Rapid on-site evaluation of transbronchial aspirates: randomised comparison of two methods

Abstract

The value of different staining methods for rapid analysis of transbronchial needle aspirates during bronchoscopy has not been explored.In the present study, we compared a Papanicolaou-based rapid stain, prepared by a technologist and read by a cytopathologist, and a Wright-Giemsa-based rapid stain, prepared and read by a cytopathologist alone. Gold standard was the final laboratory report issued on each aspirate.We harvested 827 aspirates from 218 target sites in 126 consecutive patients. At least one positive aspirate was found in 99 (79%) patients. In those 99 patients, 288 of 574 (50%) aspirates were positive for neoplastic (83%) or non-neoplastic (17%) disease. False-negative aspirates and target sites were more frequent with the rapid Wright-Giemsa than with the rapid Papanicolaou stain (14.2 versus 7.3%, p50.008, and 13.7 versus 3.6%, p50.021, respectively). The sensitivity of the Wright-Giemsa-based and Papanicolaou-based rapid stains for detecting diagnostic material was 93 and 100% in patients, 83.1 and 95.5% in target sites, and 72.8 and 84.9% in aspirates, respectively. Specificity was 100% for both methods in patients and target sites, and 90.4 and 95% in aspirates.We concluded that a Papanicolaou-based stain has superior yield and accuracy to a WrightGiemsa-based stain for rapid on-site evaluation of transbronchial needle aspirates.KEYWORDS: Biopsy, bronchoscopy, cytodiagnosis, fine-needle, lung neoplasms T ransbronchial needle aspiration (TBNA) via flexible bronchoscopy (FB) is a wellestablished sampling method for a variety of neoplastic and non-neoplastic lung lesions [1]. Its ability to establish a diagnosis and to permit staging in a single intervention has made TBNA the key technique for the evaluation of patients with suspected lung cancer [2][3][4]. Endobronchial ultrasound and rapid on-site evaluation (ROSE) have been shown to improve TBNA yield [5][6][7][8][9]. ROSE-TBNA provides the bronchoscopist with real-time guidance and allows for termination of sampling when the diagnostic objective has been met. This increases patient comfort and reduces cost [8,10]. A formal off-site review involving routine and ancillary staining methods, e.g. for microorganisms and immunocytochemistry is obligatory to confirm provisional ROSE results.Experienced bronchoscopists harvest TBNA samples in quick succession by repetitively aspirating multiple target sites to minimise false-negative results. To fulfil its purpose, a ROSE procedure must keep up with the pace of sampling. Onsite staining methods must therefore find a compromise between speed, ease of preparation and staining quality. Commonly used fast stains are modified versions of standard laboratorybased staining methods. Wright-Giemsa-based rapid stains are water-based and provide mainly cytoplasmic definition on air-dried slides. Such procedures are not labour-intensive and allow staining and evaluation by a single person. Alcohol-based modified Papanicolaou stains on alcohol-fixed slides are more time consuming but provide superior demo...

Improving ROSE: Discrepant touch preparation and histology findings in cytology of renal masses: A 10‐year retrospective review

“…The touch preparation slides are then either air‐dried and stained with Diff‐Quik stain per standard protocols or ethanol‐fixed and stained with rapid Pap stain per standard protocols. From our study, there was a higher proportion of rapid Pap‐stained slides that were interpreted as non‐diagnostic due to hypocellularity as compared to Diff‐Quik stained slides, possibly related to the differences in stain preparation, although these results are in contrast with other studies in the literature in which rapid Pap stain was found to have superior yield and accuracy . At our facility, more cytopathologists prefer to utilize the rapid Pap stain.…”

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

“…Second, the pulmonologist diagnosed specimens with DiffQuik® staining, whereas cytopathologists diagnosed specimens with Papanicolaou staining. Because a Papanicolaou‐based stain has superior yield and accuracy than a Wright‐Giemsa‐based stain for ROSE of transbronchial needle aspirates, there is a possibility that sensitivity and specificity differ between stains. Each specimen is unique and therefore different specimens were analysed by the pulmonologist and cytopathologists.…”

The Diagnostic Yield and Safety of Ultrasound-Assisted Transthoracic Biopsy of Mediastinal Masses

“…This approach has been validated for epithelial carcinomas and tuberculosis, where ROSE has been shown to have a high sensitivity for identifying diagnostic material and suggesting a provisional diagnosis [10,11,12,26,27]. Although cytology may be diagnostic in other types of pathology, further investigations are often required and the value of ROSE is therefore less well defined [28].…”