Rapid On-site Evaluation Research Articles

Utilization of Telecytopathology for Rapid On-Site Evaluation of Ultrasound-Guided Fine Needle Aspirates of Neoplastic and Non-Neoplastic Salivary Gland Lesions

Utilization of Telecytopathology for Rapid On-Site Evaluation of Ultrasound-Guided Fine Needle Aspirates of Neoplastic and Non-Neoplastic Salivary Gland Lesions

Telecytology Versus Conventional Rapid On-site Evaluation for Endobronchial Ultrasound-Guided Fine Needle Aspiration: A Single Institution’s Experience

Telecytology Versus Conventional Rapid On-site Evaluation for Endobronchial Ultrasound-Guided Fine Needle Aspiration: A Single Institution’s Experience

Remote-controlled Microscopy: A Potential Solution for Rapid On-Site Evaluation?

Remote-controlled Microscopy: A Potential Solution for Rapid On-Site Evaluation?

Diagnostic Challenges of Rapid On-Site Evaluation on Fine Needle Aspiration of the Pancreas

Diagnostic Challenges of Rapid On-Site Evaluation on Fine Needle Aspiration of the Pancreas

Accuracy of EUS-guided fine needle aspiration with rapid onsite evaluation versus eus-guided biopsy for the cyto-histological diagnosis of solid pancreatic tumors

Accuracy of EUS-guided fine needle aspiration with rapid onsite evaluation versus eus-guided biopsy for the cyto-histological diagnosis of solid pancreatic tumors

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.

Telecytology versus in-room cytopathologist for EUS-guided FNA or fine-needle biopsy sampling of solid pancreatic lesions

Rapid on-site-evaluation (ROSE) with an in-room cytopathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing EUS-guided FNA or fine-needle biopsy sampling (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and use of ROSE using telecytology (ROSE-T) to optimize clinical workflows and to address social distancing mandates created during the coronavirus disease 2019 pandemic. The purpose of this study was to compare diagnostic outcomes of ROSE-P and ROSE-T. A single-center cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. The primary outcome was overall diagnostic yield of cancer. All patients who underwent EUS-FNAB were entered into a prospectively maintained database. Statistical analyses were performed using descriptive statistics and univariate analysis. There were 165 patients in each arm. There was no difference in diagnostic yield between ROSE-P and ROSE-T (96.4% vs 94.5%, P= .428). ROSE-T was associated with an increased use of 22-gauge needles (P= .006) and more needle passes (P< .001). No significant differences were found in age, gender, lesion size, needle type, procedure times, or adverse events between the 2 groups (P< .05 for all). More pancreatic tail lesions were sampled in the ROSE-P group (P< .001). ROSE-T was not associated with any difference in final histologic diagnosis for EUS-FNAB of solid pancreatic masses. This has important implications for optimizing clinical workflows.

Applicability of On-Site Evaluation of Cervical Cytology Smears Stained with Toluidine Blue to Reduce Unsatisfactory Results

Introduction: Carcinoma of the uterine cervix is a major health problem faced by Indian women. Screening techniques like visual inspection with acetic acid, Lugol’s iodine, Papanicolaou smear, and human papillomavirus DNA testing have been suggested. Pap smear is a simple, safe, cost-effective, and reliable technique used for screening cervical lesions. Rapid on-site evaluation (ROSE) using the 1% aq. toluidine blue staining method has been less studied in cervical cytology. Materials and Methods: Our study was a prospective study done over a period of 2 years. All the cervical cytology smears were reported as per the Bethesda system 2014. Rapid stain using aqueous toluidine blue (1%) and conventional Pap stain was done on the smears received. Results: We evaluated a total of 1,300 cases, with 97.6% satisfactory samples. The spectrum of cases included 96.3% of negative for malignancy cases (including bacterial vaginosis, trichomonas, candida, and atrophic smears), atypical squamous cell of undetermined significance and atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion in 0.5% cases, low-grade squamous intraepithelial lesion and high-grade intraepithelial lesion in 0.3% cases, squamous cell carcinoma in 0.3% cases, and atypical glandular cells/adenocarcinoma in 0.2% cases. Turnaround time was within 48 h in 77% cases. With rapid stain, our unsatisfactory rate was reduced from 12% to approx. 2.4%. Conclusion: ROSE has been attempted on routine FNA cytology samples with success. However, the use of ROSE in cervical cytology has not been attempted to date. Lower unsatisfactory rate is an important indicator for the successful implementation of cervical cancer screening technique.

