Digestive Diseases and Sciences

, Volume 58, Issue 11, pp 3280–3286

Rapid On-Site Evaluation Reduces Needle Passes in Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Solid Pancreatic Lesions: A Risk–Benefit Analysis

  • Robert L. Schmidt
  • Brandon S. Walker
  • Kirsten Howard
  • Lester J. Layfield
  • Douglas G. Adler
Original Article

DOI: 10.1007/s10620-013-2750-6

Cite this article as:
Schmidt, R.L., Walker, B.S., Howard, K. et al. Dig Dis Sci (2013) 58: 3280. doi:10.1007/s10620-013-2750-6



The effectiveness of endoscopic ultrasound-guided fine-needle aspiration increases with the number of needle passes but needle passes are also associated with increased risk of adverse events. The trade-off between needle passes and adequacy has not been well-characterized.


The purpose of this study was to compare the risk–benefit tradeoff of different sampling protocols with and without rapid onsite evaluation (ROSE).

Patients and Methods

We used a discrete-event simulation model to compare eight different sampling protocols. Each sampling protocol was simulated 10,000 times to obtain the average performance for each scenario. The per-pass adequacy rates, ROSE, accuracy of the assessor and sampling limits were varied to determine the impact of these factors on the number of needle passes and adequacy rates.


Increasing per-class adequacy can be achieved at a cost of increased needle passes. Sampling with ROSE achieved higher adequacy with fewer needle passes than policies using a fixed number of needle passes without ROSE.


Variable sampling policies using ROSE generally achieve greater per-case adequacy with fewer needle passes than non-ROSE sampling policies using a fixed number of passes.


EUS FNA Pancreas ROSE 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Robert L. Schmidt
    • 1
    • 3
  • Brandon S. Walker
    • 3
  • Kirsten Howard
    • 5
  • Lester J. Layfield
    • 4
  • Douglas G. Adler
    • 2
    • 6
  1. 1.Department of PathologyUniversity of Utah School of MedicineSalt Lake CityUSA
  2. 2.Gastroenterology Division, Department of GastroenterologyUniversity of Utah School of MedicineSalt Lake CityUSA
  3. 3.ARUP LaboratoriesSalt Lake CityUSA
  4. 4.Department of Pathology and Anatomical SciencesUniversity of MissouriColumbiaUSA
  5. 5.The Sydney School of Public HealthUniversity of SydneySydneyAustralia
  6. 6.Department of Internal Medicine, Gastroenterology DivisionUniversity of Utah School of MedicineSalt Lake CityUSA

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