Rapid On-site Evaluation Group Research Articles

Role of General Anesthesia and Rapid On-site Evaluation in the Diagnosis of Lung Cancer with EBUS-TBNA

Lung cancer is a common malignant tumor of respiratory system. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a valuable tool for the diagnosis and staging of lung cancer. EBUS-TBNA is predominantly performed under local anesthesia or conscious sedation. However, the diagnostic performance of EBUS-TBNA under general anesthesia and in conjunction with rapid on-site evaluation (ROSE) remains uncertain. This study aims to investigate the value of general anesthesia and ROSE in the diagnosis of lung cancer with EBUS-TBNA. A retrospective analysis was conducted on 164 patients treated in the Department of Respiratory and Critical Care Medicine of The Affiliated Hospital of Southwest Medical University from January 2018 to December 2022. All patients were preoperatively suspected of lung cancer and underwent EBUS-TBNA. Based on whether they received general anesthesia and ROSE, the patients were divided into three groups: local anesthesia group (LA group)(n=54), general anesthesia group (GA group)(n=67) and general anesthesia with ROSE group (GA-ROSE group)(n=43). The puncture characteristics and diagnostic differences were analyzed among the groups. The number of lymph node puncture needles in the LA group was higher than in GA-ROSE group (P<0.01). The overall diagnostic rates of EBUS-TBNA for the three groups were 87.04%, 89.55% and 90.70%, respectively, with malignant tumor diagnostic rates of 88.24%, 88.89% and 94.74%. No statistically significant differences were observed among the three groups (P>0.05). There were no instances of severe complications or adverse anesthesia reactions in any of the groups. Compared to the combination of local anesthesia with intravenous analgesia and sedation, the implementation of EBUS-TBNA under general anesthesia, with or without ROSE, achieves equally accurate results, and general anesthesia combined with ROSE can reduce in the number of lymph node puncture needles.

Comparison of the diagnostic yield of rapid versus non-rapid onsite evaluation in endoscopic ultrasound-guided fine-needle aspiration cytology of solid pancreatic lesions.

The role of rapid on-site evaluation (ROSE) for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions is debatable. In this study, we aimed to compare the diagnostic yield of ROSE vs. non-ROSE in solid pancreatic lesions. This retrospective single-center study included patients undergoing EUS-FNA of solid pancreatic lesions from 2019-2021. Patients with cystic lesions, those undergoing fine-needle core biopsy, those undergoing repeat procedures, and patients with non-diagnostic smears with less than 6-month follow up were excluded. The diagnostic yield, need for repeat procedures and number of passes required with and without ROSE were analyzed in these patients. Of the 111 patients included, 56 underwent ROSE. The majority of lesions were malignant in both groups (79.6% ROSE vs. 75% non-ROSE). The diagnostic yield was 96.4% in the ROSE group and 94.5% in the non-ROSE group. Repeat samples were needed in 1 ROSE and 2 non-ROSE patients. The median number of passes made was significantly fewer in the ROSE group (3.5, interquartile range - 3,4) compared with the non-ROSE group (4, interquartile range - 3,5) P=0.01. However, the frequency of procedure-related complications was similar in both groups. The utilization of ROSE during EUS-FNA of solid pancreatic lesions does not affect the diagnostic yield or the need for repeat samples, but reduces the number of passes needed for acquiring samples.

Application of rapid on-site evaluation combined with flexible bronchoscopy in the diagnosis of lung lesions

