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Liang L, Duan H, Zhu H, Yang H, Li X, Wang C, Xie S. Value of transbronchial needle aspiration combined with a rapid on-site evaluation of cytology in the diagnosis of pulmonary lesions. Front Med (Lausanne) 2022; 9:922239. [PMID: 36275797 PMCID: PMC9579285 DOI: 10.3389/fmed.2022.922239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background The diagnostic value of rapid on-site evaluation (ROSE) of cytology during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains controversial. The purpose of this study was to validate the value of ROSE during the EUBS-TBNA procedure in the diagnosis of pulmonary lesions (PLs). Methods Enrolled in this study were 260 patients with nodules, masses, cavities, or inflammatory lesions on pulmonary CT images. They were assigned to undergo EBUS-TBNA with ROSE (n = 134) or without ROSE (n = 126). The diagnostic results of ROSE during EBUS-TBNA and the final pathologic reports were analyzed and compared by utilizing SPSS21.0 software to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In addition, we further explored whether the ROSE method during EBUS-TBNA would improve the diagnostic yield and reduce the incidence of complications. Results The overall diagnostic yield of EBUS-TBNA for malignant diseases in the ROSE and the non-ROSE group were 29.9 and 11.1%, respectively. The sensitivity, specificity, PPV and NPV of the ROSE method during EBUS-TBNA were 97.4, 96.9, 92.5, and 98.90%, respectively. The result of the chi-square test effectively proved that ROSE operation during EBUS-TBNA contributes to the diagnosis of malignancy compared with the non-ROSE group (χ2 = 13.858, P < 0.001). The number of punctures in the ROSE group was significantly lower than that in the non-ROSE group (P < 0.001). Conclusion ROSE examination during EBUS-TBNA could effectively improve the diagnostic yield of malignant diseases compared with the non-ROSE group and reduce the number of intraoperative punctures, which is a clinical application worth popularizing.
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Affiliation(s)
- Long Liang
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongxia Duan
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, China
| | - Huiyuan Zhu
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huiqiong Yang
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuan Li
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Xuan Li,
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,Changhui Wang,
| | - Shuanshuan Xie
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,Shuanshuan Xie,
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Natali F, Cancellieri A, Giunchi F, De Silvestri A, Livi V, Ferrari M, Paioli D, Betti S, Fiorentino M, Trisolini R. Interobserver agreement between pathologist, pulmonologist and molecular pathologist to estimate the tumour burden in rapid on-site evaluation smears from endosonography and guided bronchoscopy. Cytopathology 2021; 31:303-309. [PMID: 32463969 DOI: 10.1111/cyt.12867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/16/2020] [Accepted: 05/24/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A growing number of studies have suggested that non-pathologists can reliably assess the adequacy and malignancy in rapid on-site evaluation (ROSE) smears prepared during endoscopic sampling procedures. However, no study has verified whether they can also consistently estimate the tumour burden, which is critical for the molecular profiling of lung cancer. We aimed to assess the interobserver agreement (IOA) between a pathologist, a pulmonologist (previously trained in lung and lymph node cytopathology) and a molecular pathologist for the tumour burden in ROSE smears. METHODS The ROSE smears of consecutive patients with suspected lung cancer undergoing endosonography or guided bronchoscopy were assessed independently by a pathologist, a pulmonologist and a molecular pathologist (gold standard). The IOA for the tumour burden, assessed through k-statistics, was the primary outcome. RESULTS A total of 322 ROSE smears obtained from 162 patients were evaluated. The IOA between the molecular pathologist and pulmonologist was very good (moderate to substantial), although slightly inferior to the IOA between the molecular pathologist and pathologist in the whole slide set (k: 0.707, 95% confidence interval [CI]: 0.677-0.739 vs 0.793, 95% CI: 0.762-0.815), as well as in smears prepared from lymphadenopathy (k: 0.783, 95% CI: 0.760-0.855 vs 0.827, 95% CI: 0.728-0.892) or from pulmonary nodules/masses (k: 0.558, 95% CI: 0.416-0.686 vs 0.715, 95% CI: 0.621-0.767). CONCLUSIONS A professionally trained pulmonologist can reliably estimate the tumour burden in bronchoscopically derived ROSE smears, especially in the setting of lymphadenopathy. This can be particularly useful in institutions where a cytopathologist is not available regularly.
