Evaluating the Diagnostic Sensitivity of Rapid On-Site Examination (Rose) in EBUS-TBNA Sampling of Possible Granulomatous Pathology
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Authors
Hatem O.
HamiltonShield A.
Park M.
Satta G.
Nanan J.
TomasCordero B.
Coleman M.
Martin L.
Manalan K.
Datta A.
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Issue Date
2024
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Conference Proceedings
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Introduction and Objectives Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays an important role in the diagnosis of non-malignant mediastinal lymphadenopathy. Rapid on-site evaluation (ROSE) provides contemporaneous information to the bronchoscopist as to whether further sampling, and or procedures, such as transbronchial lung biopsy (TBLB) or specific microbiological diagnostics, are required. However, its utilisation is not standard practice. We sought to further evaluate the sensitivity of ROSE in combination with EBUS-TBNA for the diagnosis of granulomatous disease. Methods Patients undergoing EBUS-TBNA for suspected tuberculosis (TB) lymphadenopathy had retrospective data collected at one UK centre between 2018-2019, and prospectively at 10 UK centres between 2021-2022 in. 95 patients with a confirmed cytological diagnosis of granulomatous pathology for whom ROSE was performed were included, and results from preliminary ROSE findings were compared to final cytopathology for accuracy. Results Our population included 55 males and 40 females with a median age of 46 years (IQR 34.1- 59.5). There was concordance between preliminary ROSE findings and final cytological granuloma diagnosis in 82.1% (78/95) of patients identified. In epithelioid reactions with caseation ROSE sensitivity was 60% (6/10) and without caseation ROSE sensitivity was 83.5% (71/85). Conclusion Our study demonstrated a good level of concordance between initial ROSE sampling and final cytological diagnosis in granulomatous disease comparable to the existing literature, which showed a sensitivity of 81.6%.1 This adds weight to the argument for its continued use during EBUSTBNA procedures for the investigation of benign mediastinal lymphadenopathy. Further studies should now evaluate the impact of ROSE in optimising the number of passes for diagnostic yield and potentially improving the patient's experience with a shorter duration of the procedure.
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Thorax