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Barisione E, Genova C, Ferrando M, Boggio M, Paudice M, Tagliabue E. Rapid On-Site Evaluation Performed by an Interventional Pulmonologist: A Single-Center Experience. J Pers Med 2024; 14:764. [PMID: 39064018 PMCID: PMC11277944 DOI: 10.3390/jpm14070764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Rapid On-Site Evaluation (ROSE) during bronchoscopy allows us to assess sample adequacy for diagnosis and molecular analyses in the context of precision oncology. While extemporaneous smears are typically evaluated by pathologists, their presence during bronchoscopy is not always possible. Our aim is to assess the concordance between ROSE performed by interventional pulmonologists and cytopathologists. METHODS We performed ROSE on 133 samples collected from 108 patients who underwent bronchoscopy for the diagnosis of suspect thoracic findings or for mediastinal lymph node staging (May 2023-October 2023). Randomly selected smears (one for each collection site) were independently evaluated for adequacy by a pulmonologist and a pathologist to assess the concordance of their evaluation. RESULTS Among 133 selected smears evaluated by a pulmonologist and pathologist, 100 were adequate for both, 10 were inadequate for both and 23 were discordant; hence, global concordance was 82.7%; Cohen's Kappa was 0.385, defining fair agreement. Concordance was similar irrespective of sample collection site (lymph nodes vs. pulmonary lesions; p = 0.999) and among samples which were considered adequate or inadequate by the pulmonologist (p = 0.608). CONCLUSIONS Trained pulmonologists can evaluate the appropriateness of sampling with good concordance with cytopathologists. Our work supports autonomous ROSE by pulmonologists where pathologists are not immediately available.
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Affiliation(s)
- Emanuela Barisione
- Interventional Pulmonology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.B.); (E.T.)
| | - Carlo Genova
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Matteo Ferrando
- Riabilitative Pulmonology Unit, Ospedale di Sestri Levante, 16039 Sestri Levante, Italy;
| | - Maurizio Boggio
- Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Paudice
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy;
- University Pathology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Elena Tagliabue
- Interventional Pulmonology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.B.); (E.T.)
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Lan Z, Zhang J, Yang F, Ma X, He R. Utility of SHOX2 and RASSF1A gene methylation detection on the residual cytology material from endobronchial ultrasound-guided transbronchial needle aspiration. Cytojournal 2024; 21:19. [PMID: 38887695 PMCID: PMC11181472 DOI: 10.25259/cytojournal_114_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/29/2024] [Indexed: 06/20/2024] Open
Abstract
Objective This study aims to assess the effectiveness of Short Stature Homeobox 2 (SHOX2) and RAS Association Domain Family 1 Isoform A (RASSF1A) gene methylation detection in residual liquid-based cytology (LBC) materials from Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) and investigate the diagnostic accuracy of a comprehensive diagnostic approach. Material and Methods Between June 2022 and May 2023, a total of 110 cases that underwent EBUS-TBNA were enrolled in the study. SHOX2 and RASSF1A genes methylation detection using the residual cytological material, LBC, and cell block (CB) were conducted for each EBUS-TBNA case. The sensitivity and specificity of cytology, CB histopathology, SHOX2, and RASSF1A methylation in diagnosing EBUS-TBNA samples were determined based on follow-up data. Results Among the 72 cases confirmed as pulmonary carcinomas, the methylation test yielded positive results in 24 adenocarcinoma cases, 10 squamous cell carcinoma cases, and 14 small cell carcinoma cases. The sensitivity of the comprehensive diagnosis (combining LBC, CB, and methylation detection) in distinguishing metastatic pulmonary epithelial malignancies in mediastinal and hilar lymph nodes or masses from benign lesions was higher (97.22%, 70/72) than that of morphological diagnosis alone (LBC and CB) (88.89%, 64/72; P < 0.05). Conclusion SHOX2 and RASSF1A methylation detection demonstrates a high sensitivity and negative predictive value in the identification of pulmonary epithelial malignancies and holds promise as a valuable ancillary approach to enhance morphological diagnosis of EBUS-TBNA.