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Affiliation(s)
- Filippo Natali
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi & Ospedale Maggiore, Bologna, Italy
| | - Alessandra Cancellieri
- Pathology Unit, Policlinico Sant'Orsola-Malpighi & Ospedale Maggiore, Bologna, Italy.,Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | - Vanina Livi
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi & Ospedale Maggiore, Bologna, Italy.,Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Marco Ferrari
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi & Ospedale Maggiore, Bologna, Italy
| | - Daniela Paioli
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi & Ospedale Maggiore, Bologna, Italy.,Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Sara Betti
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi & Ospedale Maggiore, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Specialistic, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi & Ospedale Maggiore, Bologna, Italy.,Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Mathew R, Meena N, Roy WE, Chen C, Macchiraella M, Bartter T. Rapid On-Site Cytologic Evaluation: A Feasibility Study Using Ancillary Interventional Pulmonary Personnel. Respiration 2021; 100:1-6. [PMID: 33540414 DOI: 10.1159/000513432] [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: 08/22/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ancillary health professionals helping in a procedural service is a common practice everywhere. OBJECTIVES This was a proof-of-concept study to assess feasibility of using ancillary personnel for rapid on-site cytologic evaluation (ROSE) at interventional pulmonary procedures. METHODS After a training interval, a respiratory therapist (RT) performed ROSE on consecutive interventional pulmonary specimens. Sample sites included lymph nodes, lung, liver, and the left adrenal gland. RT findings were subsequently correlated with blinded cytopathology-performed ROSE and with final histopathology results, with primary foci of adequacy and the presence or absence of malignancy. RESULTS Seventy consecutive cases involved 163 separate sites for ROSE analysis. Adequacy: There was a high level of concordance between RT-performed ROSE (RT-ROSE) and cytopathology ROSE (CYTO-ROSE). They agreed upon the adequacy of 159 specimens. The Cohen's κ coefficient ± asymptotic standard error (ASE) was 0.74 ± 0.175, with p < 0.0001. Malignancy: RT-ROSE concurred highly with CYTO-ROSE, with agreement on 150 (92%) of the 163 specimens. Cohen's κ coefficient ± ASE was 0.83 ± 0.045, with p < 0.0001. When the comparison was for malignancy by case rather than individual site, Cohen's κ coefficient ± ASE was 0.68 ± 0.08, with p < 0.0001. CONCLUSION This study demonstrates that ancillary personnel supporting an interventional pulmonary service can be trained to perform initial ROSE. Cytopathology can be called after sampling and staining have produced adequate samples. This setup streamlines ROSE evaluation with regard to time and cost.
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Affiliation(s)
- Roshen Mathew
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA,
| | - Nikhil Meena
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Winnie Elma Roy
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Chien Chen
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maggie Macchiraella
- Respiratory Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Natali F, Cancellieri A, Tinelli C, De Silvestri A, Livi V, Ferrari M, Romagnoli M, Paioli D, Trisolini R. A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation. Respiration 2019; 97:540-547. [PMID: 30982053 DOI: 10.1159/000496549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/31/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials that show a lack of increase in diagnostic yield and specimen adequacy associated with its usage. OBJECTIVE We aimed to verify whether a pulmonologist can assess endosonography-derived lymph node samples after a comprehensive and reproducible training provided by a specialist pathologist. METHODS Prospective, observational trial structured in three phases. In the first (training) phase, a pathologist critically evaluated the smears from 150 archival endosonography cases with a pulmonologist. In the second (test) phase, the pulmonologist was asked to assess 50 archival endosonography-derived samples. In the last (real-life) phase, the pulmonologist classified the samples from 200 patients during the endosonography. The overall agreement between pulmonologist and pathologist (gold standard), assessed through κ-statistics, was the primary outcome. The agreement for the identification of specific cytological categories was the secondary outcome. RESULTS The overallagreement between pulmonologist and pathologist was 84% (κ0.765, 95% CI 0.732-0.826) in the test phase and 89.7% (κ 0.844, 95% CI 0.799-0.881) in the real-life phase. The agreement for specific cytological categories was 92.7% (95% CI 0.824-0.980) for inadequate samples, 90.3% (95% CI 84.5-94.5%) for reactive lymphadenopathies, 90.5% (95% CI 0.845-0.946) for malignancy, and 73% (95% CI 0.515-0.897) for granulomatous samples. CONCLUSIONS A trained pulmonologist can reliably assess adequacy and malignancy for endosonography-derived samples, which could be useful in institutions where a cytopathologist/cytotechnician is not available regularly.