BackgroundPathology is considered the gold standard for the diagnosis of lung lesions, but the pathological result is relatively lagging and cannot provide real-time guidance for the biopsy procedure. ObjectiveTo investigate the potential application of rapid on-site evaluation (ROSE) during flexible bronchoscopy (FB) in the evaluation and diagnosis of lung lesions. Patients and methodsConsecutive patients who underwent FB for the diagnosis of lung lesions between August 2022 and February 2023 were included in this retrospective study. 294 patients underwent FB with ROSE, while 304 patients underwent FB without ROSE. The final pathological results and the number of patients undergoing repeat biopsies were recorded in both groups. Specifically, we conducted separate statistical analysis for patients undergoing different biopsy methods, including the endobronchial biopsy (EBB), radial probe endobronchial ultrasound transbronchial lung biopsy with guide sheath (r-EBUS-GS-TBLB), and the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to study the detailed roles that ROSE plays under different biopsy methods. ResultsThe adequacy rate of biopsy specimens from the non-ROSE group was significantly lower than that of the ROSE group (259/281 = 92.17 % vs. 263/268 = 98.13 %, p = 0.001). Meanwhile, fewer patients underwent repeat biopsies in the ROSE group compared to the non-ROSE group (2/294 = 0.68 % vs. 10/304 = 3.29 %, p = 0.023). For the ROSE group, the consistency between ROSE diagnoses and final pathological diagnoses was 94.40 % (κ = 0.886), with 95.58 % for benign diseases and 93.55 % for malignant diseases. ConclusionThe utility of ROSE during FB increases the adequacy rate of biopsy specimens and thus decreases the need for repeat biopsies in patients with lung lesions to get a definite diagnosis. Moreover, the high consistency between ROSE diagnoses and final pathological diagnoses suggests that ROSE is a reliable tool for optimizing the diagnosis of lung lesions.

Utility of the Proposed Sydney System for Classification of Fine-Needle Aspiration Cytopathology of Lymph Node: A Retrospective Study at a Tertiary Care Center

Introduction: Fine-needle aspiration cytology (FNAC) is an established first-line technique for the evaluation of lymphadenopathy and, with the help of ancillary testing, can in many instances obviate the need for an open biopsy. The Sydney system was recently proposed to provide consensus guidelines for the performance, classification, and reporting of lymph node FNAC. The present study was undertaken to evaluate its utility and study the impact of rapid on-site evaluation (ROSE). Material and Methods: A retrospective analysis in which 1,500 lymph node FNACs was reviewed and assigned a diagnostic category from the Sydney system. Cyto-histopathological correlation and adequacy parameters were evaluated. Observation and Results: The cervical group of lymph nodes was the commonest group aspirated (89.7%). A total of 1,205/1,500 (80.3%) cases were category II (benign), and necrotizing granulomatous lymphadenitis was the most common pathology. The 750 cases with ROSE were subclassified as follows: 15 category I (inadequate), 629 category II (benign), 2 category III (atypia of undetermined significance), 9 category IV (suspicious for malignancy), and 95 category V (malignant). Among 750 cases without ROSE, 75 cases were in category I, 576 in category II, 3 in category III, 6 in category IV, and 90 in category V. Category I was thus significantly lower in the ROSE group compared to the non-ROSE group. Overall, the risk of malignancy was L1-0%, L2-0.20%, L3-100%, L4-92.3%, and L5-100%. Accuracy parameters revealed a sensitivity of 97.7%, specificity of 100%, PPV of 100%, NPV of 99.10%, and diagnostic accuracy of 99.54%. Discussion and Conclusion: FNAC can be used as the 1st line of treatment for lymph node pathology. ROSE can be used as an add-on to FNAC for reducing unsatisfactory rates and help triage material for ancillary testing whenever possible. The Sydney system should be implemented for achieving uniformity and reproducibility.

Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial.

Simple SummaryPulmonologist-performed US-NAB of “superficial” metastatic lesions is safe and has an excellent diagnostic yield for both tissue diagnosis and molecular profiling regardless of the use of rapid on-site evaluation. These findings have important implications for costs, hospital resource allocation, and the globally widespread utilization of US-NAB.Background and Objective: Studies which evaluated the role of an ultrasound-guided needle aspiration biopsy (US-NAB) of metastases from lung cancer located in “superficial” organs/tissues are scant, and none of them assessed the possible impact of rapid on-site evaluation (ROSE) on diagnostic accuracy and safety outcomes. Methods: Consecutive patients with suspected superficial metastases from lung cancer were randomized 1:1 to US-NAB without (US-NAB group) or with ROSE (ROSE group). The diagnostic yield for a tissue diagnosis was the primary outcome. Secondary outcomes included the diagnostic yield for cancer genotyping, the diagnostic yield for PD-L1 testing, and safety. Results: During the study period, 136 patients were randomized to receive an US-NAB with (n = 68) or without ROSE (n = 68). We found no significant differences between the ROSE group and the US-NAB group in terms of the diagnostic yields for tissue diagnosis (94.1% vs. 97%, respectively; p = 0.68), cancer genotyping (88% vs. 91.8%, respectively; p = 0.56), and PD-L1 testing (93.5% vs. 90.6%, respectively; p = 0.60). Compared to the diagnostic US-NAB procedures, the non-diagnostic procedures were characterized by less common use of a cutting needle (66.6% vs. 96.9%, respectively; p = 0.0004) and less common retrieval of a tissue core (37.5% vs. 98.5%; p = 0.0001). Only one adverse event (vasovagal syncope) was recorded. Conclusion: US-NAB of superficial metastases is safe and has an excellent diagnostic success regardless of the availability of ROSE. These findings provide a strong rationale for using US-NAB as the first-step method for tissue acquisition whenever a suspected superficial metastatic lesion is identified in patients with suspected lung cancer.

