Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions

Abstract

Cryobiopsy enables us to obtain larger specimens than conventional forceps biopsy despite the caution regarding complications. This study aimed to evaluate the clinical utility of rapid on-site evaluation of touch imprint cytology (ROSE-TIC) during cryobiopsy of peripheral pulmonary lesions (PPLs). We retrospectively reviewed the data of consecutive patients who underwent cryobiopsy for solid PPLs between June 2020 and December 2021. ROSE-TIC was performed on the first specimen obtained via cryobiopsy and assessed using Diff-Quik staining. The results of ROSE-TIC for each patient were compared with the histological findings of the first cryobiopsy specimen. Sixty-three patients were enrolled in this study. Overall, 57 (90.5%) lesions were ≤30 mm in size and 37 (58.7%) had positive bronchus signs. The radial endobronchial ultrasound findings were located within and adjacent to the lesion in 46.0% and 54.0% of the cases, respectively. The sensitivity, specificity, and positive and negative predictive values of the ROSE results for histological findings of the corresponding specimens were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. In conclusion, ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.

Diagnostic Utility and Safety of Non-Intubated Cryobiopsy Technique Using a Novel Ultrathin Cryoprobe in Addition to Conventional Biopsy Techniques for Peripheral Pulmonary Lesions

“…Furthermore, the clinical factor that affected the diagnostic yield of cryobiopsy using the ultrathin cryoprobes was the bronchus sign on TSCT, which is consistent with those previously reported for conventional biopsy devices [22,23]. As in previous reports of cryobiopsy, ROSE slide preparation was also possible using specimens obtained by non-intubated cryobiopsy [24,25]. In diagnosing PPLs with bronchoscopy, the primary purpose is often the collection of tumor cells, which have distinctive histopathological features that can be recognized even in small samples, from the precise location of the target lesion through the related bronchus [21,26,27].…”

Rapid on‐site evaluation of touch imprint cytology in navigation bronchoscopy for small peripheral pulmonary nodules

“…Muto et al 8 recently demonstrated that TIC-ROSE can be a suitable intraprocedural assessment tool for cryobiopsy, with a concordance rate of 76.2%. Their study was performed in a monomodality sampling setup using only cryobiopsy as the sampling T A B L E 2 Rapid on-site evaluation outcomes compared with procedural outcomes, N = 66.…”

“…Although, in endobronchial ultrasound (EBUS)-guided mediastinal lymph node staging, ROSE has had high concordance rates of 89%-96% and has been shown to reduce the amount of samples needed, 5,6 concordance rates of ROSE during navigation bronchoscopy have rarely been reported and vary widely, between 47.5% and 89.9%. 3,7,8 In the pulmonary care setting, ROSE is commonly used to examine cytology specimens obtained with transbronchial needle aspiration (TBNA) or a brush, and the use of ROSE for histologic samples is a valuable alternative and has been reported incidentally in studies. 9,10 The recently published joint guideline by Roy-Chowdhuri and colleagues 11 issued strong advice to include the use of touch imprint cytology (TIC) preparations of histologic samples for on-site evaluation.…”

“…11 A recently published study indicated that histologic transbronchial cryobiopsy samples could be assessed using ROSE with good results, showing a concordance rate with the procedural outcomes of 76.2%. 8 Although these are promising results, that study was performed in a monomodality sampling setting that only analyzed cryobiopsies. Studies have shown in recent years that diagnostic yield can be improved using multimodality sampling strategies combining cytology and histology.…”

“…Unfortunately, the literature has reported mixed results when using ROSE with navigation bronchoscopy. Although, in endobronchial ultrasound (EBUS)‐guided mediastinal lymph node staging, ROSE has had high concordance rates of 89%–96% and has been shown to reduce the amount of samples needed, 5,6 concordance rates of ROSE during navigation bronchoscopy have rarely been reported and vary widely, between 47.5% and 89.9% 3,7,8 . In the pulmonary care setting, ROSE is commonly used to examine cytology specimens obtained with transbronchial needle aspiration (TBNA) or a brush, and the use of ROSE for histologic samples is a valuable alternative and has been reported incidentally in studies 9,10 .…”