Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens

Abstract

Background:Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an integral tool in the diagnosis and staging of malignant tumors of the lung. Rapid on-site evaluation (ROSE) of fine needle aspiration (FNA) samples has been advocated for as a guide for assessing the accuracy and adequacy of biopsy samples. Although ROSE has proven useful for numerous sites and procedures, few studies have specifically investigated its utility in the assessment of EBUS-TBNA specimens. The intention of this study was to explore the utility of ROSE for EBUS-TBNA specimens.Materials and Methods:The pathology files at our institution were searched for all EBUS-TBNA cases performed between January 2010 and June 2010. The data points included number of sites sampled per patient, location of site(s) sampled, on-site evaluation performed, preliminary on-site diagnosis rendered, final cytologic diagnosis, surgical pathology follow-up, cell blocks, and ancillary studies performed.Results:A total of 294 EBUS-TBNA specimens were reviewed and included in the study; 264 of 294 (90%) were lymph nodes and 30 of 294 (10%) were lung mass lesions. ROSE was performed for 140 of 294 (48%) specimens. The on-site and final diagnoses were concordant in 104 (74%) and discordant in 36 (26%) cases. Diagnostic specimens were obtained in 132 of 140 (94%) cases with on-site evaluation and 138 of 154 (90%) without on-site evaluation. The final cytologic diagnosis was malignant in 60 of 132 (45%) cases with ROSE and 46 of 138 (33%) cases without ROSE, and the final diagnosis was benign in 57 of 132 (47%) with ROSE and 82 of 138 (59%) without ROSE. A cell block was obtained in 129 of 140 (92%) cases with ROSE and 136 of 154 (88%) cases without ROSE.Conclusions:The data demonstrate no remarkable difference in diagnostic yield, the number of sites sampled per patient, or clinical decision making between specimens collected via EBUS-TBNA with or without ROSE. As a result, this study challenges the notion that ROSE is beneficial for the evaluation of EBUS-TBNA specimens.

Utility of Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Malignant and Nonmalignant Disease

“…Our findings are consistent with previously published data, which mostly failed to show a benefit of ROSE on the accuracy of EBUS-TBNA, regardless of the study design, i.e., randomized [18, 19] or nonrandomized [15, 16]. To our knowledge, a positive impact of ROSE on accuracy in this setting was only observed in one retrospective univariate analysis of 236 patients with suspected lung cancer [17].…”

“…Both malignant and nonmalignant diseases were well represented, which contrasts with most publications on this topic [15-19]. We observed a trend toward an improved accuracy with ROSE in both univariate and multivariate analyses, but without reaching statistical significance.…”

“…Unlike all other case-control studies on this topic [5-9, 15, 16], we used a multivariate logistic regression model to control for confounding factors, such as lesion size and final diagnosis (cancer, sarcoidosis, other). We also introduced the calendar year in the regression model as a proxy for the evolution of the entire team’s performance (increasing experience, evolving practice parameters, etc.).…”

“…In 2 retrospective studies, ROSE did not improve the diagnostic yield of EBUS-TBNA [15, 16], but one of the studies reported an improvement of the adequacy of the sampled material [16]. In a recent retrospective trial, ROSE was shown to enhance the diagnostic yield [17].…”

Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosing Lung Cancer: A Randomized Study

“…The result may suggest that the optimal yield is obtained by 3 aspirates regardless of using ROSE. Griffin et al [21] also found that ROSE during EBUS-TBNA did not increase the diagnostic yield in their retrospective study. They also reported that ROSE during EBUS-TBNA did not decrease the number of lesions sampled per patient.…”