Value of transbronchial needle aspiration combined with a rapid on-site evaluation of cytology in the diagnosis of pulmonary lesions.

BackgroundThe diagnostic value of rapid on-site evaluation (ROSE) of cytology during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains controversial. The purpose of this study was to validate the value of ROSE during the EUBS-TBNA procedure in the diagnosis of pulmonary lesions (PLs).MethodsEnrolled in this study were 260 patients with nodules, masses, cavities, or inflammatory lesions on pulmonary CT images. They were assigned to undergo EBUS-TBNA with ROSE (n = 134) or without ROSE (n = 126). The diagnostic results of ROSE during EBUS-TBNA and the final pathologic reports were analyzed and compared by utilizing SPSS21.0 software to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In addition, we further explored whether the ROSE method during EBUS-TBNA would improve the diagnostic yield and reduce the incidence of complications.ResultsThe overall diagnostic yield of EBUS-TBNA for malignant diseases in the ROSE and the non-ROSE group were 29.9 and 11.1%, respectively. The sensitivity, specificity, PPV and NPV of the ROSE method during EBUS-TBNA were 97.4, 96.9, 92.5, and 98.90%, respectively. The result of the chi-square test effectively proved that ROSE operation during EBUS-TBNA contributes to the diagnosis of malignancy compared with the non-ROSE group (χ2 = 13.858, P < 0.001). The number of punctures in the ROSE group was significantly lower than that in the non-ROSE group (P < 0.001).ConclusionROSE examination during EBUS-TBNA could effectively improve the diagnostic yield of malignant diseases compared with the non-ROSE group and reduce the number of intraoperative punctures, which is a clinical application worth popularizing.

Application of rapid on‑site evaluation in computed tomography‑guided percutaneous transthoracic needle biopsy of pulmonary nodules of ≤2.0cm in diameter.

Histopathological findings are the gold standard for diagnosing lung nodules, and Invasive diagnostic procedures such as percutaneous transthoracic needle biopsy (PTNB) are often inevitable for a confirmative diagnosis. However, the traditional biopsy method is inefficient for the diagnosis of small pulmonary nodules (diameter ≤2.0 cm). The present study aimed to investigate the application of rapid on-site evaluation (ROSE) in CT-guided PTNB of pulmonary nodules (≤2.0 cm in diameter). Data from patients undergoing PTNB in the Second Affiliated Hospital of Qiqihar Medical College between June 2018 and June 2021 were retrospectively analyzed. A total of 250 patients were included and divided into the ROSE (n=177) and the non-ROSE groups (n=73). The comparison of these two groups indicated significantly higher specimen adequacy [93.22% (165/177) vs. 71.23% (52/73)] and diagnostic accuracy [90.40% (160/177) vs. 68.49% (50/73)], as well as a significantly lower rate of secondary biopsies [5.08% (9/177) vs. 28.77% (21/73)], in the ROSE group. The coincidence rate between the diagnosis with ROSE and the final pathological results was 96.73%, indicating high consistency (κ=0.925). The results indicated that the application of ROSE in PTNB of pulmonary nodules with a diameter of ≤2.0 cm can ensure sufficient material sampling, improve the diagnostic accuracy and reduce the secondary biopsy rate, without increasing complications. ROSE can ensure high consistency with the results obtained from the pathological evaluation.

Diagnostic value and safety of ultrathin bronchoscope and endobronchial ultrasonography with a guide sheath combined with rapid on-site evaluation system for peripheral pulmonary infectious diseases.

