Rapid On-Site Evaluation of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration: A Practice To Preserve or Retire?
Lauren E Schwartz, Gordon H Yu, Zubair W Baloch. Hospital of the University of Pennsylvania, Philadelphia, PA
Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has become an integral tool in the diagnosis and staging of malignant tumors of the lung. Rapid on-site evaluation (ROSE) is a central part of the practice of cytology, to assess for adequacy and provide a preliminary diagnosis. Although ROSE has proven to increase diagnostic accuracy for other sites, few studies have specifically investigated its utility in the assessment of EBUS-TBNA specimens. This study critically evaluates the possible diagnostic benefit and true utility of ROSE for EBUS-TBNA specimens.
Design: The pathology files at our institution were searched for all EBUS-TBNAs performed from 1/10 to 6/11. Data points included number of patients undergoing EBUS-TBNA, number of sites sampled per patient, location of site(s) sampled, use of ROSE, preliminary on-site diagnosis, final cytologic diagnosis, cell blocks produced and ancillary studies performed.
Results: A total of 953 EBUS-TBNA specimens, 854 (90%) lymph nodes and 99 (10%) lung lesions, were collected between 1/10 and 6/11 from 461 patients. ROSE was performed for 394/953 (41%) cases, from 202 patients. The on-site and final diagnoses were concordant in 205 (52%) and discordant in 189 (48%) cases. The main source of disagreement [100 (25%) cases], was the lack of site specific/diagnostic tissue present in on-site smears, but diagnostic tissue present in liquid based preparations and/or cell blocks. Diagnostic specimens were obtained in 366/394 (93%) cases with ROSE and 495/559 (89%) without ROSE. The final diagnosis was malignant in 171/394 (43%) cases with ROSE and 129/559 (23%) without ROSE and benign (excluding granulomatous inflammation) in 146/394 (37%) with ROSE and 328/559 (59%) without ROSE. A cell block was obtained in 364/394 (92%) cases with ROSE and 511/559 (91%) of cases without ROSE.
Conclusions: No significant difference was seen in diagnostic yield for EBUS-TBNA cases with and without ROSE. The main cause for discordant preliminary and final diagnoses in cases with ROSE was the lack of site specific/diagnostic tissue on preliminary smears, suggesting that liquid based preparations and cell blocks may offer advantages for processing these specimens. Despite the benefits of ROSE, in this era of personalized medicine and increasing health-care costs, forgoing ROSE may lead to cost savings as well as increased diagnostic material available for immunohistochemical and molecular testing in EBUS-TBNA specimens.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 257, Monday Afternoon