Single slide assessment: A highly effective cytological rapid on‐site evaluation technique for endobronchial and endoscopic ultrasound‐guided fine needle aspiration

Abstract

No standardised, comprehensive approach to rapid on‐site evaluation (ROSE) of cytology samples currently exists. Recent meta‐analysis indicates variation in the effectiveness of ROSE, however, reviews commonly omit the details of how ROSE is conducted. This review demonstrates the clinical effectiveness of single slide assessment (SSA) for ROSE of cytology samples, providing a highly effective, standardised methodology, maximising cell yield and the diagnostic potential of samples obtained via endobronchial or endoscopic ultrasound. Advances in molecular testing and immunotherapy now allow patients to access sophisticated, targeted cancer treatments and, consequently, obtaining diagnostic material alone is no longer sufficient. SSA uses specific criteria, based on the morphological presentation, to ensure sufficient material is obtained through one procedure, allowing for all the molecular profiling and tumour expression testing required to provide the patient and clinicians with the optimal treatment options. In total, 450 endobronchial or endoscopic ultrasound procedures were conducted with ROSE SSA performed by a biomedical scientist between 2010 and 2017. In 97% of cases, ROSE SSA matched the final report (inadequate vs adequate—benign material vs malignancy). ROSE SSA provided sufficient material for immunocytochemistry in 200/208 cases (96%) and for additional molecular testing/tumour profiling in 92% (85/92) of cases. The median number of needle passes was three. ROSE SSA streamlines diagnostic pathways; minimising risk of complications to patients, reducing cost and delays to treatment associated with repeat or more invasive procedures. Using SSA, sufficient material for a comprehensive diagnosis can be obtained in one procedure.

Technical aspects of the use of cytopathological specimens for diagnosis and predictive testing in malignant epithelial neoplasms of the lung

“…The cellular pathology team controls the specimen, once expressed from the end of the needle, and is able to appropriately direct it towards cell block (CB) production (in solid tumours and high grade lymphomas), microbiological examination (in granulomatous disease), and flow cytometry (for the investigation of potential low grade lymphomas). 25,28,29 In malignant disease, reduction in sites targeted and consequent focus on informative diagnostic material. In both diagnostic and staging procedures for potential carcinoma, once a target site has been identified as malignant, there is no need to sample further sites and the procedure can focus on sampling the known malignant site until sufficient material has been acquired for diagnostic and predictive testing.…”

“…The corollary to this is that if a sample with high tumour content is produced from a particular trajectory, this can be repeated to maximise the chances of success in predictive testing. 25,28 Centres already offering ROSE will have optimised their own protocols, 28,[34][35][36][37] but for those who are contemplating a service, a few pointers may be useful.…”

The Technique of Rapid on-Site Evaluation on Lung Cancer

“…These small specimens are not only used to observe cell morphology, but also for immunocytochemistry/ immunohistochemistry and molecular analysis. It is therefore very important to ensure that adequate specimens are obtained to prevent repeated interventions or unnecessary invasive procedures [2].…”

Rapid onsite evaluation uses a very small proportion of total material aspirated at endobronchial or endoscopic ultrasound in the investigation of suspected thoracic malignancy

“…The latter approach facilitates rapid onsite evaluation (ROSE), whereby direct slides are rapidly stained and evaluated in real‐time in the endoscopy suite for adequacy and the presence of diagnostic material 5‐7 …”