The aim of this study was to investigate the diagnostic value and safety of ultrathin bronchoscope and endobronchial ultrasonography with a guide sheath (EBUS-GS) combined with rapid on-site evaluation (ROSE) system for peripheral pulmonary infectious diseases. The clinical data of 196 patients visiting our hospital, who had peripheral pulmonary lesions (PPLs) indicated by spiral computed tomography (CT) of the chest and were finally diagnosed as infectious PPLs, were retrospectively collected. Then the patients were divided into ultrathin bronchoscope + ROSE group, EBUS-GS + ROSE group and ultrathin bronchoscope + EBUS-GS + ROSE group based on different diagnostic techniques. Moreover, the general conditions, diagnostic results and specific operation parameters of the patients were recorded, and the diagnostic rate, sensitivity and complications were compared. In ultrathin bronchoscope + EBUS-GS + ROSE group, the time of localizing lesions and operation time were the shortest, and the grade of bronchi reached by the bronchoscope was the highest. The differences were significant between any two groups (P<0.05). Patients with bacterial pneumonia, and patients with pulmonary tuberculosis and nontuberculous mycobacterial disease, ultrathin bronchoscope + EBUS-GS + ROSE group exhibited the highest definite diagnosis rate of bronchoscope and diagnostic sensitivity of ROSE system, with significant differences from those of the other two groups (P<0.05). The incidence rates of complications were low in all groups, and there were no significant differences between any two groups (P>0.05). Ultrathin bronchoscope and EBUS-GS combined with ROSE system can prominently decrease the time of localizing lesions and operation time, remarkably improve the diagnostic accuracy and sensitivity and result in fewer complications.

Diagnostic efficiency and safety of rapid on-site evaluation combined with CT-guided transthoracic core needle biopsy in suspected lung cancer patients.

ObjectiveThe efficacy of rapid on‐site evaluation (ROSE) combined with computed tomography‐guided transthoracic core needle biopsy (CT‐guided TCNB) is rarely investigated. This study aimed to evaluate the diagnostic efficiency and safety of ROSE combined with CT‐guided TCNB for suspected lung cancer patients.Materials and MethodsClinical data from 285 patients who received CT‐guided TCNB for suspected lung cancer in Huashan Hospital from 2015 to 2018 were retrospectively analysed. Of these 163 patients underwent CT‐guided TCNB combined with ROSE (ROSE group), while the remaining 122 patients underwent without ROSE (non‐ROSE group). The smears from TCNB were quickly processed with Diff‐Quick staining and analysed by a skilled cytologist on‐site. The consistency of ROSE with the final clinicopathological diagnosis and the diagnostic efficiency and safety of ROSE combined with CT‐guided TCNB in suspected lung cancer patients were evaluated.ResultsROSE was highly concordant with pathological diagnosis (κ = 0.791; P < 0.001), with an accuracy of 95.7%. Diagnostic accuracy was significantly higher in the ROSE compared with the non‐ROSE group (96.3% vs 86.1%; P = 0.002), with overall incidences of complications of 36.8% and 23.8%, respectively. Minor pneumothorax without drainage was slightly greater in the ROSE compared with the non‐ROSE group (14.1% vs 6.6%; P = 0.046). However, there was no significant difference in serious complications between the two groups.ConclusionROSE was highly consistent with the final clinicopathological diagnosis for suspected lung cancer. ROSE further improved the diagnostic efficiency of CT‐guided TCNB with no increased incidence of serious complications.

Impact of rapid on-site evaluation combined with endobronchial ultrasound and virtual bronchoscopic navigation in diagnosing peripheral lung lesions

BackgroundTo investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs).MethodsBetween January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in expected consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, based on the calculation of expected diagnostic yield of R-EBUS biopsy and drop out, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed.ResultsIn the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, respectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, respectively, and the average expense was 643.44 ± 706.56 US.$ (4093.15 ± 4494.67 yuan ¥). In the controls, the positive rate of brushing and biopsy were 44%, 74%, respectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, respectively. And the average expense during diagnosis was 1009.27 ± 713.89 US.$ (6420.28 ± 4541.33 yuan ¥). There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤ 2 cm in diameter was significant.ConclusionIn combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.

