„Rapid on-site evaluation“ (ROSE) in der zytologischen Diagnostik von Lungen- und Mediastinalerkrankungen

The application of artificial intelligence for Rapid On-Site Evaluation during flexible bronchoscopy

Background

Rapid On-Site Evaluation (ROSE) during flexible bronchoscopy (FB) can improve the adequacy of biopsy specimens and diagnostic yield of lung cancer. However, the lack of cytopathologists has restricted the wide use of ROSE.

Objective

To develop a ROSE artificial intelligence (AI) system using deep learning techniques to differentiate malignant from benign lesions based on ROSE cytological images, and evaluate the clinical performance of the ROSE AI system.

Method

6357 ROSE cytological images from 721 patients who underwent transbronchial biopsy were collected from January to July 2023 at the Tangdu Hospital, Air Force Medical University. A ROSE AI system, composed of a deep convolutional neural network (DCNN), was developed to identify whether there were malignant cells in the ROSE cytological images. Internal testing, external testing, and human-machine competition were used to evaluate the performance of the system.

Results

The ROSE AI system identified images containing lung malignant cells with the accuracy of 92.97% and 90.26% on the internal testing dataset and external testing dataset respectively, and its performance was comparable to that of the experienced cytopathologist. The ROSE AI system also showed promising performance in diagnosing lung cancer based on ROSE cytological images, with accuracy of 89.61% and 87.59%, and sensitivity of 90.57% and 94.90% on the internal testing dataset and external testing dataset respectively. More specifically, the agreement between the ROSE AI system and the experienced cytopathologist in diagnosing common types of lung cancer, including squamous cell carcinoma, adenocarcinoma, and small cell lung cancer, demonstrated almost perfect consistency in both the internal testing dataset (κ  =   0.930 ) and the external testing dataset (κ  =   0.932 ).

Conclusions

The ROSE AI system demonstrated feasibility and robustness in identifying specimen adequacy, showing potential enhancement in the diagnostic yield of FB. Nevertheless, additional enhancements, incorporating a more diverse range of training data and leveraging advanced AI models with increased capabilities, along with rigorous validation through extensive multi-center randomized control assays, are crucial to guarantee the seamless and effective integration of this technology into clinical practice.

Rapid Remote Online Evaluation in Endoscopic Diagnostics: An Analysis of Biopsy-Proven Respiratory Cytopathology

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.

The Use of Robotic-Assisted Bronchoscopy in the Diagnostic Evaluation of Peripheral Pulmonary Lesions: A Paradigm Shift

Despite recent developments, evaluation of peripheral pulmonary lesions (PPL) remains clinically challenging, and the diagnostic yield of many image-guided and bronchoscopy methods is still poor. Furthermore, complications from such procedures, such as pneumothorax and airway hemorrhage, are a major concern. Recently launched robotic-assisted bronchoscopy (RAB) platforms are still in the early exploration stage and may provide another tool for achieving PPL evaluation. We present our experience here as a retrospective cohort study describing the 12-month diagnostic yield with the shape-sensing Ion™ platform for minimally invasive peripheral lung biopsy. The study describes forty-two patients undergoing shape sensing robotic-assisted bronchoscopy (ssRAB) at our institute. The early performance trend reveals a lesion localization of 100% and an overall 12-month diagnostic yield of 88.10%. The diagnostic yield for lesions less than 20 mm was 76% and for lesions greater than 20 mm was 100%. We also report our complication profile; we noted no pneumothoraces, excessive bleeding, or post-operative complications. In comparison to traditional bronchoscopy and image-guided modalities, our experience shows that ssRAB can be utilized successfully to travel to extremely small peripheral lesions with a higher diagnostic yield and better safety profile.

Rapid on-site evaluation of touch imprints of biopsies improves the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy: a retrospective study

OBJECTIVE

Rapid on-site evaluation has long been used for transbronchial needle aspiration or fine-needle aspiration to evaluate the adequacy of biopsy materials for the diagnosis of peripheral lung lesions. However, research on rapid on-site evaluation combined with transbronchial forceps biopsy in the diagnosis of lung carcinoma is rarely reported. Therefore, we aimed to investigate the value of rapid on-site evaluation during transbronchial forceps biopsy for endoscopically visible (tumor, infiltrative and necrotic) or nonvisible (compressive, nonspecific and normal) malignancy.

