Rokadia Haala K, Mehta Atul, Culver Daniel A, Patel Jinesh, Machuzak Michael, Almeida Francisco, Gildea Thomas, Sethi Sonali, Zell Katrina, Cicenia Joseph
1 Pulmonary and Critical Care Division, Baylor University Medical Center, Dallas, Texas; and.
2 Respiratory Institute, and.
Ann Am Thorac Soc. 2016 Jun;13(6):850-5. doi: 10.1513/AnnalsATS.201507-435OC.
Rapid On-Site Evaluation (ROSE) of specimens collected by endobronchial ultrasound (EBUS)-guided-transbronchial needle aspiration (TBNA) ensures sample adequacy and triages subsequent biopsy procedures. EBUS-TBNA allows sampling of lymph nodes in granulomatous diseases; however, the ability of ROSE to predict the final diagnosis in this setting has not been well characterized.
We performed a retrospective evaluation to study the utility of ROSE in the diagnosis of granulomatous diseases as well as to establish the procedure characteristics that would optimize the concordance between ROSE and final diagnosis.
Charts of patients with a cytological diagnosis of granuloma by EBUS-TBNA between June 2008 and May 2013 were reviewed. Preliminary ROSE findings and final cytological diagnosis were compared. Patient demographics and procedure variables were assessed using mean (±SD). The variables collected were considered in a logistic regression analysis using concordance as the outcome.
In our study, 255 procedures were performed to sample 625 lymph nodes that contained granulomas. An average of 2.4 (±1.2) lymph nodes were biopsied per procedure, with a mean size of 14.4 (±7.9) mm. The concordance between ROSE and the final diagnosis was 81.6%. The concordance rate was not impacted by needle size, lymph nodes size or station, number of stations biopsied, or passes per lymph node. The concordance did improve with the experience of the bronchoscopist (P < 0001).
In this single-center study, there was a high concordance between ROSE and the final cytological diagnosis for mediastinal lymph nodes containing granulomas that were sampled by EBUS-TBNA. ROSE may serve to reduce procedure time, enhance sample triaging, and obviate the need for further invasive testing. The only variable associated with increased concordance was the experience of the operator.
通过支气管内超声（EBUS）引导的经支气管针吸活检（TBNA）采集的标本进行快速现场评估（ROSE）可确保样本充足，并对后续活检程序进行分类。EBUS-TBNA可对肉芽肿性疾病的淋巴结进行采样；然而，在这种情况下ROSE预测最终诊断的能力尚未得到充分描述。
我们进行了一项回顾性评估，以研究ROSE在肉芽肿性疾病诊断中的效用，并确定能够优化ROSE与最终诊断之间一致性的操作特征。
回顾了2008年6月至2013年5月间经EBUS-TBNA进行细胞学诊断为肉芽肿的患者病历。比较了ROSE的初步结果和最终细胞学诊断。使用均值（±标准差）评估患者人口统计学和操作变量。在以一致性为结果的逻辑回归分析中考虑所收集的变量。
在我们的研究中，共进行了255次操作，对包含肉芽肿的625个淋巴结进行采样。每次操作平均活检2.4（±1.2）个淋巴结，平均大小为14.4（±7.9）毫米。ROSE与最终诊断之间的一致性为81.6%。一致性率不受针的大小、淋巴结大小或部位、活检的部位数量或每个淋巴结的穿刺次数影响。随着支气管镜检查医生经验的增加，一致性确实有所提高（P < 0.001）。
在这项单中心研究中，对于经EBUS-TBNA采样的含有肉芽肿的纵隔淋巴结，ROSE与最终细胞学诊断之间具有高度一致性。ROSE可能有助于减少操作时间、加强样本分类，并避免进一步进行侵入性检查的需要。与一致性增加相关的唯一变量是操作者的经验。