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Affiliation(s)
- Zhihua Lan
- Department of Pathology, the First Affiliated Hospital of Hengyang Medical School, Hengyang, Hunan, China
| | - Jing Zhang
- Department of Pathology, the First Affiliated Hospital of Hengyang Medical School, Hengyang, Hunan, China
| | - Fang Yang
- Department of Anorectal Surgery in Traditional Chinese Medicine, the First Affiliated Hospital of Hengyang Medical School, Hengyang, Hunan, China
| | - Xin Ma
- Department of Pathology, the First Affiliated Hospital of Hengyang Medical School, Hengyang, Hunan, China
| | - Rongfang He
- Department of Pathology, the First Affiliated Hospital of Hengyang Medical School, Hengyang, Hunan, China
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3
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Chung K, Bentel J, Laycock A. Accuracy of endobronchial ultrasound-guided transbronchial needle aspiration for staging of non-small cell lung cancer. Diagn Cytopathol 2024; 52:254-263. [PMID: 38348554 DOI: 10.1002/dc.25282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/04/2024] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is routinely performed to confirm a lung cancer diagnosis and/or to clinically stage disease. EBUS-TBNA findings may be used to determine whether patients can be offered potentially curative surgery. In this study, we evaluated the reporting in our service of EBUS-TBNA cytology for early-stage (operable) non-small cell lung cancer (NSCLC), focusing on diagnostic accuracy and analyzing cases with discordant cytologic and post-surgical histopathologic conclusions. METHODS Cytology slides and cytopathology reports of 120 NSCLC patients who had undergone EBUS-TBNA and lobectomy in our hospital system between 2015 and 2021 were retrospectively reviewed. RESULTS Of 290 lymph nodes (110 cases) able to be reviewed, interpretation of 48 lymph nodes was discordant with the original cytopathology report. This included 31 lymph nodes originally reported as adequate, which were found to be non-diagnostic on review. The diagnostic accuracy (benign/malignant) of lymph nodes that were sampled at EBUS-TBNA and excised at surgery was 89%. Specific examination of cases where EBUS-TBNA cytology did not reflect post-surgical findings illustrated important features and limitations of the procedure. These included potential misclassification of lymph node stations, the presence of multiple, variably involved nodes at lymph node stations, and the failure to detect small volume disease. CONCLUSIONS Continuous evaluation of EBUS-TBNA performance identifies technical limitations and areas of improvement for cytopathology reporting. This is increasingly important in an era where lung cancer screening is expected to increase diagnosis of early-stage disease and with the advent of novel treatments, including non-surgical management options.
