RT Journal Article
SR Electronic
T1 Does pseudo-ROSE enhance the diagnostic utility for conventional TBNA?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P3590
VO 40
IS Suppl 56
A1 Andrew Medford
A1 Anilkumar Pillai
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/P3590.abstract
AB Background: Conventional transbronchial needle aspiration (TBNA) is a useful mediastinal diagnostic and staging technique1. It is more accessible and cheaper than endobronchial ultrasound. Some centres use ROSE (rapid on-site evaluation for cytology with a cytopathologist) to improve results but limited by cost and resources. There are less published studies on pseudo-ROSE (a cytotechnician assesses sample adequacy alone).Hypothesis: Pseudo-ROSE improves diagnostic utility of TBNA.Methods: 22 consecutive patients underwent pseudo-ROSE-TBNA for investigation of suspected lung cancer (with N2 or N3 disease on CT) in a UK teaching hospital by previously described methods1. Diagnostic utility to detect mediastinal metastases was calculated via contingency table analysis (GraphPad Prism 5).Results: Pseudo-ROSE-TBNA resulted in 13 true positive cases (59% of cohort) of malignancy (5 small cell, 8 non-small cell) with 7 true negative cases and 2 presumed false negative cases (10mm nodes in stations 10R and 3 on CT but not confirmed). 87% sensitivity, (compared to 78% in a UK non-ROSE study1) 78% negative predictive value, 68% cancer prevalence and 91% accuracy. Pseudo-ROSE-TBNA detected granulomatous disease due to sarcoidosis in 3 of the 7 true negative cases.Conclusion: Pseudo-ROSE improves the diagnostic utility of conventional TBNA for lymph node metastases in high prevalence cohorts with malignancy. In the absence of endobronchial ultrasound or conventional ROSE, pseudo-ROSE should be used as an effective and inexpensive adjunct to conventional TBNA.References1. Medford AR et al. A prospective study of conventional transbronchial needle aspiration: performance and cost utility. Respiration 2010;79(6):482-9.