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

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate procedure to sample mediastinal tissue. Rapid on-site cytologic evaluation (ROSE) has been advocated to improve the performance of this procedure, but its benefit remains controversial. Our objective is to assess the utility of ROSE for EBUS-TBNA diagnostic accuracy among unselected patients. Methods: We prospectively collected data from all consecutive EBUS-TBNA procedures performed between 2008 and 2014. ROSE was introduced since 2011 in our daily practice. The accuracy of EBUS-TBNA with and without ROSE was compared in a univariate and multivariate model accounting for confounding factors. The impact of ROSE was then analyzed according to the etiology and size of the lesions. Results: Among 348 EBUS-TBNA procedures analyzed, 213 were performed with ROSE. The overall accuracy tended to be better with ROSE than without (90.6 vs. 84.4%; p = 0.082). After adjustment in a multivariate model, the benefit of ROSE still did not reach statistical significance (adjusted odds ratio 1.86; 95% confidence interval 0.79–4.41). Similar results were obtained in subgroups of patients with malignant disease or sarcoidosis. The size of the lesion did not influence the impact of ROSE on accuracy. Conclusions: ROSE was associated with a moderate increase in the accuracy of EBUS-TBNA, but the difference was not statistically significant. The same effect of ROSE was observed in malignant and nonmalignant lesions and this effect was not influenced by the lesion’s size.

Diagnostic utility of rapid on‐site evaluation of endobronchial ultrasound‐guided transbronchial needle aspiration samples: A study in a region of high tuberculosis burden

“…The adequacy assessment for ROSE was in concordance with definitive cytology in all 47 cases (100%). The total time taken for the procedure and the number of passes made in our study were similar to those reported in other studies, and ROSE does not appear to influence these factors 8‐10 …”

Fast investigative lung cancer pathway and endobronchial ultrasound procedure supported by rapid on‐site evaluation

“…4 Rapid On-Site Evaluation (ROSE) can be used in conjunction with EBUS to evaluate material sufficiency and triage material during the procedure. 5,6 ROSE has been shown to improve the success rate by reducing the need for additional staging and diagnostic procedures and reduce the number of nodes sampled. 3,7 In the UK, lung cancer investigative and treatment pathway is time bound with aims to expedite within shortest possible time.…”

Endobronchial metastasis from extrathoracic malignancies: A clinicopathological study of 11 cases

“…The most common symptoms mentioned are cough and hemoptysis followed by dyspnea and wheezing in patients with EBM. [ 10 11 12 13 14 15 16 ] In our series, cough was the most frequent symptom followed by chest pain and dyspnea. This indicates that if there is any one of these symptoms in a patient with extrapulmonary malignancy, especially breast, colon or renal tumors, bronchoscopic examination is must to exclude EBM.…”

“…According to the literature, EBM is observed in various types of malignancies, including colorectal, breast, kidney, stomach, ovarian, thyroid, uterine, testicular, nasopharynx, prostate, adrenal carcinomas, sarcomas, histiocytoma, and plasmacytomas. [ 10 11 12 13 14 15 16 ] The most common EBM is from carcinomas of the colorectal region followed by the breast and kidney. [ 13 14 15 ] This was very well correlated with our study as carcinoma breast and colon were the most common.…”