METHODS

A retrospective analysis was performed between January 2015 and January 2019 in Taihe Hospital with 1216 lung cancer patients who underwent bronchoscopy procedures, and these patients were allocated into the rapid on-site evaluation group and non-rapid on-site evaluation group, depending on the timing of the procedure. According to endoscopic features, bronchoscopic appearance was described as endoscopically visible malignancy (tumor, infiltrative and necrotic) and endoscopically nonvisible malignancy (compressive, nonspecific and normal). The diagnostic yield was compared, and the concordance between the rapid on-site evaluation results and the final histology was analyzed.

RESULTS

There was a statistically significant difference in the diagnostic yield between the rapid on-site evaluation and non-rapid on-site evaluation groups for endoscopically nonvisible malignancy (74.3% vs. 51.7%, P < 0.05). However, we found no significant improvement in terms of diagnostic yield for endoscopically visible malignancy (95.2% vs. 91.2%, P > 0.05). The rapid on-site evaluation results showed high-level concordance with histology in the diagnosis of squamous cell carcinoma, adenocarcinoma and small cell carcinoma, with kappa values of 0.749 (P < 0.05), 0.728 (P < 0.05) and 0.940 (P < 0.05), respectively.

CONCLUSIONS

The findings demonstrated that the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy (compressive, nonspecific and normal) was significantly improved when rapid on-site evaluation was implemented. In addition, the rapid on-site evaluation results had high-level concordance with the final histological diagnosis.

Diagnostic value of endobronchial ultrasound combined with rapid on-site evaluation of transbronchial lung biopsy for peripheral pulmonary lesions

BACKGROUND

Rapid on-site evaluation (ROSE) has the potential to increase endobronchial ultrasound (EBUS) guide transbronchial lung biopsy (TBLB) accuracy in the diagnosis of peripheral pulmonary lesions (PPLs). However, studies have reported controversial results. The aim of the study was to evaluate the diagnostic value of EBUS-TBLB combination with ROSE in PPLs.

METHODS

A total of 152 patients with PPLs underwent EBUS were enrolled and completed this study. Patients were divided into EBUS combined with ROSE group (EBUS+ROSE group) and EBUS group (EBUS group). The diagnostic yield, operation time, and complications were compared between the two groups.

RESULTS

The diagnostic yield in EBUS+ROSE group was 85.9%, the operation time was (24.6 ± 6.8) min, the diagnostic yield in EBUS group was 70.3%, and the operative time was (32.4 ± 8.7) min, there were significant differences in diagnostic yield (χ² = 5.456, P = .016) and operation time (t = 3.167, P = .001) between the two groups. No severe procedure related complications were observed, such as, pneumothorax and hemorrhage.

CONCLUSIONS

ROSE can improve the diagnostic yield and shorten the operation time. EBUS combined with ROSE is an effective diagnostic method for PPLs.

Rapid On-Site Evaluation During Radial Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy for the Diagnosis of Peripheral Pulmonary Lesions

Objective:

To evaluate the diagnostic value of radial endobronchial ultrasound (R-EBUS) combination with rapid on-site evaluation (ROSE) guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions.

Methods:

Peripheral pulmonary lesions identified by computed tomography underwent R-EBUS with or without ROSE randomly from February 2016 to August 2017. The diagnostic yield and the operation time were compared.

Results:

In total, 158 patients were involved in and completed this research, including 84 cases in the group of R-EBUS with ROSE, and 74 in the group without ROSE. The diagnostic yield of ROSE group was 85.7%. Among these positive cases, 69.4% cases were malignant tumors, and 30.6% cases were benign lesions. The operation time was (24.6 ± 6.3) min. In the group without ROSE, the diagnostic yield was 70.3%, including 35 malignant tumors (67.3%), and 17 benign lesions (32.7%). The operation time was (31.5 ± 6.8) min. There were significant differences between both groups in the diagnostic yield (χ2 = 5.556, P = 0.018) and in the operation time (t = 3.187, P < 0.01). No serious procedure related complications were observed, such as pneumothorax and hemorrhage.