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.

ASSESSING THE DIAGNOSTIC YIELD AND SAFETY PROFILE OF A NEW ROBOTIC-ASSISTED BRONCHOSCOPY PROGRAM IN A HIGH-RISK PATIENT POPULATION

ASSESSING THE DIAGNOSTIC YIELD AND SAFETY PROFILE OF A NEW ROBOTIC-ASSISTED BRONCHOSCOPY PROGRAM IN A HIGH-RISK PATIENT POPULATION

ENDOBRONCHIAL ULTRASOUND-GUIDED INTRALESIONAL CRYOBIOPSY: A CASE SERIES

ENDOBRONCHIAL ULTRASOUND-GUIDED INTRALESIONAL CRYOBIOPSY: A CASE SERIES

S1788 Pancreatic Schwannoma: A Rare Pancreatic Tumor

Introduction: Schwannomas or Neurilemmomas are encapsulated tumors of the peripheral nerve sheath. Most schwannomas are sporadic but about 10% are associated with familial neurofibromatosis type 2. Schwannoma may occur in spinal nerve roots, internal organs, or soft tissues. The extrapancreatic nerve plexus may give rise to pancreatic schwannomas. Pancreatic schwannoma is a rare tumor that can mimic other pathologic entities with a more aggressive course such as neuroendocrine tumor or gastrointestinal stromal tumor making preoperative diagnosis critical. Case Description/Methods: A 21-year-old otherwise healthy female with a history of smoking presented with abdominal pain to the emergency department. She had no nausea, vomiting or fever and urine pregnancy test was negative. The abdomen was soft and non-tender with no masses or bruit and bowel sounds were normal. Given the unexplained pain, abdominopelvic computed tomography (CT) scan was performed. A 2.7 x 2.5 cm mass inferior to the pancreatic tail. The patient was referred for Endoscopic Ultrasonography (EUS). On EUS a round hypoechoic extraluminal lesion was visualized from the second portion of the duodenum. The lesion had a well-defined outer margin, with intact interface seen between the lesion and the pancreas. The lesion was abutting the portal vein with intact interface between the lesion and the vein. The rest of the pancreas showed no significant endosonographic abnormalities with normal pancreatic duct. Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) was performed using a 25 gauge biopsy needle. Rapid on-site evaluation (ROSE) was suggestive of a stromal cell neoplasm. Final pathological examination showed groups of bland spindle cells with no nuclear atypia, mitotic activity or necrosis and immunohistochemistry revealed diffuse immunoreactivity for S100 and focal reactivity for SOX10, CD117, and SMA consistent with the diagnosis of schwannoma (Figure). Discussion: Pancreatic Schwannoma is rare, with less than 100 reported cases in the literature. Pancreatic Schwannoma most commonly presents with abdominal pain. EUS with tissue acquisition allows for a definitive diagnosis of solid pancreatic lesions. Preoperative diagnosis of pancreatic masses is critical for appropriate surgical planning and follow-up. This case showcases a typical clinical course for pancreatic schwannoma and serves as a reminder to keep a broad differential diagnosis and appropriate workup, particularly with incidental or unexpected findings on imaging.Figure 1.: A: EUS, B: H&E, C: S100.

