EUS-FNA with ROSE for pancreatic solid lesions: a single-center experience

Rapid On-Site Evaluation (ROSE) improves sample quality and diagnostic accuracy by allowing for immediate examination of collected specimens. In this paper we evaluated diagnostic value of Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA) and ROSE for pancreatic space occupying lesions and the rapidity of ROSE. We retrospectively analyzed 107 cases of pancreatic space-occupying lesions undergoing EUS-FNA performed by a single endoscopist at the Affiliated Cancer Hospital of Guizhou Medical University between December 2022 and October 2024. ROSE and cytological examination were conducted concurrently for all cases. Utilizing final clinical diagnoses as the reference standard, we evaluated the diagnostic performance—encompassing sensitivity, specificity, accuracy, along with positive and negative predictive values—of cytological examination, rapid on-site evaluation (ROSE), endosonography-guided fine-needle aspiration (EUS-FNA), and EUS-FNA + ROSE. Additionally, the reporting times for ROSE, cytology, and EUS-FNA pathological results were analyzed. Among 107 patients (62 males, 45 females; mean age 59.92 ± 10.98 years; mean lesion size 34.31 ± 28.36 mm), final diagnoses confirmed 87 malignant and 20 benign lesions. The diagnostic performance was as follows: Cytology: sensitivity 88.5%, specificity 100%, accuracy 90.7%, PPV 100%, NPV 66.7%;ROSE alone: sensitivity 87.3%, specificity 100%, accuracy 89.7%, PPV 100%, NPV 64.5%;EUS-FNA alone: sensitivity 89.6%, specificity 100%, accuracy 91.6%, PPV 100%, NPV 70.0%; EUS-FNA + ROSE: sensitivity 98.9%, specificity 100%, accuracy 99.1%, PPV 100%, NPV 95.2%; Statistical analysis revealed substantial agreement between ROSE (κ = 0.721), cytology (κ = 0.742), and EUS-FNA (κ = 0.764) with final diagnoses (all P < 0.05). The combined approach achieved near-perfect agreement (κ = 0.970, P < 0.05). Mean turnaround times differed significantly: ROSE (38.81 min) versus cytology (2748.25 min; ~1.9 days) and EUS-FNA pathology (5168.32 min; ~3.6 days). No procedure-related complications occurred. ROSE compensates for limitations in puncture sampling and delayed cytology reporting by providing real-time preliminary diagnosis. When integrated into EUS-FNA procedures, the combined approach demonstrates high sensitivity (98.9%) and near-perfect diagnostic consistency (κ = 0.970). This synergy increases both puncture success rates and overall diagnostic accuracy, delivering evidence-based guidance for clinical decision-making.