The Value of Computed Tomography-Guided Percutaneous Lung Biopsy Combined With Rapid On-Site Evaluation in Diagnosis of Peripheral Pulmonary Nodules.

Objective: To investigate the value of computed tomography-guided percutaneous lung biopsy (CT-PLB) combined with rapid on-site evaluation (ROSE) in the diagnosis of peripheral pulmonary lesions (PPLs). Methods: A total of 108 patients who diagnosed with PPLs by chest CT examination were prospectively collected and randomly divided into ROSE group (n = 56) and No-ROSE group (n = 52). Both groups received CT-PLB and pathological examination. The smear submitted for ROSE was stained using Diff Quik dye. The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), number of punctures, puncture time and incidence of complications were compared between the two groups. Results: The accuracy, sensitivity, specificity, PPV, and NPV of the ROSE group were 89.29%, 87.50%, 91.67%, 93.33%, and 84.62%, respectively. The number of punctures in the ROSE group was significantly lower than that in the No-ROSE group (P < .05). The incidence of pneumothorax and hemoptysis in the ROSE group were lower than those in the No-ROSE group, but there was no statistical difference between the two groups (P > .05). ROSE has good concordance with routine pathological examination in the diagnosis of unidentified PPLs (Kappa = 0.786, P < .01). Conclusions: CT-PLB combined with ROSE is a safe and effective method for the diagnosis of PPLs.

Comparison between EUS-guided fine-needle biopsy with or without rapid on-site evaluation for tissue sampling of solid pancreatic lesions: A systematic review and meta-analysis.

The benefit of rapid on-site evaluation (ROSE) on the diagnostic accuracy of EUS-guided fine-needle biopsy (EUS-FNB) in patients with pancreatic masses is still matter of debate. Aim of our meta-analysis is to compare the diagnostic outcomes of these two tissue acquisition strategies. Computerized bibliographic search on the main databases was performed through December 2021 and 8 studies were identified (2147 patients). The primary outcome was sample adequacy. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test and summary estimates were expressed in terms of odds ratio (OR) or mean difference and 95% confidence Interval (CI). There was no difference in terms of baseline variables between the two groups. Pooled sample adequacy was 95.5% (95% CI 93.2%-97.8%) and 88.9% (83.4%-94.5%) in the EUS-FNB + ROSE and EUS-FNB groups, respectively (OR = 2.05, 0.94-4.49; P = 0.07). Diagnostic accuracy resulted significantly superior in the EUS-FNB + ROSE group (OR = 2.49, 1.08-5.73; P = 0.03), particularly when the analysis was restricted to reverse bevel needle (OR = 3.24, 1.19-8.82, P = 0.02), whereas no statistical difference was observed when newer end-cutting needles were used (OR = 0.71, 0.29-3.61, P = 0.56). Diagnostic sensitivity was not significantly different between the two groups (OR = 1.94, 0.84-4.49; P = 0.12), whereas pooled specificity was 100% with both approaches. The number of needle passes needed to obtain diagnostic samples was not significantly different (mean difference 0.07,-0.22 to 0.37; P = 0.62). Our meta-analysis stands for a non-superiority of EUS-FNB + ROSE over EUS-FNB with newer end-cutting needles, whereas ROSE could have still a role when reverse bevel needles are used.

Performance of a new flexible 19 G EUS needle in pancreatic solid lesions located in the head and uncinate process: A prospective multicenter study.

Background and study aims The poor flexibility of large-bore EUS needles often leads to technical failure when sampling from the duodenum. The aim of this study was to evaluate the technical and diagnostic performances of a new Menghini tip 19G nitinol EUS needle for sampling pancreatic solid lesions in the head and uncinate process. Patients and methods This was a European prospective multicenter single-arm study. A maximum of four passes were allowed. In case of failure, different needles were permitted. Results We included 75 patients (51 % males) with lesions in the head (n = 68; 91 %) and uncinate process (n = 7; 9 %) (mean size: 33 ± 12 mm; number of passes: 1.8 ± 0.9). Technical success was seen in 71 of 75 (94.7 %). Diagnostic rates were 89.3 % (67/75) and 94.4 % (67/71) in the intention-to-treat (ITT) and per-protocol (PP) analysis, respectively. In the eight cases with failure, diagnosis was obtained with another needle (n = 4), from another lesion (n = 3) or with follow-up (n = 1). A histological sample was obtained in 64 patients (ITT 85.3 % and PP 90 %) and immunohistochemistry was successfully performed in 13 of 15 lesions in which it was required. No differences between rapid on-site evaluation (ROSE) and non-ROSE groups were observed regarding diagnostic success (87.5 % vs 91 %, P = 0.582) and diagnosis at the first pass (70 % vs 81 %, P = 0.289). Number of passes was lower in the ROSE group (1.4 + 0.9 vs 2.2 + 0.7, P < 0.001). One adverse event was recorded (1.3 %) consisting in a duodenal perforation after a single session EUS-ERCP. Conclusions The new nitinol Menghini tip 19G EUS needle showed high technical diagnostic success in safely sampling solid lesions in the head and uncinate process of the pancreas.