S31 Cole Relaxation Frequency: A Parameter for Pancreatic Cancer Detection

Introduction: Pancreatic cancer (PC) accounts for half a million new cases and 4.7% of the world's cancer-related deaths in 2020. It is considered one of the most lethal malignancies with a global survival rate of only 5%. Innovative imaging and endoscopic techniques are being studied to improve the accuracy of PC detection. Endoscopic ultrasound (EUS) guided tissue acquisition is currently the gold standard for sampling pancreatic masses. EUS guided fine needle biopsy has been considered superior to fine needle aspiration, but both are limited by the subjectivity of endoscopists and invasiveness of the procedure. Nonetheless, at present, there is no standard procedure for PC detection. The Cole Relaxation Frequency (CRF) – a derived electrical bioimpedance signature for cancer detection proposed by NovaScan – has been proven to quantitatively detect cancer in breast, skin, and lung tissues. The aim of this pilot study was to determine if the CRF based NovaScan technology can detect cancer in pancreatic tissues. Methods: CRF was measured with NovaScan technology in multiple locations (Figure A) on the pancreas samples in a cohort of n=26 mice, of which 15 were KPC (model of pancreatic ductal adenocarcinoma), 2 were KC (model of pancreatic neoplasia), and 9 were wild type controls. NovaScan determined cancer presence when the CRF parameter was measured above 1 MHz (Figure:B,C). Outcomes were compared to histopathology results for each of these samples to determine the specificity and sensitivity of the NovaScan device. Results: From histology, 12 KPC pancreases were confirmed as cancerous, 9 controls were confirmed as noncancerous, while 5 pancreases (3 KPC and 2 KC) presented with pancreatic intraepithelial neoplasia (PanIN), a precancerous condition. NovaScan technology identified 4 out of 5 PanIN samples as cancerous. Considering the entire cohort (n=26), specificity and sensitivity were 100% and 94%, respectively. If PanIN samples were excluded, specificity and sensitivity were both 100% (n=21). Conclusion: Future development of NovaScan CRF based technology into a rapid onsite evaluation or an endoscopic device would provide an affordable means for accurate and quantitative PC detection that guides or substitutes pancreatic biopsy acquisition. Identification of malignant precursors indicates the technological capability of NovaScan’s device to detect early stage PCs. Further technology development could allow for the distinction between cancerous and precancerous lesions.Figure 1.: (A) KPC pancreas sample placed on Novascan’s electrode array for a series of spectral bioimpedance measurements. A zoom in of the electrode with a pancreas sample is also shown. White rectangles indicate multiple locations measured across the sample. Spectral impedance scans for a control mouse (B) and a KPC mouse (C). The examination of CRF peak properties was used for cancer identification in pancreas samples. For the control mouse the CRF peaks fall below the threshold of 1 MHz, determining no cancer. For the KPC mouse several scans have CRF peaks above the threshold of 1 MHz, determining cancer presence.

S2813 Compacted Periampullary Diverticulum Masquerading as Pancreatic Head Mass on Endoscopic Ultrasound

Introduction: Endoscopic ultrasound (EUS) has become an increasingly important modality in the diagnosis and treatment of gastrointestinal malignancy as well as both pancreatic and biliary disease. It provides high-resolution, real-time imaging of the GI tract and surrounding structures. EUS is classically operator dependent and can often display suboptimal sensitivity and specificity. Numerous techniques such as Endoscopic guided fine-needle aspiration (EUS-FNA), EUS fine needle biopsy (EUS-FNB), rapid on-site cytological evaluation (ROSE) and contrast harmonic-enhanced EUS (CH-EUS) help to increase the sensitivity and specificity of this diagnostic modality. The following case describes a patient with initial EUS findings concerning for pancreatic head malignancy which was ultimately identified as a periampullary diverticulum compacted with sludge. Case Description/Methods: A 70-year-old patient with a past medical history of prostate cancer and cholelithiasis status post recent cholecystectomy presented with CT imaging findings concerning for pancreatic head mass. The patient underwent initial EGD with EUS which illustrated a well circumscribed, heterogeneously echoic 26.8 x 24 mm uncinate process mass concerning for neuroendocrine tumor (NET). FNB was performed and cytology ultimately showed no evidence of malignancy. Due to continued concern for pancreatic NET, patient underwent repeat EGD and EUS. EUS redemonstrated the large heterogeneously echoic pancreatic head lesion concerning for mass. Attempts were made to visualize the ampulla with linear EUS scope, however there was significant debris in the second portion of the duodenum. Duodenoscope was then passed and a large caliber but narrow opening periampullary diverticulum was visualized and appeared to be filled with compacted sludge. A combination of biopsy forceps and water lavage was used to clean out the compacted sludge. The EUS scope was then re-advanced into the second part of the duodenum and the suspected mass which was previously visualized was no longer visible. (Figure) Discussion: EUS is a an important, minimally invasive diagnostic procedure that has both high clinical success rate with relatively few adverse events. EUS, like many other diagnostic modalities, has limitations when identifying and ruling out malignancy. This case highlights one such limitation showing that although initial findings were concerning for malignancy, further investigation revealed a duodenal diverticulum with compacted debris masquerading as an uncinate mass.Figure 1.: A. EUS showing heterogeneously echoic 26.8 x 24 mm uncinate process mass B. Duodenoscope showing periampullary diverticulum compacted with sludge, removed with lavage and biopsy forceps C. Repeat EUS showing absence of previously visualized uncinate mass.

