The impact of pathological analysis on endobronchial ultrasound diagnostic accuracy

Abstract

Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure used for lung cancer diagnosis and staging. Several aspects, including pathological analysis, may impact on its diagnostic accuracy. Differences in diagnostic accuracy between the different specimen processing techniques have not been demonstrated. Cytological slides are generally adequate for diagnosis, subtyping and genotyping. However, some pathological laboratories may require cell blocks or histological core biopsies for a complete molecular profiling. Rapid on-site evaluation (ROSE) is a technique for immediate evaluation of samples obtained with EBUS-TBNA. The aims of ROSE are to increase sampling adequacy, improving diagnostic yield of EBUS-TBNA and ensuring collection of adequate material for ancillary studies. However, the reported data on the impact of ROSE in the diagnostic yield of EBUS-TBNA and in lung cancer diagnosis and staging are controversial. Some series reported a valuable contribution of ROSE to diagnosis and staging of lung cancer and a high concordance between ROSE and the final diagnosis. However, randomized trials failed in finding differences in diagnostic yield between EBUS-TBNA performed with and without ROSE. The yield of EBUS-TBNA for molecular analyses varies between 72% and 98%, and ROSE may warrant the collection of adequate material for molecular profiling. In lung cancer diagnosis and staging a recommended number of three to four passes during EBUS-TBNA at each target is a minimum requirement to obtain enough material for molecular analysis. The use of ROSE may reduce the number of passes for molecular profiling and the number of additional invasive diagnostic procedures. EBUS-TBNA is a procedure with a high accuracy rate and ROSE may contribute to a further improvement of the results. The possibility to avoid additional invasive procedure is an important advantage leading to an overall improvement of patient care.

EBUS ROSE‐guided cytological evaluations of intrathoracic lesions. Assessments of the pathological material adequacy and the diagnostic efficacy

“…During EBUS‐TBNA, three to four passes for each target constitute the recommended least requirement. Here, ROSE may reduce the passes for molecular tests and the number of further invasive procedures 18 . A retrospective review of 516 EBUS‐FNA procedures revealed that ROSE assessment of the first 5 passes during the EBUS‐FNA could provide similar adequacies compared to total ROSE judgment of all punctures 19 .…”

“…for molecular tests and the number of further invasive procedures. 18 A retrospective review of 516 EBUS-FNA procedures revealed that ROSE assessment of the first 5 passes during the EBUS-FNA could provide similar adequacies compared to total ROSE judgment of all punctures. 19 According to a review on 618 subjects, the employment of ROSE during EBUS-TBNA necessitated significantly fewer needle passes.…”

Validation of a Cytological Classification System for the Rapid On-Site Evaluation (Rose) of Pulmonary and Mediastinal Needle Aspirates

“…ROSE is a widely used and effective diagnostic procedure during a needle aspiration biopsy of different organs [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. In the field of thoracic pathologies, several studies have demonstrated the utility of ROSE during both transbronchial and percutaneous needle aspiration techniques [ 1 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Even if some works failed to demonstrate that ROSE increases the sensitivity during cTBNA or EBUS-TBNA [ 15 , 16 ], there is robust evidence that ROSE may significantly reduce the need for additional passes and the complication rate, most importantly improving the adequacy of the samples addressed to molecular chacaterization of mandatory predictive biomarkers in non-small cell lung cancer [ 6 , 17 , 26 ].…”

“…A limitation of the C1–C5 system is that it mainly provides information about the diagnostic value of the sample, and in the era of tailored therapies for lung cancer, the operator should also have information about the adequacy of the sampled material in view of the subsequent tumor genotyping for predictive molecular biomarkers. ROSE may ensure the collection of adequate material for molecular profiling [ 1 ]. In a randomized controlled trial that compared EBUS-TBNA performed without and with ROSE, Trisolini et al showed that the use of ROSE increased the percentage of adequate samples obtained by EBUS-TBNA for molecular profiling [ 17 ].…”

“…Rapid on-site evaluation (ROSE) is a procedure that allows assessment of adequacy of cytological specimens generally obtained by needle aspiration techniques [ 1 , 2 ]. Using a quick staining method, it is possible to have within few minutes a smeared cytological slide ready to be evaluated using light microscopy [ 3 ].…”