Full
Outline
Determine whether a modified macroscopic on-site evaluation （MOSE) technique, by enhancing visualization of the macroscopic visible core (MVC) in 22G/25G fine needle aspiration (FNA) specimens, improves specimen adequacy and pathological diagnostic accuracy.
This single-center, prospective, randomized crossover trial enrolled 90 consecutive patients with solid pancreatic lesions scheduled for EUS-FNA from the Department of Gastroenterology at the Third People’s Hospital of Chengdu between February 2023 and August 2024. Patients were randomly assigned (1∶1) via a computer-generated sequence to Group A (first pass using traditional MOSE, second pass using modified MOSE) or Group B (first pass using modified MOSE, second pass using traditional MOSE). The core modification was the use of an adjustable white light source from 35 to 1 700 LUX at a fixed distance (37.2 mm) from the slide. Specimen adequacy was defined as MVC≥4 mm. The primary outcome was the specimen adequacy rate between groups. Secondary outcomes included the diagnostic accuracy of cytopathology and histopathology. Bias was controlled through blinded assessment (pathologists and data analysts were unaware of group allocation) and standardized operating procedures.
The specimen adequacy rate was significantly higher in the modified MOSE group (70.0%, 95%CI: 59.9 to 78.5%) than in the traditional MOSE group (43.3%, 95%CI: 33.6 to 54.6%; χ²=13.714, P<0.001). The modified MOSE group also demonstrated superior diagnostic accuracy for both cytopathology ［94.4%(95%CI: 87.7%~97.6%) vs 85.6%(95%CI: 76.8%~91.4%),χ2=4.9, P=0.021) and histopathology of tissue strips ［95.6%(95%CI: 89.1%~98.3%) vs 83.3%(95%CI: 76.8%~91.4%),χ2=7.69, P=0.003]. Subgroup analysis based on needle gauge demonstrated that for the 22G needle, which constituted 87.8% (79/90) of cases, the modified MOSE demonstrated statistically significant advantages over the traditional MOSE in the following outcomes: specimen adequacy rate [65.8% (95%CI: 55.1% to 76.5%) vs 41.8% (95%CI: 30.7% to 52.9%), P=0.003], cytological diagnostic accuracy [93.7% (95%CI: 88.1% to 99.2%) vs 84.8% (95%CI: 76.7% to 92.9%), P=0.039], and histological diagnostic accuracy [94.9% (95%CI: 90.0% to 99.9%) vs 82.3% (95%CI: 73.7% to 90.9%), P=0.013].
Modified MOSE can enhance the visualization of the MVC in specimens obtained by 22G/25G FNA, thereby improving the specimen adequacy rate and pathological diagnostic accuracy.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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