The Utility of Rapid On-Site Evaluation on Endobronchial Ultrasound Guided Transbronchial Needle Aspiration: Does It Make a Difference?

The purpose of this study was to assess the efficacy of using rapid on-site evaluation (ROSE) for samples taken during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) at Austin Health, Victoria. This was compared to data collected for cases performed without ROSE. A retrospective analysis was conducted on 188 consecutive patients who underwent EBUS-TBNA from May 2012 to July 2014 whose data was collected prospectively at the time of the procedure. The presence of a cytologist during ROSE resulted in a significant reduction in the number of lesions sampled [mean: 1.5 ± 0.7 (1, 4) versus 1.9 ± 0.8 (1, 4), P = 0.0020] and the number of TBNAs required per case [mean: 3.6 ± 1.4 (1, 8) versus 4.2 ± 1.5 (1, 8), P = 0.0017]. This could potentially result in a shorter procedure time and, ultimately, a reduction in complication rate. The quality of the samples obtained during EBUS-TBNA with ROSE was higher. A larger proportion of samples yielded a satisfactory cell block allowing the potential benefit of additional pathology testing including immunohistochemistry and molecular pathology. In summary, the use of ROSE during EBUS-TBNA was superior to off-site cytological assessment of bronchoscopy specimens. 1. Introduction Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is widely used for tissue sampling of mediastinal and hilar lesions adjacent to the proximal airway. Indications for this procedure include mediastinal lymph node staging in patients with non-small cell lung cancer, assessment of mediastinal or hilar lymphadenopathy, and direct sampling of lung lesions adjacent to the proximal airway. EBUS increases the diagnostic yield of blind TBNA and reduces complications by allowing real-time ultrasound guidance during needle insertion [1, 2]. EBUS also allows for a less invasive approach to various lymph node stations in the mediastinum and hilum compared to video-assisted thoracoscopic surgery (VATS) or mediastinoscopy [3]. Rapid on-site evaluation (ROSE) is a technique where TBNA cytology samples are rapidly stained and screened for diagnostic material in the procedure room, during the procedure. There is a high agreement between the on-site and final pathologic evaluation of EBUS-TBNA specimens [4]. The use of ROSE in conjunction with EBUS-TBNA has been shown to improve the diagnostic yield of the procedure [5–8]. ROSE also significantly improved the number of specimens that were adequate for a diagnosis of central lung cancers adjacent to the airway or lymph node metastases as described by Davenport