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Affiliation(s)
- Filippo Natali
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy
| | | | - Carmine Tinelli
- Clinical Epidemiology and Biometry Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Vanina Livi
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy
| | - Marco Ferrari
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy
| | - Micaela Romagnoli
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy
| | - Daniela Paioli
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi and Ospedale Maggiore, Bologna, Italy,
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Bang JY, Varadarajulu S. Improving the results of pancreatic endoscopic ultrasound-guided fine needle aspiration in daily practice: keep it simple. Endosc Int Open 2015; 3:E138-9. [PMID: 26135656 PMCID: PMC4477015 DOI: 10.1055/s-0034-1391416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/07/2015] [Indexed: 01/07/2023] Open
Affiliation(s)
- Ji Young Bang
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, United States
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, United States,Corresponding author S. Varadarajulu, MD Center for Interventional EndoscopyFlorida Hospital601 East Rollins StreetOrlando, FL 32803+14073032585
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Holt BA, Varadarajulu S, Hébert-Magee S. High-quality endoscopic ultrasound-guided fine needle aspiration tissue acquisition. Adv Ther 2014; 31:696-707. [PMID: 24958327 PMCID: PMC4115182 DOI: 10.1007/s12325-014-0129-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Indexed: 02/07/2023]
Abstract
Endoscopic ultrasound-guided fine needle aspiration is a multistep procedure that involves proper clinical indication, correct selection of needles, adapting evidence-based techniques such as the fanning maneuver and not routinely using suction or the stylet for tissue sampling, and establishing reliable cytopathology support. Integrating cytopathology in the training curriculum and developing a more flexible platform of needles and echoendoscopes are likely to further advance the field of endosonography. This review aims to summarize the technical issues that are key to performing high-quality endoscopic ultrasound-guided fine needle aspiration.
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Affiliation(s)
- Bronte A. Holt
- Center for Interventional Endoscopy, Florida Hospital, 601 East Rollins Street, Orlando, FL 32804 USA
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy, Florida Hospital, 601 East Rollins Street, Orlando, FL 32804 USA
| | - Shantel Hébert-Magee
- Center for Interventional Endoscopy, Florida Hospital, 601 East Rollins Street, Orlando, FL 32804 USA
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Frisch NK, Nathan R, Ahmed YK, Shidham VB. Authors attain comparable or slightly higher rates of citation publishing in an open access journal (CytoJournal) compared to traditional cytopathology journals - A five year (2007-2011) experience. Cytojournal 2014; 11:10. [PMID: 24987441 PMCID: PMC4058908 DOI: 10.4103/1742-6413.131739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/31/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The era of Open Access (OA) publication, a platform which serves to better disseminate scientific knowledge, is upon us, as more OA journals are in existence than ever before. The idea that peer-reviewed OA publication leads to higher rates of citation has been put forth and shown to be true in several publications. This is a significant benefit to authors and is in addition to another relatively less obvious but highly critical component of the OA charter, i.e. retention of the copyright by the authors in the public domain. In this study, we analyzed the citation rates of OA and traditional non-OA publications specifically for authors in the field of cytopathology. DESIGN We compared the citation patterns for authors who had published in both OA and traditional non-OA peer-reviewed, scientific, cytopathology journals. Citations in an OA publication (CytoJournal) were analyzed comparatively with traditional non-OA cytopathology journals (Acta Cytologica, Cancer Cytopathology, Cytopathology, and Diagnostic Cytopathology) using the data from web of science citation analysis site (based on which the impact factors (IF) are calculated). After comparing citations per publication, as well as a time adjusted citation quotient (which takes into account the time since publication), we also analyzed the statistics after excluding the data for meeting abstracts. RESULTS Total 28 authors published 314 publications as articles and meeting abstracts (25 authors after excluding the abstracts). The rate of citation and time adjusted citation quotient were higher for OA in the group where abstracts were included (P < 0.05 for both). The rates were also slightly higher for OA than non-OA when the meeting abstracts were excluded, but the difference was statistically insignificant (P = 0.57 and P = 0.45). CONCLUSION We observed that for the same author, the publications in the OA journal attained a higher rate of citation than the publications in the traditional non-OA journals in the field of cytopathology over a 5 year period (2007-2011). However, this increase was statistically insignificant if the meeting abstracts were excluded from the analysis. Overall, the rates of citation for OA and non-OA were slightly higher to comparable.
