Rapid On-Site Evaluation in Detection of Granulomas in the Mediastinal Lymph Nodes

Rokadia, Haala; Mehta, Atul C.; Culver, Daniel A.; Patel, Jinesh; Machuzak, Michael; Almeida, Francisco A.; Gildea, Thomas R.; Sethi, Sonali; Zell, Katrina; Cicenia, Joseph

doi:10.1513/annalsats.201507-435oc

Cited by 15 publications

(15 citation statements)

References 21 publications

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“…ROSE was concordant with final pathology in only 71% of cases. This supports the perception that many providers use ROSE as an assessment of tissue adequacy rather than as a diagnostic tool, although other studies have found higher ROSE concordance rates 38 – 40 and many factors may affect ROSE usage and efficacy. Use of ROSE was not a significant predictor of increased diagnostic yield for peripheral pulmonary lesions in NAVIGATE (78.6% with ROSE vs. 75.8% without ROSE).…”

Section: Discussionsupporting

confidence: 74%

The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

Gildea

Folch

Khandhar³

et al. 2020

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is impacted by biopsy tool strategy and rapid on-site evaluation (ROSE) use. This analysis evaluates usage patterns, accuracy, and safety of tool strategy and ROSE in a multicenter study. Methods: NAVIGATE (NCT02410837) evaluates ENB using the superDimension navigation system (versions 6.3 to 7.1). The 1-year analysis included 1215 prospectively enrolled subjects at 29 United States sites. Included herein are 416 subjects who underwent ENB-aided biopsy of a single lung lesion positive for malignancy at 1 year. Use of a restricted number of tools (only biopsy forceps, standard cytology brush, and/or bronchoalveolar lavage) was compared with an extensive multimodal strategy (biopsy forceps, cytology brush, aspirating needle, triple needle cytology brush, needle-tipped cytology brush, core biopsy system, and bronchoalveolar lavage). Results: Of malignant cases, 86.8% (361/416) of true positive diagnoses were obtained using extensive multimodal strategies. ROSE was used in 300/416 cases. The finding of malignancy by ROSE reduced the total number of tools used. A malignant ROSE call was obtained in 71% (212/300), most (88.7%; 188/212) by the first tool used (49.5% with aspirating needle, 20.2% with cytology brush, 17.0% with forceps). True positive rates were highest for the biopsy forceps (86.9%) and aspirating needle (86.6%). Use of extensive tool strategies did not increase the rates of pneumothorax (5.5% restricted, 2.8% extensive) or bronchopulmonary hemorrhage (3.6% restricted, 1.1% extensive). Conclusion: These results suggest that extensive biopsy tool strategies, including the aspirating needle, may provide higher true positive rates for detecting lung cancer without increasing complications.

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Section: Discussionsupporting

confidence: 74%

The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

Gildea

Folch

Khandhar³

et al. 2020

Journal of Bronchology &Amp; Interventional Pulmonology

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“…Several studies have assessed the value of ROSE in patients with suspected sarcoidosis undergoing EBUS‐TBNA . Plit et al performed EBUS‐TBNA with ROSE followed by TBB and bronchial biopsies in a prospective cohort of 60 patients with suspected sarcoidosis.…”

Section: Why Has Ebus Become Invaluable For the Diagnosis Of Sarcoidomentioning

confidence: 99%

“…Besides ROSE, whose role has been discussed in detail in section EBUS‐TBNA material can undergo rapid on‐site cytological evaluation , a few technical aspects specific to EBUS‐TBNA in sarcoidosis have been studied and deserve mentioning.…”

Section: Introduction Route and Technical Aspectsmentioning

confidence: 99%

Endobronchial ultrasound‐guided transbronchial needle aspiration in sarcoidosis: Beyond the diagnostic yield

et al. 2019

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the commonly used technique for pathological confirmation of clinically suspected sarcoidosis, mostly owing to its consistently high success rate in the detection of granulomas. However, other possible advantages, which are less appreciated and often poorly studied, may also contribute to the wider use of EBUS-TBNA in the future. These advantages include refinement of differential diagnoses through the study of lymph node characteristics during B-mode examination; reduction of complications associated with bronchoscopy, as well as improved triage of the specimen for ancillary studies with the use of rapid on-site evaluation; optimization of the quality of the sample through the selection of a target area for biopsy with minimal vascularity and absence of calcifications by using the colour Doppler and the B-mode; and prediction of the presence of extensive lymph node fibrosis by using the strain elastography module. Yet, limitations and possible clinical drawbacks should also be acknowledged. Indeed, due to the lack of specificity of the pathology findings in EBUSderived samples, the diagnosis of sarcoidosis is one of the exclusion and should remain essentially clinical. The external validity of EBUS-TBNA results in sarcoidosis is questionable, as they mainly derive from studies in populations with a high disease prevalence. Finally, the risk exists that the low morbidity and high diagnostic yield of EBUS-TBNA may lead to its overuse in patients with clinical/radiological findings specific enough to secure a clinical diagnosis of sarcoidosis.

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“…This study shows that not only malignant diseases, ROSE technology can also help hilar mediastinal benign lesions for on-site rapid diagnosis. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of rapid on-site evaluation in interventional pulmonology

Weng

Zhi

et al. 2020

Medicine

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Background: Rapid on-site evaluation (ROSE) is a kind of rapid evaluation of specimen satisfaction, preliminary diagnosis and priority strategy, the diagnostic accuracy of ROSE in the field of pulmonary intervention shows wide variation. The aim of the study was to further clarify the accuracy and diagnostic efficacy of ROSE in interventional pulmonology. Methods: This review summarizes and meta-analyzes studies of ROSE in interventional pulmonology, the ROSE diagnoses would be compared with the final pathologic diagnoses. The following electronic databases have been searched: PubMed, Cochrane Library, Embase, Web of science, CNKI, and WANFANG DATA. The methodologic quality of studies has been assessed using the Quality of Diagnostic Studies (QUADAS-2) instrument. This review is conducted using standard methods for systematic reviews of diagnostic accuracy studies. STATA SE 12.0 is used for data synthesis and analysis. Results: This review evaluates the accuracy and diagnostic efficacy of ROSE in interventional pulmonology, and the process factors that may influence the ROSE diagnosis are analyzed, such as Smear method, profession of smear technician, staining method, Profession of stain technician, Profession of reading slides, invasive procedure, Anesthesia method and etc. Conclusion: This review will stimulate proper evaluation of ROSE and provide assistance for clinical practice.

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Rapid On-Site Evaluation in Detection of Granulomas in the Mediastinal Lymph Nodes

Cited by 15 publications

References 21 publications

The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

Endobronchial ultrasound‐guided transbronchial needle aspiration in sarcoidosis: Beyond the diagnostic yield

Diagnostic value of rapid on-site evaluation in interventional pulmonology

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