Supplementary Material for: Rapid On-Site Evaluation of Fine-Needle Aspiration by Non-Cytopathologists: A Systematic Review and Meta-Analysis of Diagnostic Accuracy Studies for Adequacy Assessment

Objective: Rapid on-site evaluation (ROSE) has been shown to improve adequacy rates and reduce needle passes. ROSE is often performed by cytopathologists who have limited availability and may be costlier than alternatives. Several recent studies examined the use of alternative evaluators (AEs) for ROSE. A summary of this information could help inform guidelines regarding the use of AEs. The objective was to assess the accuracy of AEs compared to cytopathologists in assessing the adequacy of specimens during ROSE. Study Design: This was a systematic review and meta-analysis. Reporting and study quality were assessed using the STARD guidelines and QUADAS-2. All steps were performed independently by two evaluators. Summary estimates were obtained using the hierarchal method in Stata v14. Heterogeneity was evaluated using Higgins’ I2 statistic. Results: The systematic review identified 13 studies that were included in the meta-analysis. Summary estimates of sensitivity and specificity for AEs were 97% (95% CI: 92–99%) and 83% (95% CI: 68–92%). There was wide variation in accuracy statistics between studies (I2 = 0.99). Conclusions: AEs sometimes have accuracy that is close to cytopathologists. However, there is wide variability between studies, so it is not possible to provide a broad guideline regarding the use of AEs.研究目的：快速现场评估（Rapid on-site evaluation，ROSE）已被证实可提升标本合格率并减少穿刺次数。当前ROSE通常由细胞病理学家实施，但这类人员资源有限，且成本高于其他替代方案。近期多项研究探讨了ROSE场景下替代评估者（Alternative evaluators，AEs）的应用价值，对此类研究进行总结可为替代评估者的临床应用指南制定提供参考。本研究旨在对比替代评估者与细胞病理学家在ROSE过程中评估标本合格性的准确性。 研究设计：本研究为系统评价与Meta分析。采用STARD指南与QUADAS-2量表对研究报告质量及研究自身质量进行评估。所有研究步骤均由两名评估者独立完成。使用Stata v14软件中的分层分析法计算合并效应量，采用希金斯I²统计量（Higgins’ I2 statistic）评估研究间异质性。 研究结果：本系统评价共纳入13项研究用于Meta分析。替代评估者的合并灵敏度为97%（95%置信区间：92%~99%），合并特异度为83%（95%置信区间：68%~92%）。各项研究间的准确性统计指标存在较大异质性（I²=0.99）。 研究结论：替代评估者的诊断准确性有时可接近细胞病理学家。但由于各项研究间存在显著异质性，目前无法针对替代评估者的临床应用制定通用指南。