Endoscopic ultrasound fine needle biopsy was not more cost-effective than fine-needle aspiration with rapid on-site evaluation in gastrointestinal lesions diagnosis.

Cost-effectiveness comparison between endoscopic ultrasound (EUS)-guided acquisition techniques by fine-needle aspiration (FNA) and fine needle biopsy (FNB) in gastrointestinal lesions is still scarce. EUS-FNB has been shown to be more cost-effective than EUS-FNA, however, when adding rapid on-site evaluation (ROSE) to EUS-FNA, it is unclear whether EUS-FNB remains more cost-effective. Our aim was to assess cost-efficacy of EUS-FNB as compared to EUS-FNA with ROSE in gastrointestinal lesions. All patients who underwent EUS-FNA with ROSE or EUS-FNB at Galilee Medical Center were retrospectively reviewed. Cost-effectiveness analysis was based on the additional EUS sessions needed and on the average cost expenditure to achieve one final pathological diagnosis. Seventy-four cases were included in the final analysis. Of them, 21 patients (28.4%) were in the EUS-FNB group (group A), as compared to 53 patients (71.6%) who underwent EUS-FNA with ROSE (group B). Additional EUS sessions needed to achieve one final pathological diagnosis were needed in 14.3% of group A patients vs 9.4% in group B patients (P= .5). and, the average cost for achieving one final pathological diagnosis was similar in both groups (1226 ± 369$ for group A vs 1158 ± 309.6.7$ for group B, P= .2). Notably, even after analyzing pancreatic and non-pancreatic gastrointestinal lesions separately, there was no cost benefit of EUS-FNB over EUS-FNA with ROSE. Cost-effectiveness analysis was not different between EUS-FNB vs EUS-FNA with ROSE. Thus, the preference of one modality over the other should be based on availability and local expertise.

Diagnostic value of endobronchial ultrasound combined with rapid on‐site evaluation of transbronchial lung biopsy for peripheral pulmonary lesions

Rapid on-site evaluation (ROSE) has the potential to increase endobronchial ultrasound (EBUS) guide transbronchial lung biopsy (TBLB) accuracy in the diagnosis of peripheral pulmonary lesions (PPLs). However, studies have reported controversial results. The aim of the study was to evaluate the diagnostic value of EBUS-TBLB combination with ROSE in PPLs. A total of 152 patients with PPLs underwent EBUS were enrolled and completed this study. Patients were divided into EBUS combined with ROSE group (EBUS+ROSE group) and EBUS group (EBUS group). The diagnostic yield, operation time, and complications were compared between the two groups. The diagnostic yield in EBUS+ROSE group was 85.9%, the operation time was (24.6 ± 6.8) min, the diagnostic yield in EBUS group was 70.3%, and the operative time was (32.4 ± 8.7) min, there were significant differences in diagnostic yield (χ2 = 5.456, P = .016) and operation time (t = 3.167, P = .001) between the two groups. No severe procedure related complications were observed, such as, pneumothorax and hemorrhage. ROSE can improve the diagnostic yield and shorten the operation time. EBUS combined with ROSE is an effective diagnostic method for PPLs.

Rapid on-site evaluation of touch imprints of biopsies improves the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy: a retrospective study.