Interventional cytology benefits patients undergoing thyroid FNA.

Rapid onsite evaluation (ROSE) plays a role in preventing unnecessary surgery and will ultimately reduce the financial burden on the health care system. Data from retrospective studies supports offering interventional cytology and ROSE as the standard of care for patients undergoing thyroid fine‐needle aspiration biopsy.

Diagnostic yield and accuracy of paediatric image-guided fine needle aspiration biopsy of deep organ tumours

BackgroundPaediatric tumour cytological diagnosis by image-guided fine needle aspiration biopsy (FNAB) with rapid on-site evaluation (ROSE) has not gained wide acceptance despite increasing publications advocating the procedure.ObjectiveThe primary aim was an audit of the diagnostic yield and accuracy of paediatric image-guided FNAB with ROSE at a single institution. Evaluation of safety was a secondary aim.MethodDetails of consecutive cases of paediatric image-guided FNAB with ROSE for suspected non-benign deep-seated lesions performed from 01 January 2014 to 30 April 2020 were retrieved from the institutional radiology and laboratory databases. Diagnostic yield and accuracy were evaluated using clinico-pathological-radiological correlation and/or subsequent histological specimen diagnosis correlation. Complications and the frequency of key radiological features potentially affecting yield and accuracy were described.ResultsOf 65 cases retrieved, cytology showed malignancy in 52, benign features in five and one indeterminate diagnosis; seven samples were insufficient for cytological assessment. Of the 65 cases, 58 had subsequent formal histological diagnosis. The overall diagnostic yield was 98.5%, with 94.5% sensitivity, 100.0% specificity, 100.0% positive predictive value, 75.0% negative predictive value and 95.3% diagnostic accuracy. All cases (n = 26) demonstrating restricted diffusion on MRI yielded adequate samples and cyto-histopathological correlation.ConclusionPaediatric image-guided FNAB with ROSE has a relatively high diagnostic yield, sensitivity, specificity, positive predictive value and accuracy in the diagnosis of deep-seated tumours. The relatively low negative predictive value may reflect insufficient samples obtained from cystic and/or benign lesions. Sampling from areas of restricted MRI diffusion may enhance diagnostic yield.

Deep Learning Using Endobronchial-Ultrasound-Guided Transbronchial Needle Aspiration Image to Improve the Overall Diagnostic Yield of Sampling Mediastinal Lymphadenopathy.

