Is rapid on-site evaluation during bronchoscopy useful?

Trisolini, Rocco; Gasparini, Stefano; Patelli, Marco

doi:10.1586/17476348.2013.838017

Cited by 16 publications

(11 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rapid on‐site evaluation (ROSE) of cytological material from lymph nodes sampled with needle aspiration procedures allows clinicians to check sample adequacy, establish a preliminary diagnosis and appropriately triage the specimen for ancillary studies . Although three randomized trials failed to demonstrate an advantage in terms of diagnostic yield or specimen adequacy associated with its use, they clearly showed that ROSE helps clinicians avoid biopsies from additional targets without a loss in diagnostic yield, thus reducing the risk of bronchoscopy‐related complication .…”

Section: Why Has Ebus Become Invaluable For the Diagnosis Of Sarcoidomentioning

confidence: 99%

Endobronchial ultrasound‐guided transbronchial needle aspiration in sarcoidosis: Beyond the diagnostic yield

et al. 2019

Self Cite

View full text Add to dashboard Cite

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the commonly used technique for pathological confirmation of clinically suspected sarcoidosis, mostly owing to its consistently high success rate in the detection of granulomas. However, other possible advantages, which are less appreciated and often poorly studied, may also contribute to the wider use of EBUS-TBNA in the future. These advantages include refinement of differential diagnoses through the study of lymph node characteristics during B-mode examination; reduction of complications associated with bronchoscopy, as well as improved triage of the specimen for ancillary studies with the use of rapid on-site evaluation; optimization of the quality of the sample through the selection of a target area for biopsy with minimal vascularity and absence of calcifications by using the colour Doppler and the B-mode; and prediction of the presence of extensive lymph node fibrosis by using the strain elastography module. Yet, limitations and possible clinical drawbacks should also be acknowledged. Indeed, due to the lack of specificity of the pathology findings in EBUSderived samples, the diagnosis of sarcoidosis is one of the exclusion and should remain essentially clinical. The external validity of EBUS-TBNA results in sarcoidosis is questionable, as they mainly derive from studies in populations with a high disease prevalence. Finally, the risk exists that the low morbidity and high diagnostic yield of EBUS-TBNA may lead to its overuse in patients with clinical/radiological findings specific enough to secure a clinical diagnosis of sarcoidosis.

show abstract

Section: Why Has Ebus Become Invaluable For the Diagnosis Of Sarcoidomentioning

confidence: 99%

Endobronchial ultrasound‐guided transbronchial needle aspiration in sarcoidosis: Beyond the diagnostic yield

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…As a consequence, according to international guidelines, there is insufficient evidence to recommend the implementation of ROSE for every endosonography procedure [12, 13]. Second, constraints related to time and personnel limit the availability of cytopathologists/cytotechnicians performing ROSE at different institutions worldwide [2, 3, 14]. Finally, ROSE is un-uniformly and often inadequately reimbursed [15-17].…”

Section: Introductionmentioning

confidence: 99%

A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials that show a lack of increase in diagnostic yield and specimen adequacy associated with its usage. Objective: We aimed to verify whether a pulmonologist can assess endosonography-derived lymph node samples after a comprehensive and reproducible training provided by a specialist pathologist. Methods:Prospective, observational trial structured in three phases. In the first (training) phase, a pathologist critically evaluated the smears from 150 archival endosonography cases with a pulmonologist. In the second (test) phase, the pulmonologist was asked to assess 50 archival endosonography-derived samples. In the last (real-life) phase, the pulmonologist classified the samples from 200 patients during the endosonography. The overall agreement between pulmonologist and pathologist (gold standard), assessed through κ-statistics, was the primary outcome. The agreement for the identification of specific cytological categories was the secondary outcome. Results: The overallagreement between pulmonologist and pathologist was 84% (κ0.765, 95% CI 0.732–0.826) in the test phase and 89.7% (κ 0.844, 95% CI 0.799–0.881) in the real-life phase. The agreement for specific cytological categories was 92.7% (95% CI 0.824–0.980) for inadequate samples, 90.3% (95% CI 84.5–94.5%) for reactive lymphadenopathies, 90.5% (95% CI 0.845–0.946) for malignancy, and 73% (95% CI 0.515–0.897) for granulomatous samples. Conclusions: A trained pulmonologist can reliably assess adequacy and malignancy for endosonography-derived samples, which could be useful in institutions where a cytopathologist/cytotechnician is not available regularly.

show abstract

“…In the specific context of suspected mesothelioma with diffuse parietal pleural thickening on macroscopic inspection, deep "strip" biopsies should be obtained down to the level of periosteum in order to limit any diagnostic uncertainty on subsequent histological examination. Rapid on-site evaluation of thoracoscopic biopsies may reduce the likelihood of nondiagnostic interventions, as has been the case in endobronchial ultrasound and mediastinal node sampling [117], but as yet, there are no published data to support this conclusion (figure 4).…”

Section: Technical Considerationsmentioning

confidence: 99%

Advanced medical interventions in pleural disease

et al. 2016

View full text Add to dashboard Cite

The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease. @ERSpublications Technological advances and greater availability of techniques give a broad range of interventions for pleural disease http://ow.ly/ZNya2

show abstract

Is rapid on-site evaluation during bronchoscopy useful?

Cited by 16 publications

References 15 publications

Endobronchial ultrasound‐guided transbronchial needle aspiration in sarcoidosis: Beyond the diagnostic yield

Endobronchial ultrasound‐guided transbronchial needle aspiration in sarcoidosis: Beyond the diagnostic yield

A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation

Advanced medical interventions in pleural disease

Contact Info

Product

Resources

About