Conclusion:

ROSE can improve the diagnostic yield, and shorten the operation time. R-EBUS combined with ROSE is a safe and effective technique for peripheral pulmonary lesions.

The diagnosis value of endobronchial ultrasound transbronchial lung biopsy combined with rapid on-site evaluation in peripheral lung cancer

INTRODUCTION

Rapid on-site evaluation (ROSE) has the potential to increase endobronchial ultrasound transbronchial lung biopsy with guide sheath (EBUS-GS-TBLB) accuracy in the diagnosis of peripheral lung cancer. However, studies have reported controversial results.

OBJECTIVES

The aim of the study was to evaluate the diagnosis value of EBUS-GS-TBLB combination with ROSE in peripheral lung cancer.

METHODS

A total of 138 patients undergoing EBUS-GS-TBLB and ultimately diagnosed with lung cancer were allocated into the ROSE group and non-ROSE group. The result of the diagnostic yields, number of biopsy sites, the complication, cytopathological diagnostic cost and procedure times of EBUS-GS-TBLB with ROSE and without ROSE were compared.

RESULTS

The diagnostic yields of TBLB were 87.8% and 78.1% in ROSE group and non-ROSE group, respectively (P < .05). The number of biopsy, procedure times and the percentage of the complication in ROSE group was significantly lower than in non-ROSE group (P < .05, respectively). The cytopathological diagnostic cost of ROSE group was lower compared with non-ROSE group (P < .05).

CONCLUSIONS

EBUS-GS-TBLB combined with ROSE could be helpful to diagnose peripheral lung cancer, and could reduce the number of biopsy, procedure times, cytopathological diagnostic cost and complication.

Diagnostic value of rapid on-site evaluation during transbronchial biopsy for peripheral lung cancer

BACKGROUND

An increasing number of pulmonary lesions-particularly, peripheral lung lesions-are identified with current technological advancements. Notably, the yield of traditional bronchoscopy for the diagnosis of peripheral lung lesions is low. This study evaluated the diagnostic value of rapid on-site evaluation (ROSE) during transbronchial biopsy for peripheral lung cancer.

METHODS

This study included 641 patients who underwent transbronchial biopsy for suspected lung cancer at the Respiratory Department of Tianjin Medical University General Hospital between January 2012 and December 2016. Based on whether ROSE was used, patients were assigned to the ROSE group (353 patients) or non-ROSE group (288 patients). In the ROSE group, several air-dried smears were processed with Diff-Quik staining; the remaining samples were placed in 10% formalin. Diagnostic yields for central and peripheral lung cancer were compared between the two groups. In addition, ROSE results were compared with final diagnoses.

RESULTS

Diagnostic yield for peripheral lung cancer, stratified by pathology, was significantly higher in the ROSE group than in the non-ROSE group (42.9% vs. 30.7%, P < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ROSE for peripheral pulmonary lesions were 90.0%, 89.5%, 94.0%, 82.8% and 89.8%, respectively. Conformance was high between ROSE and final pathologic evaluations during transbronchial biopsy (Kappa = 0.780, P = 0.035). There were no procedure-related deaths.

CONCLUSIONS

ROSE during conventional transbronchial biopsy improves diagnostic yield, stratified by pathology, for patients with peripheral lung cancer via live feedback. Moreover, ROSE diagnosis correlates with final cytopathological diagnosis.

Comparing the Clinical Performance of the New 19-G ViziShot FLEX and 21- or 22-G ViziShot 2 Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Needles

