Rapid on‐site evaluation with the Hemacolor rapid staining method of medical thoracoscopy biopsy specimens for the management of pleural disease

Abstract

Background and objective: Medical thoracoscopy (MT) is useful for the management of pleural disease. Rapid on-site evaluation (ROSE) of transbronchial needle aspirates proved to be useful during bronchoscopy. We aimed to evaluate the diagnostic performance of ROSE of MT biopsy specimens and thoracoscopists' impression of the macroscopic appearance and assess the intermodality agreement between ROSE and final histopathologic diagnosis. Methods: Sixty two patients with exudative pleural effusions further investigated with MT were enrolled. MT was performed under local anaesthesia and conscious sedation, using the rigid pleuroscope. ROSE with the Hemacolor rapid staining method of the biopsy specimens was performed. Thoracoscopists' impression of the macroscopic appearance was recorded. The final diagnosis was established following histopathological examination. Results: Thoracoscopic pleural biopsies were diagnosed in 61 patients (98.4%). Group A (n = 25) consisted of patients with malignancy and group B (n = 37) with benign disorders. Area under the curve of ROSE for the diagnosis of malignancy was 0.86 (95% CI: 0.76-0.96, P < 0.001), with a sensitivity of 79.17%, specificity of 94.59%, diagnostic accuracy of 88.5%, positive predictive value of 90.5% and negative predictive value of 87.5%. Intermodality agreement between ROSE and histopathology was good (κ ± SE = 0.615 ± 0.084, P < 0.001). Area under the curve of the thoracoscopists' impression of macroscopic appearance was 0.72 (95% CI: 0.58-0.85, P = 0.001), with a sensitivity of 100%, specificity of 44.7%, positive predictive value of 53.33% and negative predictive value of 100%. Conclusion: Rapid on-site evaluation during MT was found to have high accuracy for predicting malignancy. ROSE can provide the thoracoscopist with an on-site

Combined pleuroscopy and endobronchial ultrasound for diagnosis and staging of suspected lung cancer

“…In a survey of 16 centers that performed up to 10 pleuroscopies per month, direct visual assessment correctly diagnosed malignant or benign disease in 12 (59.3%, SD 2.5) out of 20 patients [7] . ROSE of pleural biopsy samples performs better in this setting, with a recent study by Porfyrides et al, concluding that ROSE during pleuroscopy had a sensitivity of 79%, a specificity of 94%, a diagnostic accuracy of 88%, a positive predictive value of 90%, and a negative predictive value of 87% [8] . A limitation of this study is that suspicious findings and inadequate findings were collapsed into just two categories, malignant and benign, resulting in a loss of information with decreased discriminatory function.…”

Diagnostic value of rapid on-site evaluation in interventional pulmonology

“…ROSE can provide the thoracoscopist with an on-site preliminary diagnosis, especially in cases with inconclusive macroscopic appearance. [ 14 ] The above studies show that ROSE technique can help to obtain accurate and reasonable samples, improve the diagnostic efficiency of hilar and mediastinal lesions, peripheral pulmonary lesions and Pleural lesions, and reduce the risk of complications.…”

Role of imprint cytology in thoracic endoscopy suite

“…A finding of malignant cells on touch preparation cytology during thoracoscopy increases the likelihood of malignancy significantly and gives a chance for immediate pleurodsis. Porfyridis and colleagues [23] also who evaluated the value of touch preparation cytology in medical thoracoscopy in pleural diseases concluded that touch cytology was highly accurate in predicting malignancy. Additionally, a survey made by Hallifax and colleagues [24] in the current practice of medical thoracoscopists at predicting malignancy found that MT provides the option to pleurodese (to reduce risk of fluid recurrence) at the time of biopsy via talc poudrage, with high success rate.…”