Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration

Chest. 2005 Aug;128(2):869-75. doi: 10.1378/chest.128.2.869.


Study objective: To determine the extent to which rapid on-site cytologic evaluation (ROSE) of transbronchial needle aspiration (TBNA) samples can safely and cost-effectively reduce the need for additional biopsy during bronchoscopy.

Setting: University Hospital in Long Island, NY.

Patient and methods: Forty-four bronchoscopies with TBNA, most of which utilized ROSE, were evaluated prospectively. The number and types of biopsies performed during each procedure were compared to a preprocedural algorithm to determine the impact of knowing ROSE results during the procedure. Bronchoscopies performed with and without ROSE were compared, as were bronchoscopies with diagnostic and nondiagnostic ROSE results. A cost analysis was performed comparing the Medicare reimbursement for ROSE to the savings of deferring multiple biopsies.

Results: Thirty-two bronchoscopies were performed with ROSE; 12 were performed without ROSE. Fewer biopsies were performed during bronchoscopies utilizing ROSE. Diagnostic yield, TBNA sensitivity and accuracy, and procedural time were similar between these two groups.

Conclusions: ROSE during TBNA allows for deferring additional biopsy without loss in diagnostic yield, likely lowers procedural risk, and is cost-effective.

MeSH terms

  • Algorithms
  • Biopsy, Needle / methods*
  • Bronchoscopy*
  • Humans
  • Lung / pathology*
  • Prospective Studies
  • Reproducibility of Results
  • Time Factors