[2005] Rapid On-Site Cytologic Evaluation of CT-Guided Lung Biopsies: An Inter-Institutional Comparison of Two Academic Medical Centers

Kavitha P Rao, Kathriel J Brister, Paul A VanderLaan, Helen H Wang, Jonathan D Marotti. Dartmouth-Hitchcock Medical Center, Lebanon, NH; Beth Israel Deaconess Medical Center, Boston, MA

Background: Institutions vary in their methods and utilization of rapid on-site cytologic evaluation (ROSE). The purpose of this study was to compare ROSE techniques and outcomes for CT-guided lung biopsies at two academic medical centers.
Design: A retrospective review of all lung CT-guided FNA and/or core-biopsies with touch preparations between August 1, 2011 and August 1, 2012 was performed at two major academic medical centers. Following IRB approval, departmental data bases and electronic medical records were reviewed to record number of procedures with and without ROSE, procedure time, number of repeat procedures, number of passes, presence of complications, and distribution of ROSE and final diagnoses.
Results:

VariableInstitutionP value
 AB 
Procedure #18790 
Repeat procedures2 (2.3%)4 (2.1%)1.0
Patient #85181 
M:F41:4497:840.42
Mean ageM 67 (27-88)M 69 (33-91) 
 F 65 (24-89)F 67(37-89) 
Specimen type  <0.001
Core/TP only72 (83%)190 (100%) 
FNA9 (10%)0 
Core/TP & FNA6 (7%)0 
ROSE done84 (97%)190 (100%)0.01
Adequate on ROSE65 (77%)131 (69%)0.15
Average # of passes2.1 (1-7)5.0 (1-15)<0.0001
First pass that is adequate1.3 (1-4)2.1 (1-11)0.0001
Average # of passes if ROSE is adequate2.0 (1-4)5.0 (1-15)<0.0001
Average # of passes when ROSE is inadequate2.6 (1-7)4.9 (1-10)<0.0001
Average procedure time in minutes33 (10-155)36 (20-95)0.16
Complications   
Hemorrhage3 (3.5%)2 (1.1%)0.17
Pneumothorax6 (6.9%)18 (9.6%)0.46
Positive rate for adequate ROSE cases80%95%0.001
Positive rate for inadequate ROSE cases37%22%0.20
Final diagnosis  0.004
ND or negative19 (22%)47 (25%) 
Atypical6 (6.9%)0 
Suspicious3 (3.5%)6 (3.2%) 
Positive59 (68%)137 (72%) 


No significant difference was noted between patients with and without complications in procedure time (34 vs 35 minutes, P = 0.67) or number of passes (3.7 vs 4.1, P = 0.38).
Conclusions: In both institutions, core biopsy with on site evaluation of touch preps for adequacy is preferred for CT-guided lung procedures. Higher procedure volume and increased number of passes do not appear to have a major impact on procedure time, complications, or the overall final pathologic diagnosis. However, higher procedure volume was associated with a higher positive rate for those cases deemed adequate onsite. This suggests that improved familiarity of touch prep specimens by cytology personnel might lead to improved onsite diagnostic accuracy.
Category: Quality Assurance

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 287, Tuesday Morning

 

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