Vasugi Gramani Arumugam, Mathivanan Koushik Muthuraja, Rajendiran Swaminathan, Sundaram Sandhya, Ayub Irfan I
Department of Pathology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu, India.
Department of Pulmonology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu, India.
J Cytol. 2021 Oct-Dec;38(4):175-179. doi: 10.4103/JOC.JOC_60_21. Epub 2021 Nov 20.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a precise modality for tissue sampling of mediastinal and hilar lesions adjacent to the proximal airway. This study aims to determine the diagnostic efficacy, sensitivity, and specificity of rapid-on site evaluation (ROSE) in EBUS-TBNA.
This is a retrospective study that included 100 patients who underwent EBUS-TBNA of paratracheal and mediastinal lymph nodes in a tertiary care hospital in South India between March 2018 and March 2020. After the procedure, the diagnostic yield from the nodes sampled was transferred to slides that were stained with rapid hematoxylin and eosin (H and E), and then onsite evaluation was done. The tissue derived was also processed for histopathologic examination in all cases. ROSE was performed to assess sample adequacy and to arrive at a preliminary diagnosis. In patients suspected of tuberculosis, the sample was collected for GeneXpert evaluation as well.
Of the 100 cases studied, 51 were males and 49 were females. The age distribution was between 3 and 78 years. Forty-seven cases were diagnosed as granulomatous lymphadenitis, 13 as metastatic malignancies, 33 as reactive lymphadenitis, 3 as atypical cells, and 1 case was diagnosed as a cystic lesion. The diagnostic yield was not adequate for evaluation in three cases. Diagnostic yield was obtained in the first two passes where the lymph nodes were more than 2 cm in size. More diagnostic passes were required in lymph nodes less than 2 cm and those located between and adjacent to major vessels. The onsite diagnosis was correlated with the final histopathologic diagnosis.
ROSE serves as a useful adjunct to reduce procedure time and enhance sample collection and triaging, and reduces the need for further invasive testing.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）已成为一种对近端气道旁纵隔及肺门病变进行组织采样的精确方法。本研究旨在确定EBUS-TBNA中快速现场评估（ROSE）的诊断效能、敏感性和特异性。
这是一项回顾性研究，纳入了2018年3月至2020年3月期间在印度南部一家三级护理医院接受气管旁和纵隔淋巴结EBUS-TBNA的100例患者。术后，将采样淋巴结的诊断标本转移至经快速苏木精和伊红（H&E）染色的载玻片上，然后进行现场评估。所有病例的取材组织也均进行组织病理学检查。进行ROSE以评估样本充足性并得出初步诊断。对于疑似结核病的患者，也采集样本进行GeneXpert评估。
在研究的100例病例中，男性51例，女性49例。年龄分布在3至78岁之间。47例被诊断为肉芽肿性淋巴结炎，13例为转移性恶性肿瘤，33例为反应性淋巴结炎，3例为非典型细胞，1例被诊断为囊性病变。3例的诊断标本不足以进行评估。在淋巴结直径大于2 cm的前两次穿刺中获得了诊断标本。直径小于2 cm以及位于大血管之间和附近的淋巴结需要更多次穿刺才能获得诊断标本。现场诊断与最终组织病理学诊断相关。
ROSE作为一种有用的辅助手段，可减少操作时间，提高样本采集和分类效率，并减少进一步侵入性检查的需求。