Objective Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure for pulmonary and mediastinal diseases. This study compared the performance of a novel 19-G needle with a 21- or 22-G needle. Patients and Methods Eleven patients at Okayama Medical Center were enrolled retrospectively between April and December 2017. Enlarged lymph nodes and a pulmonary nodule were sampled with both 19-G and 21- or 22-G needles in nine patients. Two patients underwent biopsies for suspected lymphoma with only the 19-G needle. We examined their medical records on the diagnosis, size of the lymph nodes and pulmonary nodule, and complications. Results The median longest diameter of the 13 lymph nodes (8 #7, 4 #4R, and 1 #11) and 1 pulmonary nodule (right segment 6) in the 11 patients was 31.6 mm (range, 10.4-45.0 mm). Definitive diagnoses were made using the 19-G needle in nine patients. EBUS-TBNA with a 19-G needle resulted in successful diagnoses of one case of retinal hemangioblastoma, one case of tuberculous lymphadenitis, and one case of lung adenocarcinoma, as well as the evaluation of the programmed death-ligand 1 (PD-L1) expression following initial negative findings after a 21- or 22-G biopsy. A small pulmonary nodule (lung squamous cell carcinoma) with negative findings after a 19-G biopsy was diagnosed with a 22-G biopsy. Two suspected lymphoma patients were diagnosed with a 19-G needle: one had lymphoma and the other sarcoidosis. Three patients were diagnosed with sarcoidosis using both the 19-G and 21- or 22-G needles. Conclusion EBUS-TBNA with a 19-G needle was useful for diagnosing retinal hemangioblastoma and tuberculous lymphadenitis as well as for PD-L1 testing after 21- and 22-G biopsies were unsuccessful.

[Value of C-ROSE During EBUS-TBNA to Obtain the Tissue Sample in the Diagnosis of Lung Cancer]

背景与目的

在肺及纵隔占位性病变的患者中大部分临床考虑诊断为原发性肺癌，超声支气管镜引导下的经支气管针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA)是一种常用的获取病理组织明确诊断的手术。在EBUS-TBNA过程中，快速现场细胞学评价(cytological rapid on-site evaluation, C-ROSE)是一项有用的辅助技术。本研究探讨C-ROSE在EBUS-TBNA取样诊断肺癌中的价值。

方法

对141例经胸部计算机断层扫描(computed tomography, CT)发现存在纵隔和(或)肺门病灶(包括肿大的淋巴结/肿块)且临床高度疑诊原发性肺癌而行EBUS-TBNA患者进行回顾性分析，其中术中行C-ROSE者81例，未行C-ROSE者60例，分析两组患者的穿刺情况及并发症发生率，同时分析C-ROSE联合EBUS-TBNA取样对肺癌诊断的敏感度、特异度、阳性预测值、阴性预测值。

结果

C-ROSE组与非C-ROSE组穿刺针数及穿刺部位数无统计学差异，穿刺合格率分别为98.77%和90.00%(P < 0.05)，诊断率分别为88.89%和75.00%(P < 0.05)，并发症发生率分别为1.23%和11.67%(P < 0.05)。C-ROSE联合EBUS-TBNA对肺癌诊断的敏感度为92.21%，特异度为100.00%，阳性预测值为100.00%，阴性预测值为40.00%。

结论

C-ROSE在疑诊肺癌行EBUS-TBNA中应用可以提高穿刺成功率及诊断率、减少并发症，值得推广。

Can positron emission tomography/computed tomography be predictive of diagnostic success in endobronchial biopsies performed through a fiber-optic bronchoscopy in lung cancer?

PURPOSE

The purpose of this study is to investigate the effect of homogeneous/heterogeneous (necrotic) involvement and maximum standardized uptake value (SUVmax) value of the lesion on positron emission tomography-computed tomography (PET-CT) of patients who underwent fiberoptic bronchoscopy (FOB) for prediagnosis of lung cancer and biopsy for endobronchial lesion on the diagnostic success of biopsy procedure.

METHODS

Between January 2014 and December 2016, patients with final diagnosis of pulmonary malignancy as determined by FOB biopsy and patients who failed to be diagnosed by FOB biopsy and diagnosed with pulmonary malignancy by a different diagnostic method were examined. These patients were divided into two groups as those with diagnosis by FOB biopsy (Group 1) and those who failed to be diagnosed by this method and diagnosed with pulmonary malignancy by a different diagnostic method (Group 2). The SUVmax values of the two groups were compared with lesion characteristics of homogeneous, heterogeneous involvement/presence of necrotic component as shown by PET-CT. Group data were assessed by Chi-square test and Mann-Whitney U-test. In all tests, P < 0.05 was considered significant.

FINDINGS

A total of 193 participants with a mean age of 61 ± 9.4 were included in the study. There were 128 (66.3%) cases in Group 1 and 65 (33.7%) cases in Group 2. The mean SUVmax value was 16.4 in Group 1 and 15.1 in Group 2. There was no statistically significant difference between the two groups (P = 0.329). Homogeneous involvement was present in 103 (80.3%) cases in Group 1 versus 42 (64.6%) cases in Group 2. In the presence of homogeneous PET-CT involvement, diagnosis rate by biopsy was significantly higher (P = 0.016).