Lung cancer is the biggest cause of cancer-related death worldwide. An accurate nodal staging is critical for the determination of treatment strategy for lung cancer patients. Endobronchial-ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has revolutionized the field of pulmonology and is considered to be extremely sensitive, specific, and secure for lung cancer staging through rapid on-site evaluation (ROSE), but manual visual inspection on the entire slide of EBUS smears is challenging, time consuming, and worse, subjective, on a large interobserver scale. To satisfy ROSE’s needs, a rapid, automated, and accurate diagnosis system using EBUS-TBNA whole-slide images (WSIs) is highly desired to improve diagnosis accuracy and speed, minimize workload and labor costs, and ensure reproducibility. We present a fast, efficient, and fully automatic deep-convolutional-neural-network-based system for advanced lung cancer staging on gigapixel EBUS-TBNA cytological WSIs. Each WSI was converted into a patch-based hierarchical structure and examined by the proposed deep convolutional neural network, generating the segmentation of metastatic lesions in EBUS-TBNA WSIs. To the best of the authors’ knowledge, this is the first research on fully automated enlarged mediastinal lymph node analysis using EBUS-TBNA cytological WSIs. We evaluated the robustness of the proposed framework on a dataset of 122 WSIs, and the proposed method achieved a high precision of 93.4%, sensitivity of 89.8%, DSC of 82.2%, and IoU of 83.2% for the first experiment (37.7% training and 62.3% testing) and a high precision of 91.8 ± 1.2, sensitivity of 96.3 ± 0.8, DSC of 94.0 ± 1.0, and IoU of 88.7 ± 1.8 for the second experiment using a three-fold cross-validation, respectively. Furthermore, the proposed method significantly outperformed the three state-of-the-art baseline models, including U-Net, SegNet, and FCN, in terms of precision, sensitivity, DSC, and Jaccard index, based on Fisher’s least significant difference (LSD) test (). For a computational time comparison on a WSI, the proposed method was 2.5 times faster than U-Net, 2.3 times faster than SegNet, and 3.4 times faster than FCN, using a single GeForce GTX 1080 Ti, respectively. With its high precision and sensitivity, the proposed method demonstrated that it manifested the potential to reduce the workload of pathologists in their routine clinical practice.

Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions.

Simple SummaryWith increasing interest in precision medicine for lung cancer, cryobiopsy is expected to improve the success rate not only for histological diagnosis, but also for next-generation sequencing. Rapid on-site evaluation (ROSE) is an immediate cytological evaluation performed during bronchoscopy. However, little is known about its clinical utility during cryobiopsy. We retrospectively reviewed the data of 63 consecutive patients who underwent cryobiopsy with ROSE of touch imprint cytology (ROSE-TIC) for solid peripheral pulmonary lesions. When the results of ROSE-TIC of each patient were compared directly with the histological findings of the corresponding specimen, the sensitivity, specificity, and positive and negative predictive values were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. Therefore, we believe that ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.Cryobiopsy enables us to obtain larger specimens than conventional forceps biopsy despite the caution regarding complications. This study aimed to evaluate the clinical utility of rapid on-site evaluation of touch imprint cytology (ROSE-TIC) during cryobiopsy of peripheral pulmonary lesions (PPLs). We retrospectively reviewed the data of consecutive patients who underwent cryobiopsy for solid PPLs between June 2020 and December 2021. ROSE-TIC was performed on the first specimen obtained via cryobiopsy and assessed using Diff-Quik staining. The results of ROSE-TIC for each patient were compared with the histological findings of the first cryobiopsy specimen. Sixty-three patients were enrolled in this study. Overall, 57 (90.5%) lesions were ≤30 mm in size and 37 (58.7%) had positive bronchus signs. The radial endobronchial ultrasound findings were located within and adjacent to the lesion in 46.0% and 54.0% of the cases, respectively. The sensitivity, specificity, and positive and negative predictive values of the ROSE results for histological findings of the corresponding specimens were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. In conclusion, ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.

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.

ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions.

Subepithelial lesions (SEL) of the GI tract represent a mix of benign and potentially malignant entities including tumors, cysts, or extraluminal structures causing extrinsic compression of the gastrointestinal wall. SEL can occur anywhere along the GI tract and are frequently incidental findings encountered during endoscopy or cross-sectional imaging. This clinical guideline of the American College of Gastroenterology was developed using the Grading of Recommendations Assessment, Development, and Evaluation process and is intended to suggest preferable approaches to a typical patient with a SEL based on the currently available published literature. Among the recommendations, we suggest endoscopic ultrasound (EUS) with tissue acquisition to improve diagnostic accuracy in the identification of solid nonlipomatous SEL and EUS fine-needle biopsy alone or EUS fine-needle aspiration with rapid on-site evaluation sampling of solid SEL. There is insufficient evidence to recommend surveillance vs resection of gastric gastrointestinal stromal tumors (GIST) <2 cm in size. Owing to their malignant potential, we suggest resection of gastric GIST >2 cm and all nongastric GIST. When exercising clinical judgment, particularly when statements are conditional suggestions and/or treatments pose significant risks, health-care providers should incorporate this guideline with patient-specific preferences, medical comorbidities, and overall health status to arrive at a patient-centered approach.