Chest
BronchoscopyImpact of Rapid On-Site Cytologic Evaluation During Transbronchial Needle Aspiration
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.
References (37)
- et al.
Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy
Chest
(2000) Rapid on-site evaluation of transbronchial aspirates
Chest
(1990)- et al.
Education and experience improve the performance of transbronchial needle aspiration: a learning curve at a cancer center
Chest
(2004) - et al.
Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules
Chest
(2000) - et al.
Transbronchial needle aspiration: an underused diagnostic technique
Clin Chest Med
(1999) - et al.
Conventional versus endobronchial-guided transbronchial needle aspiration: a randomized trial
Chest
(2004) - et al.
Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes
Chest
(2004) - et al.
Transbronchial needle aspiration: guidance with CT fluoroscopy
Chest
(2000) - et al.
Transbronchial needle aspiration for histology specimens
Chest
(1989) - et al.
Diagnostic value of transbronchial needle aspiration by Wang 22-gauge cytology needle in intrathoracic lymphadenopathy
Chest
(2004)
The value of flexible transbronchial needle aspiration in the diagnosis of stage I sarcoidosis
Chest
Transbronchial needle aspiration in the diagnosis and staging of bronchogenic carcinoma
Am Rev Respir Dis
The utility of transbronchial needle aspiration in the staging of bronchogenic carcinoma
Am J Respir Crit Care Med
Transbronchial needle aspiration staging of bronchogenic carcinoma
Am Rev Respir Dis
Transbronchial needle aspiration in the practice of bronchoscopy
Mayo Clin Proc
Comparison of the diagnostic accuracy of transbronchial needle aspiration for bronchogenic carcinoma and other malignancies
J Bronchol
Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies
Gastrointest Endosc
Cited by (133)
Application of rapid on-site evaluation combined with flexible bronchoscopy in the diagnosis of lung lesions
2024, Annals of Diagnostic PathologyAssessing ROSE for adequacy of EBUS-TBNA compared with a direct-to-cell block approach as a response to the COVID-19 pandemic
2022, Journal of the American Society of CytopathologyCitation Excerpt :Rapid on-site evaluation (ROSE) of the cytology aspirate has been used during the needle aspiration procedure to improve the diagnostic yield,3-7 decrease unnecessary passes, and, ultimately, decrease the risk and complications associated with additional sampling, as well as decreasing the time and cost.6,8-12 Some investigators have argued that the use of ROSE does not help obtain adequate specimens, can only confirm specimen adequacy after the fact,13 and that more recent randomized studies found no differences in adequacy or diagnostic yield with and without ROSE.8-10,14 However, most institutes have recommended the use of ROSE during TBNA, in particular to improve clinical decision-making, including triage samples for flow cytometry analysis, microbiology studies, or predictive molecular testing for personalized treatment.6,7,9,12,14,15
The optimal approach of EBUS-FNA rapid on-site evaluation (ROSE): a five-year experience from a large academic medical center
2022, Journal of the American Society of CytopathologyManagement of Small Histologic and Cytologic Specimens in the Molecular Era
2018, IASLC Thoracic OncologyEarly experience of endobronchial ultrasound-guided transbronchial nodal cryobiopsy: a case series from Sabah, Malaysia
2024, Therapeutic Advances in Respiratory DiseaseEvaluation of automated sample preparation system for lymph node sampling
2023, Journal of Thoracic Disease
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml)