Sung Simon, Crapanzano John P, DiBardino David, Swinarski David, Bulman William A, Saqi Anjali
Department of Pathology & Cell Biology, Columbia University Medical Center, New York 10032.
Department of Medicine Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York 10032.
Diagn Cytopathol. 2018 Feb;46(2):122-130. doi: 10.1002/dc.23861. Epub 2017 Nov 12.
Endobronchial ultrasound (EBUS)-guided fine needle aspiration (FNA) is performed to diagnose and stage lung cancer. Multiple studies have described the value of Rapid On-Site Evaluation (ROSE), but often the emphasis is upon diagnosis than adequacy for molecular testing (MT). The aim was to identify variable(s), especially cytology-related, that can improve MT.
A search for EBUS-FNAs with ROSE was conducted for lung adenocarcinomas or when this diagnosis could not be excluded. All such cases underwent reflex MT on cell blocks. The impact of cytology-related variables [i.e., number of pass(es), dedicated pass(es) directly into media, cytotechnologist (CT), laboratory technician (LT) and triage with 1 or >1 cytologist] was evaluated. The latter category was divided into Group A [ROSE, triage and slide preparation by cytopathologist (CP) and CT at start of the procedure] and Group B (ROSE only by CT or by CT/CP after start of procedure; triage and slide preparation by CT or clinical staff). The impact of all these variables on MT was assessed.
A total of 100 cases were identified, and 79 had sufficient tissue for MT. Of all variables evaluated, MT was positively affected by performing a direct dedicated pass (P = 0.013) and ROSE by Group A (P = 0.033).
ROSE with appropriate triage, including performing a dedicated pass and proper slide preparation, improves MT, and this is enhanced by having >1 cytologist at the start of the procedure. In the era of personalized medicine, "adequate" should denote sufficient tissue for diagnosis and MT.
支气管内超声（EBUS）引导下细针穿刺抽吸（FNA）用于肺癌的诊断和分期。多项研究描述了快速现场评估（ROSE）的价值，但通常重点在于诊断而非分子检测（MT）的充足性。目的是确定可改善MT的变量，尤其是与细胞学相关的变量。
对有ROSE的EBUS-FNA进行检索，纳入肺腺癌或不能排除该诊断的病例。所有此类病例均对细胞块进行回顾性MT。评估与细胞学相关的变量[即穿刺次数、直接接种到培养基中的专用穿刺、细胞技术人员（CT）、实验室技术人员（LT）以及由1名或多名细胞学家进行分类]的影响。后一类分为A组[在操作开始时由细胞病理学家（CP）和CT进行ROSE、分类和玻片制备]和B组（仅由CT或在操作开始后由CT/CP进行ROSE；由CT或临床工作人员进行分类和玻片制备）。评估所有这些变量对MT的影响。
共识别出100例病例，其中79例有足够的组织用于MT。在所有评估的变量中，直接进行专用穿刺（P = 0.013）和A组的ROSE（P = 0.033）对MT有积极影响。
进行适当分类的ROSE，包括进行专用穿刺和正确的玻片制备，可改善MT，并且在操作开始时有>1名细胞学家可增强这一效果。在个性化医疗时代，“充足”应表示有足够的组织用于诊断和MT。