CONCLUSION

We concluded that the high SUVmax value of the mass lesion on PET-CT did not increase the diagnostic value of the biopsy procedure in patients prediagnosed with lung cancer and that the diagnostic success of FOB biopsy was poor in cases where PET-CT showed heterogeneous involvement of the mass lesion.

[The value of transbronchial needle aspiration combined with rapid on-site evaluation of cytology in the diagnosis of lung cancer]

背景与目的

国内外目前已有多篇现场细胞学应用于经支气管镜针吸活检（transbronchial needle aspiration, TBNA）的报道，但专门针对肺癌患者的研究很少。本研究的目的是探讨TBNA联合现场细胞学在肺癌诊断中的作用。

方法

回顾性分析2012年12月-2013年12月在滨州市人民医院行TBNA并最终确诊为肺癌的69例患者，其中行现场细胞学者37例，未行现场细胞学者32例。比较现场细胞学结果与最终HE染色结果的一致性，同时比较两组患者的诊断率、每个淋巴结穿刺针数、并发症发生率及细胞学诊断费用。

结果

现场细胞学与HE染色一致性为94.1%（32/34）。现场细胞学组诊断率与非现场细胞学组相比无统计学差异（91.9% vs 78.1%, P=0.20）；但平均穿刺针数及并发症发生率，现场细胞学组少于非现场细胞学组（t=29.5, P < 0.05; χ²=4.4, P < 0.05），现场细胞学组患者细胞学诊断费用低于非现场细胞学组（t=10.9, P < 0.05）。

结论

TBNA联合现场细胞学诊断肺癌，与HE染色一致性好，且能减少穿刺针数及并发症，节省细胞学诊断费用，值得推广。

Advanced diagnostic bronchoscopy using conscious sedation and the laryngeal nerve block: tolerability, thoroughness, and diagnostic yield

PURPOSE

Although bronchoscopy has conventionally been performed using conscious sedation, advanced diagnostic techniques like endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), peripheral EBUS, and electromagnetic navigational bronchoscopy add to procedural complexity. The adaptation of these techniques by bronchoscopists of varied backgrounds is expanding. It is not clear how patients will tolerate these advanced procedures when they are performed using traditional conscious sedation.

METHODS

We prospectively studied patients that underwent diagnostic bronchoscopic procedures using conscious sedation over a 1-year period. The primary outcome was patient tolerability measured with four questions soliciting subjective responses. Secondary outcomes included required dosage of medications, thoroughness of the procedure, diagnostic yield, and occurrence of complications.

RESULTS

A total of 181 patients were enrolled. Compared to patients in whom conventional bronchoscopy with transbronchial biopsies were performed, there was no difference in patient tolerability using the advanced techniques. Although some of the advanced procedures added to the procedure time, the required amount of medication was within commonly accepted dosages. When EBUS-TBNA was performed, a mean of 2.8 lymph node stations per patient were sampled. A specific diagnosis was obtained in 55.9 % of patients who solely underwent EBUS-TBNA. The diagnostic yield increased to 75.7 % when a parenchymal abnormality prompted additional biopsies. One patient required sedation reversal. Complications were minimal.

CONCLUSIONS

This study suggests that advanced diagnostic bronchoscopic procedures are well tolerated using conscious sedation with no compromise of thoroughness, diagnostic yield, or safety. This may be useful for bronchoscopists using these techniques who do not have ready access to general anesthesia.

Diagnostic concordance rate between histologic and cytologic specimens of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer: A single institution experience

BACKGROUND

The aspirates from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were examined using the tissue core and cytology. We assessed that the tissue core was a more reliable specimen and attempted to analyze how many discrepancies were found between the two specimens. We investigated diagnostic concordance rate between histology and cytology.

METHODS

From January 2011 to December 2011, a total of 267 consecutive patients with lung cancer, who underwent EBUS-TBNA, were included in this retrospective study.

