POSITIVE ECONOMIC AND DIAGNOSTIC-ACCURACY IMPACTS OF ON-SITE EVALUATION OF FINE-NEEDLE ASPIRATION BIOPSIES BY PATHOLOGISTS

OBJECTIVE: To investigate the impact of pathologists' immediate evalua tion of fine needle aspiration biopsy (FNAB) on increasing diagnostic yield and decreasing related expenses. STUDY DESIGN: All FNABs perform ed at our 420-bed hospital between January 1992 and December 1994 were reviewed. The 1992-1993 FNABs were all performed without pathologist attendance. Smears were wet fixed in 95% alcohol and later stained by the Papanicolaou or hematoxylin and eosin methods. The remaining aspir ated material was collected in Saccomano's preservative, and a cell bl ock was made. Nearly all the 1994 FNABs were performed with the pathol ogist present; he examined air-dried, Diff-Quik-stained smears for pre liminary evaluation of the aspirate. An average of three passes were d one. The rest of the procedure was as usual. RESULTS: The total number of 1992-1993 FNABs was 227 (108 + 119); of them, 104 (46%) were inade quate for diagnosis. In contrast, the 1994 FNABs totaled 169, with onl y 40 (24%) inadequate for diagnosis. The vast majority of the aspirate s were done on deep-seated lesions under computed tomography (CT) guid ance. CONCLUSION: The results of our experience indicate that on-site evaluation by a pathologist greatly increases the diagnostic yield. An other advantage is the significant financial savings as compared to ex cisional tissue biopsy. In general, the expenses of a CT-guided FNAB ( e.g., pancreas) average around $1,400, while charges for excisional bi opsy under general anesthesia with a subsequent two- to three-day hosp italization average about $7,720.