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

Abstract

Introduction Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) has emerged as a very useful tool for precise diagnosis of thoracic lesions. However, the procedure sometimes has a poor yield. Rapid on‐site evaluation (ROSE) in EBUS‐TBNA has been shown to be helpful to improve its diagnostic yield and minimise the need for repeat procedures. Most of the studies that have evaluated the utility of ROSE have focused on malignant lesions; however, it is important to understand its utility in benign lesions, particularly in a country with a high tuberculosis burden. Objective This study was undertaken to evaluate the utility of ROSE in EBUS‐TBNA for the diagnosis of patients presenting with mediastinal lymphadenopathy and/or thoracic mass for benign and malignant pathologies. Methods This was a prospective study including 47 patients who underwent EBUS‐TBNA for thoracic lesions (lung masses and hilar/mediastinal lymphadenopathy) over a 10‐month period at a single tertiary care centre. In addition to ROSE and definitive cytology, the aspirated material was also sent for cell block and microbiological studies. Endobronchial/transthoracic biopsy was conducted for histopathological evaluation (HPE) where required, at the discretion of the clinician. ROSE diagnosis was then compared with the final diagnosis. Results Of the 47 patients examined using ROSE, granulomas were observed in 33 cases, non‐specific inflammation in six cases, and malignancy in five cases; one case was inconclusive and the sample was found to be inadequate in two cases. The ROSE assessment matched the final diagnosis in 84.45% patients. Conclusion ROSE is a simple procedure that is able to provide an immediate and accurate assessment of adequacy and has a significant yield, enabling a preliminary diagnosis to be made in both benign and malignant samples.

Myeloid Sarcoma: Features in Cytological Preparations and the Utility of Rapid On-Site Evaluation (ROSE) in Triage

“…In addition, since pathologists are best equipped to assess the need for additional testing, their presence on-site allows the opportunity to collect specimens for ancillary testing such as microbial cultures, FCI, cytogenetics, FISH, and molecular analysis. By granting pathologists control over these preanalytic variables for a biopsy they will ultimately inherit, ROSE reduces the overall nondiagnostic rates [45][46][47][48][49]. In our study, ROSE provided the correct preliminary impression and allowed the procurement of adequate material for histologic assessment and ancillary testing, leading to a timely, complete, and accurate diagnosis of MS in all 15 cases.…”

Utility of Rapid On-Site Evaluation during Bronchoscopy in the Diagnosis of Pulmonary Tuberculosis

“…ROSE can play a role in the diagnosis of PTB because of its specific cytological manifestations, which have been reported for the diagnosis of PTB and tuberculous lymphadenopathy [10,14]. In our study, of the 238 sputum-negative TB patients who were treated with ROSE, 183 patients were considered TB by ROSE according to the criteria for cytological diagnosis of TB, with a sensitivity of 76.9%, and 123 patients with positive bacteriological tests (AFB smear and/or mycobacterial culture) performed at the same time, with a sensitivity of 51.7%.…”

“…However, it is important to understand its utility in benign lesions, particularly in PTB. This is particularly important in populations with a high burden of TB, in order to initiate the correct and early treatment of the disease [10].…”