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Affiliation(s)
- Kimberley Chung
- PathWest Anatomical Pathology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jacqueline Bentel
- PathWest Anatomical Pathology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Andrew Laycock
- PathWest Anatomical Pathology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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4
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Elmas H, Önal B, Steurer S, Hantzsch-Kuhn B, Claussen M, Mehdi E, Ince Ü, Rabe KF, Sauter G, Welker L. Rapid Remote Online Evaluation in Endoscopic Diagnostics: An Analysis of Biopsy-Proven Respiratory Cytopathology. Diagnostics (Basel) 2023; 13:3329. [PMID: 37958225 PMCID: PMC10647841 DOI: 10.3390/diagnostics13213329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND This prospective study assesses the use of rapid remote online cytological evaluation for diagnosing endoscopical achieved biopsies. It focuses on its effectiveness in identifying benign and malignant conditions using digital image processing. METHODS The study was conducted between April 2021 and September 2022 and involved analyses of 314 Rapid Remote Online Cytological Evaluations in total (154 imprint cytologies, 143 fine needle aspirations and 17 brush cytologies) performed on 239 patients at the LungenClinic Grosshansdorf. During on-site evaluation via telecytology, the time requirement was recorded and the findings were compared with the cyto-/histological and final diagnoses. RESULTS By means of rapid remote online evaluation, findings of 86 cytological benign, 190 malignant and 38 unclear diagnoses were recorded (Ø assessment time, 100 s; range, 11-370 s). In 27 of the 37 specimens with unclear diagnoses, the final findings were malignant tumours and only 6 were benign changes. The diagnosis of another 4 of these 37 findings remained unclear. Excluding these 37 specimens, rapid remote online evaluation achieved a sensitivity of 90.5% with a specificity of 98.5% and a correct classification rate of 92.4% with regard to the final diagnosis of all cases. As expected, an increase in the sensitivity rate for the cytological detection of malignant tumours (76.1% vs. 92.5%) was found especially in fine-needle aspirations. CONCLUSIONS Rapid remote online analysis allows the fast quantitative and qualitative evaluation of clinically obtained cytological specimens. With a correct classification rate of more than 93%, sampling deficiencies can be corrected promptly and diagnostic and therapeutic approaches can be derived.
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Affiliation(s)
- Hatice Elmas
- Section Cytopathology, Institute of Pathology, University Medical Center Hamburg-Eppendorf UKE, D-20246 Hamburg, Germany; (S.S.); (G.S.); (L.W.)
| | - Binnur Önal
- Acıbadem Healthcare Group, Pathology Department, Acıbadem University, 34752 Istanbul, Turkey; (B.Ö.); (Ü.I.)
| | - Stefan Steurer
- Section Cytopathology, Institute of Pathology, University Medical Center Hamburg-Eppendorf UKE, D-20246 Hamburg, Germany; (S.S.); (G.S.); (L.W.)
| | - Birgit Hantzsch-Kuhn
- LungenClinic Großhansdorf, D-22927 Großhansdorf, Germany; (B.H.-K.); (M.C.); (K.F.R.)
- Airway Research North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), D-35037 Marburg, Germany
| | - Martin Claussen
- LungenClinic Großhansdorf, D-22927 Großhansdorf, Germany; (B.H.-K.); (M.C.); (K.F.R.)
- Airway Research North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), D-35037 Marburg, Germany
| | - Elnur Mehdi
- Department of Nuclear Medicine, National Center of Oncology, 1012 Baku, Azerbaijan;
| | - Ümit Ince
- Acıbadem Healthcare Group, Pathology Department, Acıbadem University, 34752 Istanbul, Turkey; (B.Ö.); (Ü.I.)
| | - Klaus F. Rabe
- LungenClinic Großhansdorf, D-22927 Großhansdorf, Germany; (B.H.-K.); (M.C.); (K.F.R.)
- Airway Research North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), D-35037 Marburg, Germany
| | - Guido Sauter
- Section Cytopathology, Institute of Pathology, University Medical Center Hamburg-Eppendorf UKE, D-20246 Hamburg, Germany; (S.S.); (G.S.); (L.W.)
| | - Lutz Welker
- Section Cytopathology, Institute of Pathology, University Medical Center Hamburg-Eppendorf UKE, D-20246 Hamburg, Germany; (S.S.); (G.S.); (L.W.)
