Rapid On-Site Digital Histopatholocal Evaluation (RODE) on Endobronchial Ultrasound (EBUS) Mediastinal Lymph Node Cryobiopsy Sampling Using Confocal Laser Microscopy-A Proof-Of-Concept Study.

The current standard for determining sample adequacy during Endobronchial Ultrasound guided Mediastinal Sampling is ROSE (Rapid on-site Evaluation) on samples obtained by Fine needle Aspiration. There is an increasing interest in Mediastinal Lymph node cryobiopsy, where tissue samples are obtained using a 1.1 mm cryoprobe. Rapid onsite evaluation on cryobiopsy samples can also be performed by imprint cytology. This proof-of-concept study explores the use of Viva Scope 2500 for rapid on-site digital histopathological evaluation of Endobronchial Ultrasound (EBUS) guided mediastinal lymph node cryobiopsy samples. Confocal Laser Microscopy allows for high-resolution imaging and expedites diagnosis. The study involved four cases of mediastinal lymph node cryobiopsy, and the samples obtained were subjected to rapid digital histopathological examination by Viva Scope 2500 (confocal laser microscopy), enabling lesion in tool confirmation and the results obtained were compared with the final conventional histopathology results. Confocal Laser microscopy by Viva Scope 2500 was found to be comparable to conventional histopathology, superior to conventional histopathology in providing rapid on-site diagnosis minimising the time to diagnosis, with added advantage of better sampled tissue preservation for downstream molecular analysis. RODE reduces procedural time and increases confidence in the operator during mediastinal lymph node sampling enabling lesion in tool confirmation. RODE is a better alternative to ROSE and conventional histopathology decreasing the time to diagnosis.