Validation of the usefulness of rapid on-site evaluation of cytology during transbronchial and endobronchial ultrasound-guided transbronchial biopsy and detailed examination in cases with atypical cells

Abstract

Objective : To determine the usefulness of rapid on-site cytology evaluation (ROSE) and perform a detailed evaluation of cases with atypical cells.

Study Design : The study was conducted in 254 subjects who underwent ROSE during transbronchial biopsy (TBB) or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), with the diagnoses eventually confirmed by histopathology.

The diagnostic accuracy was determined from the concordance rate of histological diagnosis in cases categorized as “suspicious for malignancy” and compared between ROSE and the final cytology report (FCR). The malignancy rate for each ROSE assessment was determined. Next, detailed examination of the findings in cases with atypical cells, including the background, pattern of arrangement of the cells, presence/absence of large solitary cells, and cytoplasmic findings was conducted and compared between the “benign” and “malignant” groups. Furthermore, the diagnostic accuracy of ROSE was re-evaluated by adding significant findings in cases with atypical cells to the “malignant” group.

Results : The diagnostic accuracy of ROSE was high ; however, the malignancy rate associated with the finding of atypical cells tended to be as high as 64.3％ (18/28). The atypical cells in the “malignant” group exhibited significant necrosis and large solitary cells, and re-evaluation of ROSE taking these two findings into account enhanced its sensitivity to the same level as that of FCR and reduced the malignancy rate to 42.9％ (6/14) for atypical cells.

Conclusion : The diagnostic accuracy of ROSE was similar to that of FCR. Presence of a necrotic background and large solitary cells could improve the diagnostic accuracy in cases with atypical cells.