Utility of Rapid On-Site Evaluation on Endobronchial Ultrasound-Guided Transbronchial Needle Aspirate of the Mediastinal and Hilar Lymph Nodes in Patients with Suspected Sarcoidosis
Abstract
Background Rapid on-site evaluation (ROSE) is a technique where transbronchial needle aspiration (TBNA) cytology samples are rapidly stained and screened for diagnostic material in the procedure room, during the procedure. We hypothesized the sensitivity of ROSE in patients with sarcoidosis is very low, leading to unjustified use of an expensive technique.
Data and Methods This was a retrospective study at an inner-city hospital. Medical records of all patients who underwent EBUS-TBNA of mediastinal and hilar lymph nodes with ROSE over a 3-year period were evaluated. The sensitivity, specificity, and positive and negative predictive values of ROSE in patients with sarcoidosis were calculated, with pathologic diagnosis by cell block as the “gold standard.” Patients with malignancy were used as a comparison.
Results One hundred eighty-four patients who had ROSE on EBUS-TBNA of mediastinal and hilar lymph nodes were included. Thirty were diagnosed with sarcoidosis, 95 with malignancy, and 59 with benign lymph nodes. The sensitivity of ROSE in patients with sarcoidosis was 44%, specificity and positive predictive value were 100%, and negative predictive value was only 17%.
Conclusion Given low sensitivity and negative predictive value, ROSE may not be as useful in diagnosing sarcoidosis as it is in diagnosing malignancy.
References
Herth F, Becker HD, Ernst A. Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial. Chest. 2004;125(1):322-5. https://doi.org/10.1378/chest.125.1.322
Chin R Jr, McCain TW, Lucia MA, Cappellari JO, et al. Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed? Am J Respir Crit Care Med. 2002;166(3):377-81. https://doi.org/10.1164/rccm.2106153
Diacon AH, Schuurmans MM, Theron J, Louw M, et al. Utility of rapid on-site evaluation of transbronchial needle aspirates. Respiration. 2005;72(2):182-8. https://doi.org/10.1159/000084050
Diette GB, White P Jr, Terry P, Jenckes M, et al. Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy. Chest. 2000;117(4):1186-90. https://doi.org/10.1378/chest.117.4.1186
Davenport RD. Rapid on-site evaluation of transbronchial aspirates. Chest. 1990;98(1):59-61. https://doi.org/10.1378/chest.98.1.59
Baram D, Garcia RB, Richman PS. Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration. Chest. 2005;128(2):869-75. https://doi.org/10.1378/chest.128.2.869
Oki M, Saka H, Kitagawa C, Kogure Y, et al. Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosing Lung Cancer: A Randomized Study. Respiration 2013;85:486-492. https://doi.org/10.1159/000346987
Wong RWM, Thai A, Khor YH, Ireland-Jenkin K, et al. The Utility of Rapid On-Site Evaluation on Endobronchial Ultrasound Guided Transbronchial Needle Aspiration: Does It Make a Difference? Journal of Respiratory Medicine. 2014. 245974. https://doi.org/10.1155/2014/245974
Plit ML, Havryk AP, Hodgson A, James D, et al. Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis. Eur Respir J. 2013;42(5):1302-8. https://doi.org/10.1183/09031936.00128312
Hu LX, Chen RX, Huang H, Shao C, et al. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration versus Standard Bronchoscopic Modalities for Diagnosis of Sarcoidosis: A Meta-analysis. Chin Med J (Engl). 2016;129(13):1607-15. https://doi.org/10.4103/0366-6999.184458
Şimon M, Pop B, Toma IL, Vallasek AK, et al. The use of EBUS-TBNA and ROSE in the diagnosis of lung cancer. Rom J Morphol Embryol. 2017;58(1):79-87.
Copyright (c) 2024 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
The author(s) retain the ownership of the copyrights for their work published in EJMS without any restrictions. Upon submission, the author(s) grants EJMS a license to publish, including to display, store, copy, and reuse the published content.
License to Publish
By submitting a manuscript to EJMS, the author(s) grant the journal a non-exclusive license to:
- Publish and distribute the content in all formats, media, and platforms (both existing and future), while identifying EJMS as the original publisher.
- Reproduce, display, and store the content in both print and online formats, including institutional and digital repositories.
- Translate, adapt, and summarize the work, including reprints, extracts, and abstracts.
- Develop derivative works based on the original content.
- Include the work in electronic databases and provide links to third-party materials.
Creative Commons Licensing
In addition to EJMS’s publishing rights, authors grant third parties the right to use, share, and distribute their work under the Creative Commons Attribution 4.0 (CC BY 4.0) International License. This allows unrestricted use of the content, provided proper attribution is given to the original author(s) and the journal.