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Affiliation(s)
- Nora K. Frisch
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Romil Nathan
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Yasin K. Ahmed
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Vinod B. Shidham
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
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Bellevicine C, Malapelle U, Vigliar E, de Luca C, Troncone G. Epidermal growth factor receptor test performed on liquid-based cytology lung samples: experience of an academic referral center. Acta Cytol 2014; 58:589-94. [PMID: 25428205 DOI: 10.1159/000369756] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/10/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In this study we reviewed our practice of lung cancer epidermal growth factor receptor (EGFR) mutational testing in an academic centralized laboratory setting, where direct smears and liquid-based cytology (LBC) slides represent the most frequent cytological specimens received. The aim was to assess the differences, if any, between these sample types in terms of DNA yield, adequacy rates and overall EGFR testing performance. STUDY DESIGN A total of 362 cases were retrieved - received from January 2012 to January 2014 for EGFR testing - including 204 LBC specimens and 158 smears. Exon 19 deletions and the L858R point mutation in exon 21, detected by fragment assay and TaqMan assay, respectively, were confirmed by direct sequencing or by high-resolution melting. RESULTS Although the direct smears showed a higher DNA yield (60.94 vs. 23.07 ng/µl) and were more frequently cell-rich (54%) than the LBC slides (31.4%), the differences in adequacy (direct smears: 97.4%; LBCs: 94.1%) and in mutant rate (direct smears: 10.3%; LBCs: 14.0%) between the two sample types did not reach statistical significance. CONCLUSIONS Not only direct smears but also LBC slides represent an effective preparation and storage medium for cytological material to be used for EGFR molecular testing.
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Affiliation(s)
- Claudio Bellevicine
- Pathology Section, Department of Public Health, University of Naples Federico II, Naples, Italy
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Collins BT, Murad FM, Wang JF, Bernadt CT. Rapid on-site evaluation for endoscopic ultrasound-guided fine-needle biopsy of the pancreas decreases the incidence of repeat biopsy procedures. Cancer Cytopathol 2013; 121:518-24. [PMID: 23983161 DOI: 10.1002/cncy.21340] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/01/2013] [Accepted: 07/09/2013] [Indexed: 02/06/2023]
Abstract
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.
