PosterID=116079&rnd=0.9733847

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Supported by Industry Grant: No Table 1: Showing main outcome variables for each biopsy site


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Site of Biopsy Esophagus

Total cases 19

TP 11

TN 5

FP 3

FN 0

Sensitivity 100%

Specificity 62.5%

PPV 78.6%

NPV 100%

Accuracy 84.2%

Gastroesophageal juntion

5

3

2

0

0

100%

100%

100%

100%

100%

Stomach Duodenum Ampulla of Vater Biliary tract Pancreas Jejunum Ileocecal valve Colorectal Anal canal Total

17 20 15 103 3 3 2 32 3 222

11 9 9 23 2 1 0 22 2 93

4 7 5 71 0 2 1 8 0 105

2 3 1 8 1 0 0 2 1 21

0 1 0 1 0 0 1 0 0 3

100% 90% 100% 95.8% 100% 100% 0% 100% 100% 96.8%

66.6% 70% 83.3% 89.9% 0% 100% 100% 80% 0% 83.3%

84.6% 75% 90% 74.1% 66.6% 100% 100% 66.6% 81.6%

100% 87.5% 100% 98.6% 100% 50% 91.6% 97.2%

88.2% 80% 93.3% 91.2% 66.6% 100% 50% 94% 66.6% 89.1%

TP: true positive; TN: true negative; FP: false negative; PPV: positive predictive value; NPV: negative predictive value.

Table 2: Showing final histologic diagnosis for each biopsy site


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Site of Biopsy Esophagus Gastroesophageal junction Stomach Duodenum Ampulla of Vater Biliary tract Pancreas Jejunum Ileocecal valve Colorectal Anal canal Total

Squamous cell Neuroendocrine High grade Hepatocellular Adenocarcinoma Melanoma GIST Undifferentiated Benign carcinoma tumor dysplasia carcinoma 4 5 1 1 8 -

3

-

-

-

-

-

-

2

1 6

11 4 8 18 1 1 19 1 71

1 1

4 4 1 1 2 13

1 1 2

1 1

1 1

1

6 10 6 79 1 2 1 10 1 126

GIST: Gastrointestinal stromal tumor

Citation: . THE UTILITY OF ROSE-TIC (TOUCH IMPRINT CYTOLOGY) IN EXPEDITING THE DIAGNOSIS OF INTESTINAL AND PANCREATOBILIARY LESIONS DURING ENDOSCOPIC PROCEDURES. Program No. P1361. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

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Saeed Ali Resident Physician Florida Hospital Orlando, Florida


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