Chest
Volume 128, Issue 2, August 2005, Pages 869-875
Journal home page for Chest

Bronchoscopy
Impact of Rapid On-Site Cytologic Evaluation During Transbronchial Needle Aspiration

https://doi.org/10.1378/chest.128.2.869Get rights and content

Study objective

To determine the extent to which rapid on-site cytologic evaluation (ROSE) of transbronchial needle aspiration (TBNA) samples can safely and cost-effectively reduce the need for additional biopsy during bronchoscopy

Setting

University Hospital in Long Island, NY

Patient and methods

Forty-four bronchoscopies with TBNA, most of which utilized ROSE, were evaluated prospectively. The number and types of biopsies performed during each procedure were compared to a preprocedural algorithm to determine the impact of knowing ROSE results during the procedure. Bronchoscopies performed with and without ROSE were compared, as were bronchoscopies with diagnostic and nondiagnostic ROSE results. A cost analysis was performed comparing the Medicare reimbursement for ROSE to the savings of deferring multiple biopsies

Results

Thirty-two bronchoscopies were performed with ROSE; 12 were performed without ROSE. Fewer biopsies were performed during bronchoscopies utilizing ROSE. Diagnostic yield, TBNA sensitivity and accuracy, and procedural time were similar between these two groups

Conclusions

ROSE during TBNA allows for deferring additional biopsy without loss in diagnostic yield, likely lowers procedural risk, and is cost-effective

Section snippets

Materials and Methods

Patients scheduled to undergo TBNA at Stony Brook University Hospital were approached for study consent. The utilization of ROSE was decided by the pulmonary attending independent of the patient’s decision to participate in this study and was generally determined by scheduling concerns.

Prior to the procedure, the attending physician delineated a biopsy algorithm that listed which biopsies would be performed if ROSE were not available, which biopsies would be performed if ROSE were available and

Overall TBNA Results

In all, 44 bronchoscopies were performed on 42 patients (Table 1). Sixty-eight TBNAs were performed, of which 32 were of mediastinal lesions, 14 were of hilar lesions, and 22 were of parenchymal lesions. Ultrasound guidance was utilized for only one lesion; a lesion abutting the left mainstem lesion was aspirated and found to be a loculated pericardial effusion. No complication occurred during these bronchoscopies.

Based on the final pathology report and the clinical information available, 41

Discussion

In our study, a diagnostic ROSE result frequently spared the need for additional sampling without a reduction in diagnostic yield. Avoiding transbronchial biopsy likely reduced procedural risk. Reducing the number of samples sent to the laboratory lowered the overall cost of the procedure, and therefore ROSE was cost-effective. Utilizing ROSE did not shorten procedure time as time saved when ROSE was diagnostic was balanced by the additional time spent waiting for nondiagnostic ROSE results (

Conclusions

ROSE is accurate during TBNA and allows the deferral of additional biopsy without compromising yield. This is cost-effective and likely reduces procedural risk. ROSE did not affect diagnostic yield or procedure length. Careful preprocedure planning can predict the possible impact of ROSE, allowing optimized scheduling in institutions with limited ROSE availability. TBNA is highly accurate, and in most cases diagnostic tissue can be obtained with the first two passes. Histologic biopsy adds a

Acknowledgments

We thank the cytotechnologists and endoscopy staff who provided invaluable assistance to us in the care of our patients.

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