Risk Factors for False-Negative Results of Rapid On-Site Evaluation of Touch Imprint Cytology in Cases Diagnosed as Malignant Tumors by Transbronchial Lung Biopsy

Abstract

Background: Rapid on-site evaluation (ROSE) is increasingly being performed during radial endobronchial ultrasound (R-EBUS)-guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions. Although ROSE can support immediate clinical decision-making, discrepancies with the final diagnosis of TBLB occasionally occur, potentially leading to inappropriate management. The clinical and radiological characteristics associated with such discrepancies remain unclear.

Materials and Methods: We retrospectively analyzed 361 patients who underwent R-EBUS-guided TBLB with ROSE of touch imprint cytology (ROSE-TIC) between October 2020 and December 2023. The ROSE-TIC results (positive or negative for malignancy) were compared with the pathological diagnoses by TBLB. Among patients diagnosed with malignancy, the clinical and radiological features were compared between the ROSE-TIC–positive and false-negative groups. Additionally, we investigated the risk factors for false negatives in ROSE-TIC.

Results: Of the 361 patients, 221 were diagnosed with malignancy by TBLB; all these cases were ultimately confirmed as malignant on final diagnosis. Of the 221 patients with malignancy, 196 were ROSE-TIC–positive and 25 were false-negative. The false-negative group had significantly higher rates of part-solid nodules on computed tomography, "adjacent to" findings on EBUS, and smaller lesion sizes than the positive group. In a multivariate logistic regression analysis, part-solid nodule (versus solid nodule) (adjusted odds ratio [OR] 4.68; 95% confidence interval [CI] 1.46-15.0; p = 0.010) and smaller lesion size (adjusted OR 0.62; 95% CI 0.41-0.94; p = 0.023) were independently associated with false negatives.

Conclusions: Part-solid nodules, compared with solid nodules and smaller lesion sizes were associated with ROSE-TIC false-negative results. Clinicians may need to exercise caution when interpreting negative ROSE-TIC findings in such cases, and tissue sampling may be considered, while acknowledging the potential risk of false-negative ROSE-TIC results.