- Airway Research North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), D-35037 Marburg, Germany
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5
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Mohan A, Madan K, Hadda V, Mittal S, Suri T, Shekh I, Guleria R, Khader A, Chhajed P, Christopher DJ, Swarnakar R, Agarwal R, Aggarwal AN, Aggarwal S, Agrawal G, Ayub II, Bai M, Baldwa B, Chauhan A, Chawla R, Chopra M, Choudhry D, Dhar R, Dhooria S, Garg R, Goel A, Goel M, Goyal R, Gupta N, Manjunath BG, Iyer H, Jain D, Khan A, Kumar R, Koul PA, Lall A, Arunachalam M, Madan NK, Mehta R, Loganathan N, Nath A, Nangia V, Nene A, Patel D, Pattabhiraman VR, Raja A, Rajesh B, Rangarajan A, Rathi V, Sehgal IS, Shankar SH, Sindhwani G, Singh PK, Srinivasan A, Talwar D, Thangakunam B, Tiwari P, Tyagi R, Chandra NV, Sharada V, Vadala R, Venkatnarayan K. Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations. Lung India 2023; 40:368-400. [PMID: 37417095 PMCID: PMC10401980 DOI: 10.4103/lungindia.lungindia_510_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 07/08/2023] Open
Abstract
Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.
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Affiliation(s)
- Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tejas Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Irfan Shekh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abdul Khader
- Institute of Pulmonology, Allergy and Asthma Research, Calicut, India
| | | | | | | | | | - Ritesh Agarwal
- Department of Pulmonary Medicine, PGIMER, Chandigarh, India
| | | | - Shubham Aggarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gyanendra Agrawal
- Department of Internal Medicine, Respiratory and Critical Care Medicine, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Irfan Ismail Ayub
- Department of Pulmonology, Sri Ramachandra, Medical Centre, Chennai, India
| | - Muniza Bai
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bhvya Baldwa
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Chauhan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Chawla
- Department of Pulmonary Medicine, Jaipur Golden Hospital, Delhi, India
| | - Manu Chopra
- Department of Medicine, Command Hospital Eastern Command Kolkata, India
| | - Dhruva Choudhry
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, India
| | - Raja Dhar
- Department of Pulmonology, Calcutta Medical Research Institute, Kolkata, India
| | | | - Rakesh Garg
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Goel
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Goel
- Department of Pulmonology, Fortis, Gurugram, India
| | - Rajiv Goyal
- Department of Respiratory Medicine, Rajiv Gandhi Cancer Institute, Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - BG Manjunath
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, India
| | - Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajmal Khan
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, India
| | - Raj Kumar
- Director, Vallabhbhai Patel Chest Institute, Delhi, India
| | - Parvaiz A. Koul
- Director, Sher-e-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ajay Lall
- Department of Pulmonary Medicine, Max Hospital, Saket, Delhi, India
| | - M. Arunachalam
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neha K. Madan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ravindra Mehta
- Department of Pulmonary and Critical Care Medicine, Apollo Hospitals, Bengaluru, India
| | - N Loganathan
- Department of Pulmonary Medicine, Sri Ramakrishna Hospital, Coimbatore, India
| | - Alok Nath
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, India
| | - Vivek Nangia
- Department of Pulmonology and Respiratory Medicine, Max Super Speciality Hospital Saket, New Delhi, India
| | - Amita Nene
- Bombay Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Arun Raja
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Benin Rajesh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amith Rangarajan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vidushi Rathi
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sujay H. Shankar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Sindhwani
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Pawan K. Singh
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, India
| | | | | | | | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Tyagi
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naren V. Chandra
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - V. Sharada
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Vadala
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kavitha Venkatnarayan
- Department of Pulmonary Medicine, St. John’s National Academy of Health Sciences, Bengaluru, India
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Avasarala SK, Matta M, Singh J, Bomeisl P, Michael CW, Young B, Panchabhai TS, Di Felice C, Dahlberg G, Maldonado F. Rapid On-site Evaluation Practice Variability Appraisal (ROSE PETAL) survey. Cancer Cytopathol 2023; 131:90-99. [PMID: 36048711 DOI: 10.1002/cncy.22641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) is frequently used during diagnostic procedures in patients with or suspected to have lung cancer. There is variation in ROSE use among bronchoscopists, and discussion of ROSE results can have significant consequences for patients. This study was performed to define ROSE practice and result disclosure patterns among bronchoscopists. METHODS This cross-sectional study was performed using an electronic survey disseminated to the members of the American Association for Bronchology and Interventional Pulmonology and the Society for Advanced Bronchoscopy. The questions centered around ROSE availability, utilization, barriers, and discussion of results with patients. RESULTS There were 137 respondents. Most identified themselves as interventional pulmonologists (109, 80%); most respondents worked in an academic setting (71, 52%). Availability of ROSE was reported by 121 (88%) respondents. Time constraints (28%), availability of cytology (22%), and scheduling conflicts (20%) were the most reported barriers to ROSE use. Endobronchial ultrasound transbronchial needle aspiration (85%) and nonrobotic peripheral bronchoscopy (65%) were the most reported procedures that used ROSE. There was heterogeneity regarding discussion of ROSE results with the patient or their caregiver in the immediate postprocedure setting: yes - always (40, 33%), yes - sometimes (32, 26%), yes - rarely (18, 15%), or no (31, 26%). Thirty-eight respondents reported they believed ROSE was ≥90% concordant with final cytology results. CONCLUSIONS The results confirmed the heterogeneity of practice patterns. Estimates of ROSE-final cytology concordance were lower than previously published concordance results. Notably, the discussion of ROSE results varied significantly.
