Rapid on-site evaluation vs. randomly collected samples from mediastinal and
abdominal lymph nodes obtained by endoscopic ultrasound-guided fine-needle-aspiration

Endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) of lymph nodes is an important diagnostic instrument for an increasing number of disorders. A representative sample of the lymph node is essential for making a diagnosis. Therefore, there is an ongoing ambition to improve the diagnostic accuracy of EUS-FNA. Rapid on-site evaluation
(ROSE), with a cytotechnician or cytopathologist on-site, is an option to achieve this. However, the additional value of ROSE with regard to lymph nodes has never been studied
in a randomized controlled trial. We hypothesize that ROSE increases the diagnostic accuracy of EUS-FNA of mediastinal and abdominal lymph nodes when compared to random “blind” FNA.

The hypothesis is that rapid on-site evaluation increases diagnostic accuracy of EUS-FNA aof lymph nodes

Baseline: patient characteristics

1 week after procedure: (severe) adverse events

1 month after procedure: (severe) adverse events

6 months after procedure: Final diagnosis is determined

patients who gave informed consent in who EUS-FNA of a mediastinal/abdominal lymph node is performed are randomized to rapid on-site evaluation after each pass or to 'Random', in which case 5 passes are done before the cyto-technician informs the endosonographer whether the samples are adequate. This way, a situation in which the technician is not in the room is simulated. At a later time, all samples are reviewed by a dedicated pathologist.