Comparison of the quality of smears in transbronchial fine‐needle aspirates using two staining methods for rapid on‐site evaluation

Abstract

Transbronchial needle aspiration (TBNA) via flexible bronchoscopy is a well-established sampling modality for lung masses. The procedure is useful in the diagnosis of neoplastic and non-neoplastic lesions as well as for staging of bronchogenic carcinoma. Rapid on-site evaluation (ROSE) adds value as it has the advantage of triaging material during the procedure so avoiding a battery of investigations. Frequently used rapid stains are the modified Wright-Giemsa water-based stain (WG-ROSE) and the alcohol-based modified Papanicolaou stain (Pap-ROSE). Final review of laboratory-based Giemsa and Pap stains supplemented by ancillary investigations is essential for quality assurance. To investigate whether and how ROSE influenced the quantity and quality of the material submitted to the laboratory we randomized 126 patients to WG-ROSE, requiring only one pathologist on-site, or combined WG- and Pap-ROSE, requiring an additional person on-site to assist with staining. In those patients with positive TBNA we graded the laboratory-based slides of the first pass containing diagnostic material into insufficient, suspicious, adequate and excellent. The first diagnostic pass was found after 3.06 ± 1.94 (SD) passes and 3.13 ± 2.16 passes with WG-ROSE and combined ROSE (P = 0.87), respectively. Following WG-ROSE and combined ROSE 69% and 71.1% (P = 0.509) of slides were diagnostic (adequate or excellent) on laboratory-based Giemsa stains, and 93.3% and 100% (P = 0.134) were scored adequate or excellent on laboratory-based Pap stains. We concluded that the less costly and labour intensive WG-ROSE procedure is adequate for TBNA. This has cost implications especially in resource poor settings.

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

“…One study [44] suggested that the less costly and labor-intensive method of Wright-Giemsa staining for ROSE provided equivalent diagnostic and quality performance compared to Papanicolaou staining. Another study [42] suggested that liquid-based cytology was resource saving in that only 1 slide required preparing and examination (compared to 7 for Papanicolaou staining), and that pathology reporting time may be reduced by up to 20 min per case.…”

“…For definitive analysis, often a second slide is fixed for Papanicolaou staining. One study compared ROSE performed with Wright-Giemsa staining versus ROSE with Papanicolaou staining and did not find a significant difference in the yield [44]. …”

Prospective comparison of cytological specimen adequacy assessment by different rapid staining techniques for rapid on‐site evaluation in fine needle aspiration cytology and their cost‐effectiveness

“…Most studies have used Diff Quik stain, TB and ultra-fast Pap for the purpose of ROSE 5,7,8,10,11 , and very few studies comparing at least two rapid stains are available in the literature. 15 In our study, we have found rapid pap (RP) to be the best stain for ROSE, when only the quality of stain and morphological details are taken into consideration.…”

Diagnostic utility and accuracy of rapid on-site evaluation of bronchoscopic brushings

“…Different staining methods used in the preparation of lymph node TBNA specimens are associated with varying sensitivity [29][30][31], suggesting the important need to examine the optimal staining method for ROSE on brushings in future studies.…”