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Affiliation(s)
- Sameer K Avasarala
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Maroun Matta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jaspal Singh
- Atrium Health and Levine Cancer Institute, Charlotte, North, Carolina, USA
| | - Philip Bomeisl
- Department of Pathology, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Claire W Michael
- Department of Pathology, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin Young
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tanmay S Panchabhai
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher Di Felice
- Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Greta Dahlberg
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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7
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Matias MI, Caldeira JN, Matos P, de Santis M, Fonseca AL, Barradas L. Useful on-site macroscopic quantitative evaluation of EBUS-TBNA samples. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield. Optimal specimen acquisition is of a key importance; however, rapid on-site cytology examination (ROSE) during EBUS-TBNA has limited access. In an attempt to provide immediate feedback to the operator, the intervention pulmonology team started to classify macroscopically every lymph node sample in terms of abundance. The main objective of this study was to clarify whether this on-site macroscopic evaluation of EBUS sample was related to histology results and therefore any helpful for clinical practice.
Results
From a total of 288 lymph node stations sampled, adequate/diagnostic histological results were present in 11.1% of “insufficient” samples, 40.9% “sufficient” samples, 76.4% “good” samples and 88.1% of “excellent” samples. This was statistically significant with p-value under 0.0001. Also, there was a statistical agreement between samples that were macroscopically “insufficient” or “sufficient” with “inadequate” and “dubious” histological results and also between macroscopically “good” and “excellent” samples and histological results that were adequate/diagnostic. And that statistical agreement was of moderate magnitude according to the “Landis and Koch” classification (k = 0.386).
Conclusions
The positive relationship between the on-site macroscopic evaluation of the EBUS sample as “excellent” and the “adequate/diagnostic” histological result is of high clinical importance since it represents a fast, cheap and easy method that provides immediate feedback to the operator influencing his conduct; by obtaining additional passes to achieve an “excellent” will ensure a higher percentage of samples with a diagnosis, accelerating the patients treatment.
