The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: a prospective study

Chest. 2014 Jan;145(1):60-65. doi: 10.1378/chest.13-0756.

Abstract

Background: Rapid on-site cytologic evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions. ROSE is not a widespread technique, however, because of a lack of time and resources. Our aim was to verify whether, in comparison with a board-certified cytopathologist, a pulmonologist could evaluate the adequacy of transbronchial needle aspiration (TBNA) specimens on-site to diagnose hilar/mediastinal adenopathies/masses after receiving training in cytopathology. Our secondary aim was to assess and compare the accuracy of ROSE as performed by both physicians.

Methods: A pulmonologist and a cytopathologist, the latter deemed the gold standard, performed ROSE and classified specimens into five diagnostic categories. Agreement between clinicians was assessed through κ statistics. The accuracy of ROSE was established according to definitive cytologic assessment.

Results: A total of 362 TBNAs were performed on 84 patients affected by hilar/mediastinal lymphadenopathies. There was an 81% overall substantial agreement between observers (κ, 0.73; 95% CI, 0.61-0.86; P , 0.001), which became excellent in cases of malignant disease (κ, 0.81; 95% CI, 0.70-0.90; P , 0.001). The accuracy of ROSE performed by the pulmonologist (80%; 95% CI, 77-90) was not statistically different from that provided by the cytopathologist (92%; 95% CI, 85-94).

Conclusions: Our study provides the first evidence, to our knowledge, that a trained pulmonologist can assess the adequacy of cytologic smears on-site. Training pulmonologists to have a basic knowledge of cytopathology could obviate most difficulties related to the involvement of cytopathologists in routine diagnostic activities and may reduce the costs of the procedure.

Publication types

  • Observational Study

MeSH terms

  • Adenocarcinoma / pathology
  • Aged
  • Biopsy, Needle / methods*
  • Bronchoscopy / methods*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Squamous Cell / pathology
  • Cohort Studies
  • Female
  • Humans
  • Lung Neoplasms / pathology
  • Lymph Nodes / pathology*
  • Lymphatic Diseases / pathology*
  • Male
  • Mediastinal Diseases / pathology*
  • Mediastinum
  • Pathology / standards*
  • Prospective Studies
  • Pulmonary Medicine / standards*
  • Sarcoidosis / pathology
  • Sensitivity and Specificity
  • Small Cell Lung Carcinoma / pathology