THE UTILITY OF RAPID ON-SITE CYTOLOGIC EVALUATION FOR DIAGNOSING PULMONARY NODULES: A RETROSPECTIVE STUDY

Abstract

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: Background: The usefulness of rapid on-site cytologic evaluation (ROSE) as a means of on-site assessment materials for improving diagnostic rates during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains controversial. Objectives: The purpose of this study was to investigate the effect of using ROSE during EBUS-TBNA on the diagnostic yield of pulmonary nodules and postoperative complications. METHODS: Methods: 260 patients with pulmonary CT imaging showing nodules, masses, cavities or inflammatory lesions were enrolled in this study and randomized to undergo EBUS-TBNA with or without ROSE. We compared and analyzed the effect of ROSE operation during EBUS-TBNA on the incidence of postoperative complications such as pneumothorax and hemoptysis in both groups, and evaluated the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and agreement rate of the ROSE. RESULTS: Results: The number of puncture in ROSE group was significantly reduced than that in non-ROSE group (2.07±0.26 vs 3.23±0.42; p<0.001). 2 pneumothorax cases were found in non-ROSE group, while there was no pneumothorax case in ROSE group. No significant statistical difference in hemoptysis between two groups (P=0.402). The sensitivity, specificity, PPV, NPV and agreement rate of ROSE during EBUS-TBNA were 97.4%, 96.9%, 92.5%, 98.9% and 97.0% respectively. The area under the ROC curve (AUC) of ROSE diagnosis of pulmonary nodules was 0.971, which was significant statistical differences(P<0.001). CONCLUSIONS: Conclusions: ROSE during EBUS-TBNA is closely associated with puncture numbers and higher diagnostic yield. CLINICAL IMPLICATIONS: The incidence and mortality of lung cancer have been at the level of high risk among all kinds of cancers1. The traditional pathological result is the gold standard for accurate diagnosis of the lesion. The difficulty of sampling and the time consuming of the diagnosis process are the shortcomings of the traditional examination, which may delay the patient's health status and the length of hospitalization, and increase the patient's economic burden. While, ROSE examination during the EBUS-TBNA period can realize the rapid diagnosis of the lesion on the spot, avoiding the defects of traditional pathological diagnosis. EBUS-TBNA, as a minimally invasive procedure, has been widely used in the early diagnosis of lung cancer in recent years due to it provides real-time visualization of lymph nodes and surrounding structures, which can point the needle tip to the target region 2,3,4. ROSE, as an immediate method to explain the pathological properties of puncture objects, has also been tried in EBUS-TBNA procedure. DISCLOSURES: No relevant relationships by changhui wang, source=Web Response no disclosure on file for shuanshuan xie