Rapid on-site evaluation has long been used for transbronchial needle aspiration or fine-needle aspiration to evaluate the adequacy of biopsy materials for the diagnosis of peripheral lung lesions. However, research on rapid on-site evaluation combined with transbronchial forceps biopsy in the diagnosis of lung carcinoma is rarely reported. Therefore, we aimed to investigate the value of rapid on-site evaluation during transbronchial forceps biopsy for endoscopically visible (tumor, infiltrative and necrotic) or nonvisible (compressive, nonspecific and normal) malignancy. A retrospective analysis was performed between January 2015 and January 2019 in Taihe Hospital with 1216 lung cancer patients who underwent bronchoscopy procedures, and these patients were allocated into the rapid on-site evaluation group and non-rapid on-site evaluation group, depending on the timing of the procedure. According to endoscopic features, bronchoscopic appearance was described as endoscopically visible malignancy (tumor, infiltrative and necrotic) and endoscopically nonvisible malignancy (compressive, nonspecific and normal). The diagnostic yield was compared, and the concordance between the rapid on-site evaluation results and the final histology was analyzed. There was a statistically significant difference in the diagnostic yield between the rapid on-site evaluation and non-rapid on-site evaluation groups for endoscopically nonvisible malignancy (74.3% vs. 51.7%, P<0.05). However, we found no significant improvement in terms of diagnostic yield for endoscopically visible malignancy (95.2% vs. 91.2%, P>0.05). The rapid on-site evaluation results showed high-level concordance with histology in the diagnosis of squamous cell carcinoma, adenocarcinoma and small cell carcinoma, with kappa values of 0.749 (P<0.05), 0.728 (P<0.05) and 0.940 (P<0.05), respectively. The findings demonstrated that the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy (compressive, nonspecific and normal) was significantly improved when rapid on-site evaluation was implemented. In addition, the rapid on-site evaluation results had high-level concordance with the final histological diagnosis.

Diagnostic Value of Rapid On-Site Evaluation for CT-Guided Percutaneous Fine Needle Aspiration in the Diagnosis of Pulmonary Occupying Lesions

Objective Rapid on-site evaluation (ROSE) is an effective and efficient auxiliary examination, but its value for CT-guided percutaneous fine-needle aspiration (FNA) in the diagnosis of pulmonary occupying lesions is unclear. This study is aimed at evaluating the clinical utility of ROSE for CT-guided percutaneous FNA. Methods We reviewed 234 patients from September 2018 to April 2019. The result using ROSE was compared with the final pathological diagnosis of CT-guided percutaneous FNA, and we also compared the complications between the ROSE group and the NO-ROSE group. The final pathological diagnosis results served as the gold standard. We also analyzed the diagnostic rate of FNA and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of malignancy. The correlation between diverse pathological types of lung cancer was also taken into consideration. Results In total, 132 patients underwent CT-guided percutaneous FNA with ROSE (ROSE group), and 102 did not (NO-ROSE group). The diagnostic rate, sensitivity, specificity, PPV, and NPV of the ROSE group were 91.6%, 89.1%, 94.1%, 93.4%, and 90.1%, respectively. The complication rates of the ROSE group and the NO-ROSE group were 8.33% and 16.67%, respectively. This difference was not statistically significant (P > 0.05). In subsets of adenocarcinoma (AC) and small cell lung cancer (SCLC) patients, the ROSE result was highly consistent with the final pathological result. Conclusion CT-guided percutaneous FNA combined with ROSE has a high diagnostic rate, sensitivity, and specificity for pulmonary occupying lesions and an acceptable rate of complications. This method is worthy of wide use given its high efficiency and safety.

Rapid On-Site Evaluation During Radial Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy for the Diagnosis of Peripheral Pulmonary Lesions.

Objective:To evaluate the diagnostic value of radial endobronchial ultrasound (R-EBUS) combination with rapid on-site evaluation (ROSE) guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions.Methods:Peripheral pulmonary lesions identified by computed tomography underwent R-EBUS with or without ROSE randomly from February 2016 to August 2017. The diagnostic yield and the operation time were compared.Results:In total, 158 patients were involved in and completed this research, including 84 cases in the group of R-EBUS with ROSE, and 74 in the group without ROSE. The diagnostic yield of ROSE group was 85.7%. Among these positive cases, 69.4% cases were malignant tumors, and 30.6% cases were benign lesions. The operation time was (24.6 ± 6.3) min. In the group without ROSE, the diagnostic yield was 70.3%, including 35 malignant tumors (67.3%), and 17 benign lesions (32.7%). The operation time was (31.5 ± 6.8) min. There were significant differences between both groups in the diagnostic yield (χ2 = 5.556, P = 0.018) and in the operation time (t = 3.187, P < 0.01). No serious procedure related complications were observed, such as pneumothorax and hemorrhage.Conclusion:ROSE can improve the diagnostic yield, and shorten the operation time. R-EBUS combined with ROSE is a safe and effective technique for peripheral pulmonary lesions.

