FNAC in intrathoracic lesions

Abstract

Background:Mediastinal lymphadenopathy (ML) presents a diagnostic challenge. The technique to sample the lymph nodes has evolved from conventional “blind” transbronchial needle aspiration (TBNA) to the present day endobronchial ultrasound (EBUS)-guided procedure that improves the accuracy of sampling.Objective:This study was undertaken to evaluate the utility of “rapid on-site evaluation” (ROSE) in EBUS-guided TBNA (EBUS-TBNA) for the diagnosis of ML.Patients and Methods:This prospective study included 80 patients who underwent EBUS-TBNA for computed tomography/positron emission tomography (CT/PET) diagnosed ML over a 4-month period at a single tertiary care center. All 80 of these patients underwent histopathological evaluation (HPE) in addition to cytology. Three out of these 80 (3.7%) patients were excluded in view of inadequate material on EBUS-TBNA. After the sampling of nodes was done, the slides were stained with rapid hematoxylin and eosin (H&E) and then on-site evaluation was done. The tissue derived was also processed for HPE in all cases.Results:ROSE revealed granuloma in 27 patients and malignancy in 14 patients, and the remaining patients showed nonspecific inflammation. Concomitant histopathology revealed granuloma in 34 patients and malignancy in 14 patients. Considering HPE as gold standard, the overall sensitivity and specificity of EBUS-TBNA for diagnosis were 85.4% and 89.6%, respectively. For malignancy alone, the sensitivity and specificity were 100% and 98.4%, respectively.Conclusion:This novel approach is safe, has good diagnostic yield, and has an excellent potential in assisting safe and accurate diagnostic interventional bronchoscope.

International association for the study of lung cancer map, Wang lymph node map and rapid on-site evaluation in transbronchial needle aspiration

“…Similar results have been reported in the other studies (26,38,39). Recently Mallya et al (40) evaluated the utility of ROSE in EBUS-TBNA for the diagnosis of ML. They found ROSE facilitates sample adequacy, aids in rapid clinical decision-making, and equals the gold standard for diagnosis of ML.…”

“…That which we call a rose…”: A critical analysis of rapid on‐site evaluation

“…ROSE EBUS-TBNA has been touted as a useful technique that has revolutionized the field of pulmonology, and ROSE itself as a game changer for pathologists. 6 It is now hardwired into the lexicon of interventional radiologists and virtually anyone else who performs any kind of aspiration procedure. Pathologists are expected to provide ROSE and train their nonpathology colleagues to perform it, regardless of the degree of evidence of its effectiveness.…”

“…Of the 16 articles published in 6 cytology specialty journals ( Acta Cytologica, Cytopathology, Journal of Cytology, Diagnostic Cytopathology, Cancer Cytopathology , and CytoJournal ) during these 18 months, only 2 offer an actual definition of ROSE and these 2 articles are from the same group. In the remaining 14 articles, the term is used to describe the assessment of cytologic adequacy, immediate diagnosis, preliminary diagnosis, the interchangeable use of diagnosis and adequacy in the same article, standard of practice with no further definition, and as a way to ensure adequate cell blocks.…”

“…ROSE EBUS‐TBNA has been touted as a useful technique that has revolutionized the field of pulmonology, and ROSE itself as a game changer for pathologists . It is now hardwired into the lexicon of interventional radiologists and virtually anyone else who performs any kind of aspiration procedure.…”

Endobronchial Ultrasound in Suspected Non-Malignant Mediastinal Lymphadenopathy

“…All patients referred consecutively for investigation of mediastinal lymphadenopathy were included in the study and only 6 % of examinations were not representative. Depending on examination conditions, the operator's experience and artefactual changes (for example due to transport time), the quality of examination result differs [44,45].…”