Rapid On-Site Evaluation - Efficacy of Eus FNA in Gastrointestinal and Mediastinal Lesions

Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has become an important minimally invasive technique for the evaluation of gastrointestinal and mediastinal lesions. Rapid On-Site Evaluation (ROSE) performed by a cytopathologist during the procedure allows immediate assessment of specimen adequacy and provides a preliminary diagnosis. This approach helps reduce inadequate samples, minimizes repeated needle passes, and facilitates early clinical decision-making. The present study was undertaken to evaluate the diagnostic utility and efficacy of ROSE in EUS-FNA of gastrointestinal and mediastinal lesions in a tertiary care centre. Material and Methods: This retrospective study was conducted in the Department of Pathology at a tertiary care centre over a period of one year (April 2023–May 2024). A total of 34 cases of gastrointestinal and mediastinal lesions undergoing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with Rapid On-Site Evaluation (ROSE) were included in the study. Aspirated samples were fixed in isopropyl alcohol and stained with hematoxylin and eosin. Cytological findings obtained during ROSE were analyzed and correlated with subsequent histopathological diagnosis wherever available. Demographic details, lesion sites, cytological diagnosis, and diagnostic accuracy were evaluated. Results: A total of 34 patients were included in the study, with the majority belonging to the 50–70-year age group. There was a male predominance with 20 males and 14 females. The pancreas was the most common site of lesion (60%). Among the cases studied, 12 were malignant, 10 were benign neoplastic lesions, and 12 were non-neoplastic lesions. Rapid On-Site Evaluation demonstrated a positive correlation with the final histopathological diagnosis in 22 out of 34 cases. ROSE also helped in assessing specimen adequacy and reduced the need for repeated needle passes. Conclusion: Rapid On-Site Evaluation combined with EUS-FNA is a valuable diagnostic tool for gastrointestinal and mediastinal lesions. It improves diagnostic accuracy, ensures specimen adequacy, facilitates early diagnosis, and aids in prompt clinical management with minimal complications.

Keywords: Rapid on-site evaluation, mediastinal, gastrointestinal.