Rapid On-Site Evaluation Improves Needle Aspiration Sensitivity in the Diagnosis of Central Lung Cancers: A Randomized Trial

Abstract

Background: Few prospective studies have evaluated the role of endobronchial needle aspiration in diagnosing central airways neoplasms. Rapid on-site evaluation has long been used in transbronchial needle aspiration of adenopathies and peripheral lesions, but its role in sampling central malignancies has not been substantiated yet. Objectives: In this study we evaluated if endobronchial needle aspiration may increase the sensitivity of bronchoscopy for diagnosing central airways neoplasms when added to conventional diagnostic methods (forceps biopsy, brushing and bronchial washing), and if rapid on-site evaluation may be beneficial in patients undergoing endobronchial needle aspiration. Methods: 125 patients (77% males, aged 70 ± 7 years; mean ± SD) with central lung cancers were randomized to undergo bronchoscopy including conventional diagnostic methods and needle aspiration, with or without rapid on-site evaluation, stratifying the patients on the basis of the neoplasm growth pattern (exophytic and submucosal/peribronchial disease). Results: Needle aspiration significantly increased the sensitivity of bronchoscopy when added to conventional methods (from 76 to 91%; p < 0.001), primarily resulting from differences in submucosal/peribronchial diseases (68 vs. 90%; p < 0.001) and independently from the presence of rapid on-site evaluation; needle aspiration guided by rapid on-site evaluation guaranteed a higher improvement in bronchoscopy sensitivity than conventional needle aspiration (98 vs. 84%, respectively; p = 0.004). Needle aspiration guided by rapid on-site evaluation showed a significantly higher sensitivity than the conventional method (97 vs. 76%, respectively; p = 0.001). Conclusions: Needle aspiration increases the sensitivity of bronchoscopy in diagnosing central airways malignancies when added to conventional diagnostic methods, with a further significant improvement when guided by rapid on-site evaluation.

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

“…A recently performed RCT on EBUS-TBNA by Oki et al [49] was also, unfortunately, underpowered. Finally, the study of Mondoni et al [73] was not blinded and focused on patients with centrally located lung cancer, but showed that ROSE improved the sensitivity from 76 to 97%. Of note, although both the study of Trisolini et al [47] and the study of Yarmus et al [48] did not solely study patients with (suspected) lung cancer but contained approximately 30% other diagnoses, we feel that this is of minor influence in relation to this PICO question.…”

Utility of Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Malignant and Nonmalignant Disease

“…Two randomized trials failed to show an improvement in the diagnostic yield, but they did highlight a decrease both in procedure time and the need for additional transbronchial biopsies [12, 13]. A third randomized trial showed that ROSE improved the sensitivity from 76 to 97% [14]. …”

An investigation into false‐negative transthoracic fine needle aspiration and core biopsy specimens

“…Recently, investigators have explored the use of rapid on‐site evaluation and the area shows promise . This could have potentially helped some of the FN cases where cellularity was a confounding factor.…”

“…Recently, investigators have explored the use of rapid on-site evaluation and the area shows promise. [17][18][19] This could have potentially helped some of the FN cases where cellularity was a confounding factor. Currently, at our institution we regularly perform adequacy assessments on our TFNAs, however, even when informed of a nondiagnostic or negative aspirate, our clinicians rarely rebiopsy patients due to a number of contributing factors such as difficult to access lesions, lesions too small to sample, low suspicion of malignancy or satisfaction with quality of tissue biopsy.…”