Improved Diagnostic Efficacy by Rapid Cytology Test in Fluoroscopy-Guided Bronchoscopy

Abstract

Background: Fluoroscopy-guided bronchoscopy is a safe and routine method used to obtain a histologic or cytologic specimen of peripheral lung nodules, but it has low sensitivity in diagnosing malignant tumors. Although feedback from rapid cytology tests are expected to improve diagnostic rates, the value of the routine use of rapid cytology tests has not been established. Materials and Methods: We prospectively studied 657 patients with suspected peripheral malignant lung lesions on chest computed tomography who underwent fluoroscopy-guided bronchoscopy between January 2002 and December 2004. Rapid on-site cytopathologic examinations (ROSE) were performed during bronchoscopic examinations. The additional approach to the lesions was performed immediately after conventional bronchoscopic examinations when ROSE was not considered diagnostic. Results: There were 528 patients diagnosed as having malignant lesions. In 477 of these patients (90.3%), final malignant diagnosis was established by the initial bronchoscopy. Among these, 84 patients (15.9%) were diagnosed only with the additional feedback from ROSE. Of 240 peripheral lesions Յ2 cm, 174 were found to be malignant. Without ROSE, 110 (63.2%) of peripheral malignant lesions were diagnosed by bronchoscopy. The integration of ROSE enabled us to diagnose an additional 40 patients (23.0%) by bronchoscopy. ROSE improved diagnostic yield independent of the site and histology of the lesions and experience of the operators. Conclusion: ROSE increased the diagnostic yield of bronchoscopy from 74.4% to 90.3% and therefore is an effective reinforcement in bronchoscopic diagnosis of peripheral pulmonary malignancies. The use of ROSE in routine bronchoscopy should be encouraged.

Rapid on-site evaluation and low registration error enhance the success of electromagnetic navigation bronchoscopy

“…[1619] It has been previously reported that ROSE had 85-92% and 100% sensitivity and specificity, respectively, when it is used in combination with EMN and PET-CT.[1520] The present study has shown that the combination of EMN and ROSE overcomes the limitations related to obtaining adequate biopsy specimen. Mean pass number was four for MLN and three for PL representing optimal number for such diagnostic work-ups.…”

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

“…However, Uchida et al. reported that integrating ROSE into bronchoscopic examination for peripheral tumours of size <20 mm improved the diagnostic sensitivity from 63.2% to 86.2% . Conversely, Maekura et al.…”

Diagnostic Yield of Flexible Bronchoscopy Without Fluoroscopic Guidance in Evaluating Peripheral Lung Lesions

“…Third, our study did not have access to ROSE, which improves diagnostic efficacy independent of localization, lesion histology, and operator experience. 33 However, ROSE is costly and requires a longer procedure time. In addition, ROSE is still not routinely available in many centers, so our results are representative of a large portion of pulmonary practice.…”