Rapid on‐site evaluation of EBUS‐TBNA specimens of lymph nodes: Comparative analysis and recommendations for standardization

Abstract

BACKGROUND:There is no widely accepted rapid on-site evaluation (ROSE) reporting system for endobronchial ultrasound-guided transbronchial needle aspiration. At the University of Arkansas for Medical Sciences, ROSE reporting was unstructured. The goal was to evaluate, compare, and improve upon 2 structured approaches proposed in the literature. METHODS:One hundred eighteen consecutive nodal aspirates were retrospectively reviewed by a pathology resident and a staff cytopathologist, both of whom were blinded to the original unstructured readings. Each reviewer interpreted every specimen with 2 different structured criteria proposed in the literature: criteria from the University of Minnesota (the Min- nesota [MN] criteria) and criteria from the North Shore Long Island Jewish Health System (the New York [NY] criteria).The data allowed a comparison of the original unstructured ROSE system with the MN and NY scoring schemes and the final diagnosis. RESULTS: Original on-site adequacy (OSA) had been assessed at 96%. Three cases were false-adequate according to the original unstructured approach; these had been called adequate on site, but a subsequent slide review including cell blocks did not show definite nodal tissue. OSA dropped to 86% with the MN criteria and to 85% with the NY criteria. No false-adequate on-site diagnoses would have been rendered with the application of either structured criteria.There were no significant differences between the MN and NY criteria with respect to the determination of OSA. An assessment of ease of application favored the NY criteria. With respect to diagnostic categories, each of the systems (MN and NY) was felt to have a category of value not used by the other system. CONCLUSIONS: A standardized intra-and inter-institutional system for ROSE reporting is needed. On the basis of comparative analyses and consensus, modifications to prior criteria have been proposed in the hope of approaching this goal. Cancer (Cancer Cytopathol) 2015;123:362-72.

Easily detectable cytomorphological features to evaluate during ROSE for rapid lung cancer diagnosis: from cytology to histology

“…In eliminating unnecessary sampling, it also helps to reduce costs [15, 16]. Given that ROSE is a widely used technique, different evaluation criteria have been proposed to determine specimen suitability for samples obtained by EBUS-TBNA, e.g .…”

“…Given that ROSE is a widely used technique, different evaluation criteria have been proposed to determine specimen suitability for samples obtained by EBUS-TBNA, e.g . amount of lymphoid elements, presence of polluting bronchial cells, number of pigmented macrophages, amount of necrosis and presence of mucus and blood [15–18]. Jeffus et al performed a comparison between Minnesota and New York criteria to establish the adequacy of EBUS-TBNA specimens [15], while Idowu and Powers analyzed the cytomorphological characteristics of primary lung cancers.…”

“…amount of lymphoid elements, presence of polluting bronchial cells, number of pigmented macrophages, amount of necrosis and presence of mucus and blood [15–18]. Jeffus et al performed a comparison between Minnesota and New York criteria to establish the adequacy of EBUS-TBNA specimens [15], while Idowu and Powers analyzed the cytomorphological characteristics of primary lung cancers. In particular, typical cytomorphological features of adenocarcinoma include cellular clusters or acinar (glandular) arrangements, large vacuolated cells, high nuclear/cytoplasm (N/C) ratio, prominent nucleoli and finely granular chromatin [19].…”

Specimen acquisition training with a new biosimulator in endobronchial ultrasound-guided transbronchial needle aspiration

“…In addition, an objective evaluation of adequacy was also performed based on the previously published definition, with an adequate sample defined as a mean lymphocyte density >40 cells/10 fields at 40×). [8,9] …”

Committee II: Guidelines for cytologic sampling techniques of lung and mediastinal lymph nodes

“…Their on‐site adequacy rates determined by using the two separate systems were almost identical (85% vs. 86%). The authors recommended a combined modified system, consisting of the adequacy assessment criteria and the tiered diagnostic system …”