Traveling with ROSE in EBUS-TBNA - Experience from a Tertiary Care Hospital in South India

Abstract

Aims and objectives: 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.

Materials and methods: 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.

Results: 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.

Conclusion: ROSE serves as a useful adjunct to reduce procedure time and enhance sample collection and triaging, and reduces the need for further invasive testing.

Keywords: Bronchoscope; EBUS-TBNA; ROSE.

Figure 1

(a) 18 × 18.3 mm subcarinal station 7 lymph node with central necrosis. (b) Aspirate with epithelioid histiocytes and background showing lymphocytes. (c) 10.5 × 11.3 mm level 4R heterogeneous lymphadenopathy. (d) Aspirate showing clusters of atypical cells with background showing lymphocytes, bronchial epithelial cells, and macrophages. (e) 25.7 × 25.9 mm left interlobar 11 L heterogeneous lymph node. (f) Cellular smears composed of sheets of atypical cells exhibiting marked pleomorphism