Adequate at rapid on‐site evaluation (ROSE), but inadequate on final cytologic diagnosis: Analysis of 606 cases of endobronchial ultrasound‐guided trans bronchial needle aspirations (EBUS‐TBNA)

Abstract

Background EBUS‐TBNA is a minimally invasive, reliable technique with high sensitivity and accuracy. ROSE plays a crucial role in triaging specimens to guide management. This study analyzes aspirates that were deemed “adequate” on ROSE, but inconclusive upon final cytologic interpretation. Design EBUS‐TBNAs from 2015 and 2016 were retrospectively reviewed and analyzed for ROSE adequacy versus final cytologic diagnosis. Concurrent and subsequent procedures were evaluated to determine the outcome of ROSE‐adequate cases with inconclusive final cytologic diagnosis of non‐diagnostic (ND), atypical (ATY), and suspicious for malignancy (SUS). Interpretation at ROSE was determined to be “appropriate” if published criteria for lymph node adequacy were met. Results A total of 606 cases of EBUS‐FNA with ROSE were obtained of which 61% were deemed adequate. 5% of cases deemed “adequate” at ROSE resulted in inconclusive final interpretation with 4 ND, 7 ATY, and 6 SUS. Their distribution, anatomic location, presence or absence of diagnostic aspirate, appropriateness of ROSE adequacy statement, and any concurrent or subsequent procedures on the same or different site as well as any impact on management was reviewed. Cytotechnologist (CT) experience ranged from 1 to 25 years. Conclusions ROSE and final cytology discrepant cases formed a very small fraction of total number of EBUS‐TBNA cases with onsite evaluation. None of these discordant cases had any major clinical impact. There will remain a small fraction of cases that will be inappropriately deemed as “adequate” at ROSE due to the challenging nature of the procedure.

Diagnostic utility of rapid on‐site evaluation of endobronchial ultrasound‐guided transbronchial needle aspiration samples: A study in a region of high tuberculosis burden

“…The adequacy assessment for ROSE was in concordance with definitive cytology in all 47 cases (100%). The total time taken for the procedure and the number of passes made in our study were similar to those reported in other studies, and ROSE does not appear to influence these factors 8‐10 …”

Feasibility of rapid on‐site cytological evaluation of lung cancer by a trained pulmonologist during bronchoscopy examination

“…Careful attention to the presence of cilia and cellular uniformity, and absence of mitoses and abnormal nucleoli is necessary to assess a benign diagnosis . Air‐drying artefacts leading to cellular enlargement may be misinterpreted during ROSE . These discrepancies have been reported as difficult cases for cytopathologists.…”

“…21 Air-drying artefacts leading to cellular enlargement may be misinterpreted during ROSE. 22 These discrepancies have been reported as difficult cases for cytopathologists.…”

Usefulness and problems of cytological examination by endobronchial ultrasound‑guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy: A retrospective single‑centre study

“…The usefulness of EBUS-TBNA in the diagnosis of lymphadenopathy in patients without lung cancer has also been reported (4). However, few studies have evaluated the diagnostic results of mediastinal lymphadenopathy using EBUS-TBNA in consecutive patients with or without lung cancer (4,5). The aim of the present study was to analyse the results of the cytological examination using EBUS-TBNA in the diagnosis of mediastinal lymphadenopathy in a single centre, and also discuss the usefulness and diagnostic problems in cytological examination using EBUS-TBNA in patients with mediastinal lymphadenopathy.…”