Marotti Jonathan D, Rao Kavitha P, Brister Kathriel J, Gutmann Edward J, Tsapakos Michael J, Sheiman Robert, Wang Helen H, VanderLaan Paul A
Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
J Am Soc Cytopathol. 2015 May-Jun;4(3):160-169. doi: 10.1016/j.jasc.2015.01.004. Epub 2015 Jan 14.
Cytologic rapid on-site evaluation (ROSE) during minimally invasive biopsy procedures is an increasingly important service provided by cytopathology to increase diagnostic yield and appropriately triage cellular material. Although ROSE can be performed by cytopathologists, cytotechnologists, or cytopathology fellows, few studies have directly compared both procedural and diagnostic outcome measures among different ROSE personnel.
We evaluated all transthoracic computed tomography (CT)-guided lung biopsies in which ROSE was performed during a 1-year period at 2 academic institutions with similar patient populations and procedural methods: Dartmouth-Hitchcock Medical Center (DHMC) (where ROSE is performed by cytopathologists) and the Beth Israel Deaconess Medical Center (BIDMC) (where ROSE is rendered by either cytotechnologists or cytopathology fellows).
A total of 273 CT-guided transthoracic lung biopsies (190 DHMC, 83 BIDMC) were analyzed. There was no major difference in procedure time with respect to ROSE personnel. The repeat procedure rate for nondiagnostic biopsies was similar at DHMC (cytopathologists) and BIDMC (cytotechnologists or cytology fellows) (2.1% versus 2.3%, P = 1.0). Adequacy rates for cytopathologists, cytotechnologists, and cytopathology fellows were comparable (P = 0.23). ROSE assessments by cytopathologists were more concordant with the final diagnosis (87%) than those by cytotechnologists (82%) or cytopathology fellows (79%); this difference was not statistically significant (P = 0.28).
ROSE procedural and diagnostic outcomes for transthoracic CT-guided lung biopsies were similar among cytopathologists, cytotechnologists, and cytopathology fellows.
在微创活检程序中进行的细胞学快速现场评估（ROSE）是细胞病理学提供的一项日益重要的服务，以提高诊断率并合理分类细胞材料。尽管ROSE可由细胞病理学家、细胞技术人员或细胞病理学住院医师进行，但很少有研究直接比较不同ROSE人员的操作和诊断结果指标。
我们评估了在两家学术机构进行的所有经胸计算机断层扫描（CT）引导下的肺活检，这两家机构患者群体和操作方法相似，为期1年：达特茅斯-希区柯克医疗中心（DHMC）（ROSE由细胞病理学家进行）和贝斯以色列女执事医疗中心（BIDMC）（ROSE由细胞技术人员或细胞病理学住院医师进行）。
共分析了273例CT引导下的经胸肺活检（190例在DHMC，83例在BIDMC）。就ROSE人员而言，操作时间没有重大差异。DHMC（细胞病理学家）和BIDMC（细胞技术人员或细胞病理学住院医师）非诊断性活检的重复操作率相似（2.1%对2.3%，P = 1.0）。细胞病理学家、细胞技术人员和细胞病理学住院医师的充分率相当（P = 0.23）。细胞病理学家的ROSE评估与最终诊断的一致性（87%）高于细胞技术人员（82%）或细胞病理学住院医师（79%）；这种差异无统计学意义（P = 0.28）。
在细胞病理学家、细胞技术人员和细胞病理学住院医师中，经胸CT引导下肺活检的ROSE操作和诊断结果相似。