RESULTS

Of the 267 lung cancer patients, 207 (77.5%) were men. The median age was 65 years old. The most common pathologic type was adenocarcinoma (120, 44.9%), followed by squamous cell carcinoma (79, 29.6%). Among the 267 patients, 579 mediastinal and hilar lymph nodes were punctured. The right lower paratracheal (204, 35.2%) and subcarinal (172, 29.7%) lymph nodes were the most common nodal stations. Among the 579 lymph nodes, malignant cells were observed in 267 (46.1%) nodes, in either the histologic, cytologic or both slides: 209 in both histology and cytology, 37 in histology only, and 21 in cytology only slides. The diagnostic concordance rate between the tissue core and cytology was 90.0% (95% confidence interval CI, 87.1-92.2) (κ = 0.79).

CONCLUSIONS

The diagnostic concordance rate between the histology and cytology of EBUS-TBNA in lung cancer was 90.0% (95% CI, 87.1-92.2) (κ = 0.79).

Rapid on-site evaluation with BIOEVALUATOR(®) during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing pulmonary and mediastinal diseases

AIM:

Rapid on-site evaluation (ROSE) is used widely during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). BIOEVALUATOR^® is a device used for determining whether the tissues obtained by EBUS-TBNA are appropriate for a pathological diagnosis. This study describes our experience with ROSE using BIOEVALUATOR^® during EBUS-TBNA for diagnosing pulmonary and mediastinal diseases.

MATERIALS AND METHODS:

We retrospectively evaluated the results of 35 patients who underwent EBUS-TBNA with BIOEVALUATOR^® between December 2011 and February 2013. For the diagnosis, the tissue areas were appearing white and red through BIOEVALUATOR^® are considered to be appropriate and inappropriate, respectively. We examined their medical records to obtain information concerning the examination of BIOEVALUATOR^® results of the patient's materials (white/red), the diagnosis yield, site and size of lymph nodes and number of needle passes.

RESULTS:

The median longest diameter of 40 lymph nodes (21 #7, 13 #4R, 4 #4L and 2 #11) from 35 patients was 27.9 (range 12.4-50.6) mm and the median number of needle passes was 2 (range 1-5). The definitive diagnosis was made by EBUS-TBNA in 28 of 35 patients, by thoracotomy in one patient and BIOEVALUATOR^® results were white and lymphocytes were seen in the rest six patients. The BIOEVALUATOR^® results of other patients without accurate diagnosis were left indefinitive. Finally, the six patients were judged as having benign lymphadenopathy because the lymph node size on computed tomography decreased or remained stable after for at least 8 months.

CONCLUSIONS:

Checking aspirated samples using BIOEVALUATOR^® appears useful for determining their adequacy for pathological diagnosis.

Rapid on-site evaluation for endoscopic ultrasound-guided fine-needle biopsy of the pancreas decreases the incidence of repeat biopsy procedures

BACKGROUND

Rapid on-site evaluation (ROSE) for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy of the pancreas provides immediate feedback regarding cellular adequacy to aid in obtaining a definitive diagnosis and has the potential to avoid repeat procedures. The objective of the current study was to measure the impact of ROSE service on the incidence of repeat EUS FNA biopsy procedures.

METHODS

Over a consecutive 3-year period, the pathology database at Washington University Medical Center was searched for patients with both an initial and subsequent EUS FNA biopsy demonstrating a solid lesion of the pancreas. These were divided temporally between the time before and after the introduction of ROSE service. Reports were reviewed and results were recorded.

RESULTS

A total of 379 patients underwent ROSE service and 377 patients did not. The percentage of repeat non-ROSE EUS FNA cases was 5.8% and the percentage of repeat ROSE EUS FNA cases was 2.9%. The use of the ROSE service was found to decrease the number of repeat procedures by approximately 50% (P = .024). For those patients who underwent a repeat EUS-FNA procedure, the ROSE service provided a higher rate of definitive diagnosis among patients undergoing repeat procedures (67%) versus the non-ROSE cohort (27%).

CONCLUSIONS

The use of ROSE for EUS-FNA biopsy of the pancreas was found to result in fewer patients undergoing repeat procedures. Patients who required a repeat procedure with the use of ROSE had a higher percentage of definitive diagnostic categorization on the repeat biopsy. Initial use of ROSE for EUS-FNA of solid pancreatic lesions was found to decrease the number of patients who required a repeat procedure.