[2028] Rapid On-Site Evaluation (ROSE) for Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA): An Inter-Institutional Comparative Study

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

Background: ROSE is generally considered a beneficial practice to improve diagnostic yield of EBUS-FNAs; however, complicating factors are often not considered. To address this issue, a study of two academic medical centers with different ROSE practice patterns was performed to probe the impact of ROSE on EBUS-FNA procedures and subsequent outcomes.
Design: Following IRB approval, retrospective data were collected from all EBUS-FNAs performed over a one-year time period (8/2011-8/2012) at two tertiary-care Academic Medical Centers: AMC-A where ROSE is only occasionally utilized for EBUS-FNA procedures, and AMC-B where ROSE is routinely used for EBUS-FNA procedures. Variables investigated included % of repeat procedures and ROSE, site and number of stations sampled, procedure time, and distribution of final diagnoses. Statistical significance was determined by t-test for continuous variables and by chi-squared test for categorical variables.
Results: Study results are presented in the table below.

VariableInstitutionp value
Procedure #304187 
Repeat procedures10 (3.3%)5 (2.7%)0.7
ROSE done28 (9.2%)183 (98%)<0.001
Specimen type <0.001
Mass only32 (11%)31 (17%) 
Lymph nodes only212 (70%)146 (78%) 
Both60 (20%)10 (5.4%) 
Number of sampled nodal stations <0.001
None32 (11%)31 (17%) 
177 (25%)137 (73%) 
285 (28%)18 (9.6%) 
373 (24%)1 (0.5%) 
4 or more37 (12%)0 (0%) 
Mean time per procedure (min)63 (15-162)63 (14-142)0.88
Mean time: 1 site sampled56 (15-127)58 (14-142)0.52
Mean time: 2 sites sampled58 (25-130)90 (42-142)<0.0001
Mean time: 3+ sites sampled72 (18-162)105 (87-117)0.03
Final Diagnosis 0.57
Non-diagnostic22 (7.2%)8 (4.3%) 
Negative111 (37%)66 (35%) 
Atypical22 (7.2%)11 (5.9%) 
Suspicious6 (2.0%)3 (1.6%) 
Positive143 (47%)99 (53%) 

Conclusions: The routine use of ROSE for EBUS FNA procedures tends to lead to slightly lower non-diagnostic rates; however, ROSE significantly prolongs the procedure time relative to the increasing number of sites sampled. Without ROSE, a more complete mediastinal staging (i.e. more lymph node stations) can be performed without significantly increasing the procedure time. From a cytopathology management perspective, routine use of ROSE can represent a significant personnel cost. With an increasingly likely bundled payment environment for health care reimbursement, further study is needed to determine the optimal utilization of ROSE to maximize both the quality and efficiency of patient care.
Category: Quality Assurance

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 289, Tuesday Morning


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