Efficacy of On-Site Specimen Adequacy Evaluation of Image-Guided Fine and Core Needle Biopsies

OBJECTIVE: To assess the value of on-site specimen adequacy evaluations. STUDY DESIGN: We reviewed reports of 144 image-guided fine and/or core needle biopsies from kidney, liver, lung, pancreas and retroperitoneum. One hundred nine (76%) had on-site evaluations performed, and 35 (24%) specimens did not receive any evaluation at the time of the procedure. Followup information up to 30 months was obtained on 131 (91%) to determine the nature of the lesion. RESULTS: For procedures involving lung, radiologists requested on-site evaluations for 93% of their procedures, while pulmonologists did not request on-site evaluations during the study period but obtained both fine needle aspirates and cores in 76% of their procedures. Radiologists were much more likely to obtain a definitive positive diagnosis for lesions that were confirmed to be malignant than pulmonologists were (20/23 [87%] vs. 5/11 [45%], p = 0.03). CONCLUSION: On-site evaluations improved the percentage of definitive "positive" diagnoses of the malignant lesions on cytology from 33% (5/15) to 74% (53/72) (p = 0.003). On-site evaluation did not have any effect on the diagnostic yield of the lesions that were determined to be benign on followup (p = 0.54).