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8
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Sandoh K, Ishida M, Okano K, Ito H, Tsuta K. Usefulness and problems of cytological examination by endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy: A retrospective single-centre study. Mol Clin Oncol 2021; 15:138. [PMID: 34055353 PMCID: PMC8145344 DOI: 10.3892/mco.2021.2300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive and useful technique for sampling mediastinal lymph nodes. High sensitivity and specificity of EBUS-TBNA in staging lung cancer have been reported. However, few studies have addressed the results of EBUS-TBNA in the diagnosis of mediastinal lymphadenopathy with or without lung cancer, since various neoplastic and non-neoplastic conditions can involve the mediastinal lymph nodes. The present study analysed the results of the cytological examination of mediastinal lymphadenopathy using EBUS-TBNA in Kansai Medical University Hospital (Hirakata, Japan). A total of 41 consecutive patients with mediastinal lymphadenopathy who underwent EBUS-TBNA between January 2008 and December 2019 in Kansai Medical University Hospital were enrolled. This cohort included 29 males and 12 females. Cytological analyses demonstrated that 16/17 (94.1%) patients with metastatic carcinoma were diagnosed as having carcinoma (malignancy). The sensitivity, specificity and positive predictive value of the cytological examination in cases of carcinoma were 94.1, 100 and 100, respectively. However, only 3/11 (27.3%) patients with sarcoidosis were diagnosed by cytological examination. The present study demonstrated that EBUS-TBNA may be a useful method for detecting metastatic carcinoma in the mediastinal lymph nodes. However, the detection rate of epithelioid granuloma, which is a characteristic feature of sarcoidosis, was low in the present cohort. Hence, an improvement in the sampling technique is necessary.
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Affiliation(s)
- Kaori Sandoh
- Department of Pathology and Clinical Laboratory, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Clinical Laboratory, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Kimiaki Okano
- Department of Pathology and Clinical Laboratory, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Hiroko Ito
- Department of Pathology and Clinical Laboratory, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Koji Tsuta
- Department of Pathology and Clinical Laboratory, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
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Bharati P, Deepak D, Kaushal M, Gupta P. Diagnostic utility of rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration samples: A study in a region of high tuberculosis burden. Cytopathology 2021; 32:428-435. [PMID: 33848034 DOI: 10.1111/cyt.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/28/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool for precise diagnosis of thoracic lesions. However, the procedure sometimes has a poor yield. Rapid on-site evaluation (ROSE) in EBUS-TBNA has been shown to be helpful to improve its diagnostic yield and minimise the need for repeat procedures. Most of the studies that have evaluated the utility of ROSE have focused on malignant lesions; however, it is important to understand its utility in benign lesions, particularly in a country with a high tuberculosis burden. OBJECTIVE This study was undertaken to evaluate the utility of ROSE in EBUS-TBNA for the diagnosis of patients presenting with mediastinal lymphadenopathy and/or thoracic mass for benign and malignant pathologies. METHODS This was a prospective study including 47 patients who underwent EBUS-TBNA for thoracic lesions (lung masses and hilar/mediastinal lymphadenopathy) over a 10-month period at a single tertiary care centre. In addition to ROSE and definitive cytology, the aspirated material was also sent for cell block and microbiological studies. Endobronchial/transthoracic biopsy was conducted for histopathological evaluation (HPE) where required, at the discretion of the clinician. ROSE diagnosis was then compared with the final diagnosis. RESULTS Of the 47 patients examined using ROSE, granulomas were observed in 33 cases, non-specific inflammation in six cases, and malignancy in five cases; one case was inconclusive and the sample was found to be inadequate in two cases. The ROSE assessment matched the final diagnosis in 84.45% patients. CONCLUSION ROSE is a simple procedure that is able to provide an immediate and accurate assessment of adequacy and has a significant yield, enabling a preliminary diagnosis to be made in both benign and malignant samples.
