Abstract
Background Rapid on-site evaluation (ROSE) is commonly used to evaluate the adequacy of biopsy materials in fine-needle aspiration; however, the diagnostic performance of ROSE during fiber optic bronchoscopy (FOB) biopsy under direct vision is rarely reported. Here, we evaluated the role of ROSE during FOB biopsy of visible lesion in trachea or bronchi. Methods The role of ROSE was prospectively evaluated in consecutive bronchoscopy specimens obtained between January 2016 and January 2018. The agreement and accuracy between ROSE and final histopathological interpretation were assessed. The frequency and possible reasons for discrepancy between ROSE and definitive histopathology results were identified. Histological and cytological classification was performed according to the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society (IASLC/ATS/ERS) criteria of lung ADCs classification. Results The study enrolled 651 patients, of which 33 were excluded because of insufficient cells. Final diagnosis of malignancy was achieved in 462 cases (74.8%), whereas 156 cases (25.2%) were nonmalignant. ROSE and pathology were well correlated for the diagnosis of squamous cell carcinoma (SCC) (Kappa = 0.718, p < 0.05), adenocarcinoma (AdC) (Kappa = 0.662; p < 0.05) and small cell lung cancer (SCLC) (Kappa = 0.955; p < 0.05). In 24 cases diagnosed as malignant by ROSE and nonmalignant by pathology, the lesion tissues were surgically excised and re-analyzed, and the 24 cases were finally confirmed as malignant by pathology. Conclusions ROSE technique allows bronchoscopists to obtain viable and adequate material for the diagnosis of histopathology, and provides them with an onsite preliminary diagnosis especially in cases with inconclusive macroscopic appearance. ROSE and pathology should be used in combination to increase the accuracy of diagnosis.
Highlights
Rapid on-site evaluation (ROSE) is commonly used to evaluate the adequacy of biopsy materials in ne-needle aspiration; the diagnostic performance of rapid on-site evaluation (ROSE) during ber optic bronchoscopy (FOB) biopsy under direct vision is rarely reported
We demonstrate that ROSE ensures the quality of biopsy specimens during FOB procedure, and the results of ROSE correlated well with the nal pathological diagnosis based on hematoxylin and eosin (H&E) staining of biopsy samples of FOB
Technical advances in histopathology have reduced the processing time for small biopsies to a few hours [13], cytology remains the method of choice for an immediate assessment of sample adequacy, whereas biopsies can be used for di erent purposes [14]. e proportion of inadequate specimens reportedly ranges from 2.7% to 14.3% during FNA biopsy [6, 15, 16], consistent with our nding of 5.1% (33/651) inadequacy
Summary
Rapid on-site evaluation (ROSE) is commonly used to evaluate the adequacy of biopsy materials in ne-needle aspiration; the diagnostic performance of ROSE during ber optic bronchoscopy (FOB) biopsy under direct vision is rarely reported. Fassina et al [8] reported a satisfactory overall agreement of 71.4% was achieved in di erentiating the cancer histological types in ne needle aspiration (FNA) for ROSE, and Nakajima et al [2] reported a concordance rate of ROSE and nal pathologic diagnosis of 94.3% in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The utility of ROSE during bronchoscopy biopsy under direct vision is rarely reported, and so its role has remained unclear We conducted this prospective randomized study to further clarify the role of ROSE in assessing materials’ adequacy and categorizing diagnosis during biopsy procedure
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