Performance of Rapid On-Site Evaluation in Breast Fine-Needle Aspiration Biopsies: Identifying Areas of Diagnostic Challenge

Torous, Vanda F.; López, Silvia Huerta; Xu, Christine L.; Sweeney, Brenda; Pitman, Martha B.

doi:10.1159/000518579

Cited by 4 publications

(2 citation statements)

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“…The occurrence of early cancer is often accompanied by the phenomenon of adjacent lymphadenopathy ( 19 ), and the clinical value of ROSE is to take full advantage of less sampling and fast diagnosis to achieve rapid identification of abnormal cells in lymph nodes ( 13 , 20 – 24 ). ROSE enables rapid and accurate interpretation of cancerous tissues and surrounding cancerous tissues and then instructs clinicians to adjust the direction of puncture, which can reduce intraoperative traumas and facilitate the detection of diseased tissues ( 25 – 27 ), contributing to the choice of surgical modes ( 28 – 31 ). Although the clinical utility of ROSE has been reported in kinds of literature, it is still a controversial question on whether can be popularized in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Value of transbronchial needle aspiration combined with a rapid on-site evaluation of cytology in the diagnosis of pulmonary lesions

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

Value of transbronchial needle aspiration combined with a rapid on-site evaluation of cytology in the diagnosis of pulmonary lesions

et al. 2022

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“…FNA not only minimizes the time to diagnosis but also significantly decreases unsatisfactory specimen rates. This has been made possible thanks to the application of ROSEs to FNA samples [111,112]. Studies show that having an interventional pathologist make an on-the-spot cytological evaluation is a crucial part of the highly efficient triple test [113] and may sharply reduce unnecessary CNBs and surgery for benign lesions [93].…”

Section: Introductionmentioning

confidence: 99%

Real-World Diagnostic Accuracy of the On-Site Cytopathology Advance Report (OSCAR) Procedure Performed in a Multidisciplinary One-Stop Breast Clinic

Suciu,

El Chamieh,

Soufan

et al. 2023

Cancers

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Fine-needle aspiration (FNA) cytology has been widely used for the diagnosis of breast cancer lesions with the objective of differentiating benign from malignant masses. However, the occurrence of unsatisfactory samples and false-negative rates remains a matter of concern. Major improvements have been made thanks to the implementation of rapid on-site evaluation (ROSE) in multidisciplinary and integrated medical settings such as one-stop clinics (OSCs). In these settings, clinical and radiological examinations are combined with a morphological study performed by interventional pathologists. The aim of our study was to assess the diagnostic accuracy of the on-site cytopathology advance report (OSCAR) procedure on breast FNA cytologic samples in our breast OSC during the first three years (April 2004 till March 2007) of its implementation. To this goal, we retrospectively analyzed a series of 1820 breast masses (1740 patients) radiologically classified according to the American College of Radiology (ACR) BI-RADS lexicon (67.6% being either BI-RADS 4 or 5), sampled by FNA and immediately diagnosed by cytomorphology. The clinicoradiological, cytomorphological, and histological characteristics of all consecutive patients were retrieved from the hospital computerized medical records prospectively registered in the central information system. Histopathological analysis and ultrasound (US) follow-up (FU) were the reference diagnostic tests of the study design. In brief, we carried out either a histopathological verification or an 18-month US evaluation when a benign cytology was concordant with the components of the triple test. Overall, histology was available for 1138 masses, whereas 491 masses were analyzed at the 18-month US-FU. FNA specimens were morphologically nondiagnostic in 3.1%, false negatives were observed in 1.5%, and there was only one false positive (0.06%). The breast cancer prevalence was 62%. Diagnostic accuracy measures of the OSCAR procedure with their 95% confidence intervals (95% CI) were the following: sensitivity (Se) = 97.4% (96.19–98.31); specificity (Sp) = 94.98% (92.94–96.56); positive predictive value (PPV) = 96.80% (95.48–97.81); negative predictive value (NPV) = 95.91% (94.02–97.33); positive likelihood ratio (LR+) = 19.39 (13.75–27.32); negative predictive ratio (LR−) = 0.03 (0.02–0.04), and; accuracy = 96.45% (95.42–97.31). The respective positive likelihood ratio (LR+) for each of the four categories of cytopathological diagnoses (with their 95% CI) which are malignant, suspicious, benign, and nondiagnostic were 540 (76–3827); 2.69 (1.8–3.96); 0.03 (0.02–0.04); and 0.37 (0.2–0.66), respectively. In conclusion, our study demonstrates that the OSCAR procedure is a highly reliable diagnostic approach and a perfect test to select patients requiring core-needle biopsy (CNB) when performed by interventional cytopathologists in a multidisciplinary and integrated OSC setting. Besides drastically limiting the rate of nondiagnostic specimens and diagnostic turn-around time, OSCAR is an efficient and powerful first-line diagnostic approach for patient-centered care.

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Diagnostic Accuracy and Clinical Utility of Fine-Needle Aspiration in Breast Lesions: A Correlation with Surgical Pathology

Hrizat,

Doxzon,

Post

et al. 2024

Acta Cytologica

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Background: Fine-needle aspiration (FNA) is a valuable diagnostic tool for evaluating breast lesions, yet its use is less frequent compared to core needle biopsies. This study aims to assess the diagnostic performance and clinical utility of FNA in correlation with surgical pathology outcomes. Methods: We performed a three-year retrospective search using our institutional database to identify cases of breast mass FNAs performed by interventional radiologists under ultrasound guidance. We reviewed cytopathology reports and glass slides, and correlated cytologic diagnoses with concurrent or subsequent surgical pathology results. Results: A total of 65 breast FNA cases from --- patients were reviewed. The diagnostic outcomes were: 23% insufficient for diagnosis, 11% atypical, 8% suspicious for malignancy, 3% positive for malignancy, and 55% negative for malignancy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNA for detecting malignancy were 76%, 96%, 93%, and 85%, respectively. One false positive case, categorized as atypical due to degenerative changes, was later confirmed as benign apocrine metaplasia. Three false negative cases, initially categorized as non-diagnostic, were later diagnosed as invasive ductal carcinoma, Hodgkin lymphoma, and papillary carcinoma. An additional false negative case, categorized under negative for malignancy, was later diagnosed as invasive ductal carcinoma. Conclusion: Breast FNAs, while less frequently performed than core needle biopsies, provide significant diagnostic insights, particularly for cystic lesions. The study demonstrates high specificity and PPV for FNA in detecting malignancy, underscoring its value as a diagnostic tool when integrated with imaging and clinical assessment. These findings support the continued use of FNA in the diagnostic evaluation of breast lesions.

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Performance of Rapid On-Site Evaluation in Breast Fine-Needle Aspiration Biopsies: Identifying Areas of Diagnostic Challenge

Cited by 4 publications

References 47 publications

Value of transbronchial needle aspiration combined with a rapid on-site evaluation of cytology in the diagnosis of pulmonary lesions

Value of transbronchial needle aspiration combined with a rapid on-site evaluation of cytology in the diagnosis of pulmonary lesions

Real-World Diagnostic Accuracy of the On-Site Cytopathology Advance Report (OSCAR) Procedure Performed in a Multidisciplinary One-Stop Breast Clinic

Diagnostic Accuracy and Clinical Utility of Fine-Needle Aspiration in Breast Lesions: A Correlation with Surgical Pathology

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