Author of

• 12759

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  P3.17 - Poster Session 3 - Bronchoscopy, Endoscopy (ID 185)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12766

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    P3.17-007 - Rapid On-Site Cytologic Evaluation (ROSE) of bronchial brushings during bronchoscopic investigation of peripheral pulmonary lesions: diagnostic accuracy and impact on procedure time (ID 2749)

    09:30 - 09:30  |  Author(s): I. Laska
    • Abstract

    Background
    Rapid on-site evaluation (ROSE) of transbronchial needle aspirates is cost-effective due to its ability to reduce biopsy number and complication rates without compromising diagnostic yield. Use of ROSE during sampling of peripheral pulmonary lesions (PPLs) has not previously been examined. We aimed to determine the ability of ROSE performed on transbronchial brushings of peripheral pulmonary lesions to accurately determine final procedural diagnosis. To determine if use of ROSE impacts on procedural time or procedural complication rates.

    Methods
    Prospective cohort of patients undergoing radial probe endobronchial ultrasound-guided bronchoscopy for investigation of PPLs. ROSE was performed using a Rapid Romanowsky stain. If ROSE demonstrated diagnostic malignant material the procedure was determined to be successful and no further sampling was undertaken. Non-diagnsotic ROSE assessment resulted in further sampling including transbronchial lung biopsy, and possibly sampling from different locations.

    Results
    Specimens obtained from 128 lesions in 118 consecutive patients in whom radial EBUS successfully localized a peripheral pulmonary lesion. Final procedural diagnoses included non-small cell lung cancer (n=76), carcinoid (3), metastatic malignancy (n=3), benign inflammatory/infective infiltrate (n=46). Positive predictive value of ROSE for a malignant bronchoscopic diagnosis was 97% (63/65). Two patients had positive diagnoses made on ROSE but final procedural diagnosis was “reactive bronchial cells” however both of these patients were subsequently confirmed to have NSCLC following alternate biopsy procedures. Procedure times were significantly shorter in those in whom ROSE specimens demonstrated malignancy than in those in whom ROSE was non-diagnostic (19+8 minutes vs. 31+11 minutes, respectively. p<0.0001) In four procedures, initial negative ROSE results prompted redirection of sampling from alternate bronchial segments resulting in positive diagnostic tissue being obtained.

    Conclusion
    ROSE examination of brushings specimen had high positive predictive value for bronchoscopic diagnosis of cancer. ROSE of brushings specimens has the potential to shorten bronchoscopy times, reduce complications and is likely to be cost-effective. It may also improve diagnostic performance via live feedback, allowing proceduralists to redirect subsequent sampling procedures.