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Shidham VB, Demay RM. Announcement of first time Cytojournal impact factor for 2012 coincides with Cytojournal decade celebration (2004-2013). Cytojournal 2013; 10:18. [PMID: 24082914 PMCID: PMC3779425 DOI: 10.4103/1742-6413.117359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 12/25/2022] Open
Affiliation(s)
- Vinod B Shidham
- Address: Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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Joseph M, Jones T, Lutterbie Y, Maygarden SJ, Feins RH, Haithcock BE, Veeramachaneni NK. Rapid on-site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging. Ann Thorac Surg 2013; 96:403-10. [PMID: 23731611 DOI: 10.1016/j.athoracsur.2013.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 03/31/2013] [Accepted: 04/02/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endobronchial ultrasonography with transbronchial needle aspiration (EBUS-TBNA) has been shown to be equivalent to mediastinoscopy in lung cancer staging for mediastinal node involvement. Rapid on-site evaluation (ROSE) to determine the adequacy of nodal sampling has been claimed to be beneficial. METHODS A retrospective evaluation was performed in 170 patients who underwent EBUS-TBNA from July 2008 to May 2011. The patients were classified as having either high or low pretest probability for mediastinal disease based on history and radiographic imaging. ROSE was compared with the final pathology reports based on slides and cell blocks. RESULTS One hundred thirty-one (77%) patients were classified as being in the high pretest cohort based on clinical staging. Of these, 101 (77%) patients had adequate tissue sampling based on ROSE, with 70 (69%) patients having positive mediastinal disease. In the 30 (23%) patients who had inadequate tissue by ROSE, the final analysis of all the prepared slides and cell blocks allowed for a diagnosis in all but 8 patients. The sensitivity and specificity of ROSE in the high pretest probability cohort were 89.5% and 96.4%, respectively, whereas the overall sensitivity and specificity of EBUS-TBNA was 92.1% and 100%, respectively. Despite having inadequate tissue on ROSE in 30 of 131 patients, sufficient tissue was available on final analysis for diagnosis in 22 of 30 patients. CONCLUSIONS ROSE does not impact clinical decision making if a thorough mediastinal staging using EBUS is performed. Despite inadequate tissue sampling assessment by ROSE, a final diagnosis was made in most patients, potentially avoiding an additional surgical procedure to prove mediastinal disease.
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Affiliation(s)
- Mark Joseph
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Yasufuku K, Feith JF. Cytological specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration: Sample handling and role of rapid on-site evaluation. Ann Pathol 2012; 32:e35-46, 421-32. [DOI: 10.1016/j.annpat.2012.09.212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/13/2012] [Indexed: 11/29/2022]
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Fleury-Feith J, Yasufuku K. Prélèvements cytologiques guidés par échoendoscopie bronchique : prise en charge du matériel recueilli et rôle de l’examen extemporané. Ann Pathol 2012. [DOI: 10.1016/j.annpat.2012.09.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Griffin AC, Schwartz LE, Baloch ZW. Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens. Cytojournal 2011; 8:20. [PMID: 22145008 PMCID: PMC3229807 DOI: 10.4103/1742-6413.90081] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 11/08/2011] [Indexed: 11/07/2022] Open
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.
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Affiliation(s)
- Adrienne Carruth Griffin
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15261, USA
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Davey DD, Neal MH. Coding changes in the United States front and center. Cancer Cytopathol 2011; 119:310-4. [DOI: 10.1002/cncy.20159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 03/29/2011] [Accepted: 03/30/2011] [Indexed: 01/20/2023]
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Dhillon I, Pitman MB, Demay RM, Archuletta P, Shidham VB. Compensation crisis related to the onsite adequacy evaluation during FNA procedures-Urgent proactive input from cytopathology community is critical to establish appropriate reimbursement for CPT code 88172 (or its new counterpart if introduced in the future). Cytojournal 2010; 7:23. [PMID: 21082041 PMCID: PMC2980694 DOI: 10.4103/1742-6413.71741] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 10/01/2010] [Indexed: 11/04/2022] Open
Abstract
The confusion centered around appropriate use of the CPT billing code 88172 is addressed in the commentary from the Economic and Government Affairs Committee of the American Society of Cytopathology (ASC) who have written a timely commentary in this issue of Cytojournal, "Adequate Reimbursement is Crucial to Support Cost-Effective Rapid Onsite Cytopathology Evaluations". Currently, lack of standardized use within and between pathology departments is stirring unhealthy practices of denying reimbursements for this critical and legitimate cytopathology service. This editorial discusses the important concerns raised in this commentary and recommends immediate corrective action. (See also Al-Abbadi MA, et al. Adequate reimbursement is crucial to support cost-effective rapid on-site cytopathology evaluations. CytoJournal 2010;7:22).
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Affiliation(s)
- Inderpreet Dhillon
- Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, Detroit, MI
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