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Affiliation(s)
- Purnima Bharati
- Department of Pathology, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Desh Deepak
- Department of Respiratory Medicine, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Manju Kaushal
- Department of Pathology, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Prajwala Gupta
- Department of Pathology, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
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Umeda Y, Otsuka M, Nishikiori H, Ikeda K, Mori Y, Kobayashi T, Asai Y, Takahashi Y, Sudo Y, Kodama K, Yamada G, Chiba H, Takahashi H. Feasibility of rapid on‐site cytological evaluation of lung cancer by a trained pulmonologist during bronchoscopy examination. Cytopathology 2019; 30:628-633. [DOI: 10.1111/cyt.12771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Yasuaki Umeda
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Mitsuo Otsuka
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Hirotaka Nishikiori
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Kimiyuki Ikeda
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Yuki Mori
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Tomofumi Kobayashi
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Yuichiro Asai
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Yohei Takahashi
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Yuta Sudo
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Kentaro Kodama
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Gen Yamada
- Department of Respiratory MedicineTeine Keijinkai Hospital Sapporo Hokkaido Japan
| | - Hirofumi Chiba
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
| | - Hiroki Takahashi
- Department of Respiratory Medicine and AllergologySapporo Medical University School of Medicine Sapporo Japan
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This 'Rose' Has no Thorns-Diagnostic Utility of 'Rapid On-Site Evaluation' (ROSE) in Fine Needle Aspiration Cytology. Indian J Surg Oncol 2019; 10:688-698. [PMID: 31857767 DOI: 10.1007/s13193-019-00981-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023] Open
Abstract
Fine needle aspiration (FNA) cytology is a basic diagnostic technique used to investigate superficial and deep swellings. Rapid on-site evaluation (ROSE) using toluidine blue (TB) is easily available, cheap, cost-effective, can be used both for testing adequacy and giving provisional diagnosis. To evaluate the role of ROSE using toluidine blue staining in arriving at a diagnosis in comparison to routine stains. A total of 1500 cases of FNA of palpable swellings from sites like salivary gland, breast, thyroid, lymph node, and soft tissue lesions [non-image guided] during a 9-month period were studied. All the cases were evaluated by ROSE using toluidine blue stain and routine Giemsa/PAP staining. The results were compared in each case. Only 2% cases proved inadequate on TB, Giemsa and PAP combination, commonest site of inadequacy being lymph node. Adequate sample was obtained within two passes in 92.5% cases. The turn-around time (TAT) was 1 day in 96.4% of cases. The average time for making a provisional diagnosis on TB was 3 minutes. There was 99.2% concordance between TB and final cyto-diagnosis. Validity parameters: sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 99.8%, efficacy 99.2% and false negative 1.94%. ROSE using toluidine blue is a reliable means of demonstrating sample adequacy, for making a provisional diagnosis and guiding collection of diagnostic material for microbiology, immunocytochemistry (ICC), cell block and molecular testing etc. The technique is easy enough for general laboratories to incorporate into their routine practice. ROSE can be called as the "frozen section of cytology".
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Sandoh K, Ishida M, Okano K, Miyasaka C, Mori S, Tokuhara M, Suzuki R, Okazaki T, Nakamura N, Tsuta K. Utility of endoscopic ultrasound‐guided fine‐needle aspiration cytology in rapid on‐site evaluation for the diagnosis of gastric submucosal tumors: Retrospective analysis of a single‐center experience. Diagn Cytopathol 2019; 47:869-875. [DOI: 10.1002/dc.24252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Kaori Sandoh
- Department of Pathology and Laboratory MedicineKansai Medical University Osaka Japan
| | - Mitsuaki Ishida
- Department of Pathology and Laboratory MedicineKansai Medical University Osaka Japan
| | - Kimiaki Okano
- Department of Pathology and Laboratory MedicineKansai Medical University Osaka Japan
| | - Chika Miyasaka
- Department of Pathology and Laboratory MedicineKansai Medical University Osaka Japan
| | - Shigeo Mori
- Third Department of Internal MedicineKansai Medical University Osaka Japan
- Mori Internal Medicine and Dermatology Clinic Osaka Japan
| | - Mitsuo Tokuhara
- Third Department of Internal MedicineKansai Medical University Osaka Japan
| | - Ryou Suzuki
- Third Department of Internal MedicineKansai Medical University Osaka Japan
| | - Takashi Okazaki
- Third Department of Internal MedicineKansai Medical University Osaka Japan
| | - Naohiro Nakamura
- Third Department of Internal MedicineKansai Medical University Osaka Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory MedicineKansai Medical University Osaka Japan
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