Rapid On-Site Evaluation in the Endobronchial Ultrasound-Guided Fine Needle Aspiration Biopsy of Mediastinal Lymph Nodes
D Marks-Jones, LA Teot, WE Khalbuss, G Cai. University of Pittsburgh Medical Center, Pittsburgh, PA
Background: Endobronchial ultrasound-guided fine needle aspiration biopsy (EBUS-FNA) has been increasingly used in the nodal staging of lung cancer and evaluation of mediastinal lymphadenopathy of other etiologies. Rapid on-site evaluation (ROSE) is a crucial component of the FNA biopsy to assure adequate sampling and appropriate specimen triage. Preliminary diagnosis rendered at the ROSE may also guide clinical management. In this retrospective study, we compared the ROSE diagnosis to the final cytological diagnosis and assessed the impact of ROSE diagnosis on patient management.
Design: A total of 166 mediastinal lymph nodes in 84 patients were biopsied via EBUS-FNA at our institution from August 2007 to July 2008. ROSE was performed by cytopathologists with cytomorphologic analysis on Diff-Quik stained smears. The final cytological diagnosis was rendered by integrating the findings on smears, cell-block, and ancillary studies if applicable. The ROSE and final cytological diagnoses were classified as negative, granuloma, atypical, suspicious or malignant.
Results: Satisfactory EBUS-FNA biopsy was seen in 123 of 166 lymph nodes (74%) and in 56 of 84 (67%) patients. Overall, the ROSE and final diagnoses were precisely correlated in 106 of 123 lymph nodes (86%).
|Final Cytological Diagnosis|
|Negative||55||51 (92%)||2 (4%)||2 (4%)||0||0|
|Atypical||12||3 (25%)||0||4 (33%)||1 (9%)||4 (33%)|
|Suspicious||6||0||0||2 (33%)||1 (17%)||3 (50%)|
Thirty-seven patients (44%) had surgical follow up with mediastinal lymph node biopsy. Sixteen patients who underwent lymph node biopsy had unsatisfactory EBUS-FNA biopsies. The remaining 21 patients had satisfactory EBUS-FNA biopsies that were diagnosed by ROSE as negative (n=10), granuloma (n=2), atypical (n=5), suspicious (n=2), and malignant (n=2), respectively.
Conclusions: The results suggest that ROSE results correlate with the final cytological diagnoses in most cases, especially in cases with a diagnosis of negative, granuloma or malignant. For the unsatisfactory cases or cases with atypical and suspicious diagnoses, clinical correction is required for appropriate patient management.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 44, Wednesday Afternoon