Efficacy of rapid on-site evaluation for diagnosing pulmonary lesions and mediastinal lymph nodes: a systematic review and meta-analysis

Although rapid on-site evaluation (ROSE) is gradually becoming an integral part of the modern Interventional Pulmonology, the clinical benefit of ROSE is still a matter of controversy. The objective of this meta-analysis was to clarify whether ROSE is effective in diagnosing pulmonary lesions and mediastinal lymph nodes, synchronously, to assess circumstances under which ROSE makes more sense. MEDLINE and EMBASE were searched for studies comparing any outcome between ROSE and no-ROSE group in diagnosing pulmonary lesions and mediastinal lymph nodes. Statistical calculations were conducted using Review Manager, version 5.3, and Stata Release 12.0. Meta-analysis was completed using a random-effects model when I2≥50% or a fixed-effect otherwise. Heterogeneity was assessed by the I2-statistic test. Publication bias was assessed by the Begg's test. This Literature search yielded 27 studies altogether. The pooled risk difference of adequate rate was 0.12 [95% confidence intervals (CI): 0.07-0.16, I2=0%], the combined risk difference (RD) of diagnostic yield was 0.14 (95% CI: 0.09-0.18, I2=57%) while the pooled RD of sensitivity for malignancy was 0.10 (95% CI: 0.06-0.14, I2 =20%). Significant heterogeneity only existed in diagnostic yield (I2=57%, P=0.001). Further subgroup analysis documented a higher increase in diagnostic yield when sampling solid pulmonary lesions than sampling hilar/mediastinal lymph nodes 0.16 (95% CI: 0.12-0.20, I2=0%) versus 0.08 (95% CI: 0.04-0.13, I2=10%) and when applied to patients with suspected/diagnosed lung cancer than unselected patients 0.12 (95% CI: 0.06 to 0.18) versus 0.11 (95% CI: -0.07 to 0.28). ROSE is a useful technology in diagnosing pulmonary lesions and mediastinal lymph nodes, especially when sampling solid pulmonary lesions or applied to patients with suspected lung cancer.

The role of rapid on-site evaluation on diagnostic accuracy of endoscopic ultrasound fine needle aspiration for pancreatic, submucosal upper gastrointestinal tract and adjacent lesions.

Our aim was to assess adequacy and diagnostic accuracy of endoscopic ultrasound-fine needle aspiration (EUS-FNA) specimens with or without rapid on-site evaluation (ROSE) from pancreatic, upper gastrointestinal tract (UGIT) and adjacent masses. A retrospective cohort study based on patients' files who underwent EUS-FNA in Galilee Medical Center in a 4years period. Number of needle passes, repeated EUS and ROSE effect on tissue adequacy and diagnostic accuracy were reported. One-hundred sixty-one patients were included. Ninety-three patients (57.7%) underwent EUS-FNA without ROSE (group A) compared to 68 patients (42.3%) with ROSE (group B). The most common location was in the pancreas (55% in group A vs 81% in group B). Addition of ROSE yielded a significantly higher specimen adequacy (65% in group A vs 92.6% in group B (Chi-Square<0.0001, OR 6.72, 95% CI 2.45-18.38). The matching rate (accuracy) between ROSE diagnosis and final histopathological diagnosis was noticed in 61 out of 68 patients (89.7%, 95% CI 0.7993-0.9576). The Kappa coefficient correlations of matching rate between ROSE and final histopathological diagnosis of all lesion and in pancreatic lesions were 0.7558, (95% CI 0.625-0.887) and 0.7814, (95% CI 0.639-0.924), respectively. EUS-FNA with ROSE significantly improve specimen adequacy and was associated with high diagnostic accuracy.