Shikano Kohei, Ishiwata Tsukasa, Saegusa Fumie, Terada Jiro, Sakayori Masashi, Abe Mitsuhiro, Kawasaki Takeshi, Ikari Jun, Kawata Naoko, Tada Yuji, Tatsumi Koichiro
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Division of Endoscopic Diagnostics and Therapeutics, Chiba University Hospital, Chiba University, Chiba, Japan.
J Thorac Dis. 2020 Jun;12(6):3057-3064. doi: 10.21037/jtd-20-671.
Rapid on-site evaluation (ROSE) of cytologic material is widely performed because it provides clinicians with instant diagnostic information. However, the utility of ROSE of touch imprint cytology (ROSE-TIC) during transbronchial biopsy (TBB) remains unclear. The aim of this study was to evaluate the feasibility and accuracy of ROSE-TIC for TBB.
A retrospective study was performed on patients who underwent diagnostic bronchoscopy combined with ROSE-TIC. The results of ROSE-TIC, diagnosed as either positive or negative for malignancy, were compared with the histological findings and final diagnosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The success rate of molecular testing on TBB specimens was also assessed.
Overall, 460 patients underwent bronchoscopy with ROSE-TIC. Of these, 377 cases (82.0%) were malignant and 83 cases (18.0%) were non-malignant in the final diagnosis. Compared with the histological findings, ROSE-TIC showed sensitivity, specificity, PPV, NPV, and diagnostic accuracy values of 91.1%, 90.4%, 94.8%, 84.0%, and 90.9%, respectively. Compared with the final diagnosis, ROSE-TIC showed sensitivity, specificity, PPV, NPV, and diagnostic accuracy values of 75.3%, 91.6%, 97.6%, 45.0%, and 78.3%, respectively. Seven discordant cases (1.5%) were positive on ROSE-TIC and negative on final diagnosis. The success rates for molecular analysis from TBB samples were 96.6% for mutation, 87.3% for ALK rearrangement, 93.1% for ROS1 rearrangement, and 96.2% for PD-L1 expression.
The accuracy of ROSE-TIC is high. It can be useful for obtaining instant diagnosis, contributing to a high success rate of molecular analysis for targeted therapy.
对细胞学材料进行快速现场评估（ROSE）应用广泛，因为它能为临床医生提供即时诊断信息。然而，经支气管活检（TBB）期间触摸印片细胞学的快速现场评估（ROSE-TIC）的效用仍不明确。本研究的目的是评估ROSE-TIC用于TBB的可行性和准确性。
对接受诊断性支气管镜检查并结合ROSE-TIC的患者进行回顾性研究。将ROSE-TIC诊断为恶性或非恶性的结果与组织学结果和最终诊断进行比较。计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性。还评估了TBB标本分子检测的成功率。
总体而言，460例患者接受了ROSE-TIC支气管镜检查。其中，最终诊断为恶性377例（82.0%），非恶性83例（18.0%）。与组织学结果相比，ROSE-TIC的敏感性、特异性、PPV、NPV和诊断准确性分别为91.1%、90.4%、94.8%、84.0%和90.9%。与最终诊断相比，ROSE-TIC的敏感性、特异性、PPV、NPV和诊断准确性分别为75.3%、91.6%、97.6%、45.0%和78.3%。7例不一致病例（1.5%）ROSE-TIC为阳性而最终诊断为阴性。TBB样本分子分析的成功率分别为：突变检测96.6%，ALK重排检测87.3%，ROS1重排检测93.1%，PD-L1表达检测96.2%。
ROSE-TIC的准确性较高。它有助于获得即时诊断，提高靶向治疗分子分析的成功率。
