Rapid on-site cytologic evaluation by pulmonologist improved diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy
Journal
Journal of the Formosan Medical Association
Date Issued
2020
Author(s)
Abstract
Background/Purpose: Rapid on-site cytologic evaluation (ROSE) has been shown to improve the diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB). However, ROSE by a cytopathologist or cytotechnologist is not always available during the procedure. The purposes of this study were to verify that a pulmonologist, after receiving training in cytology, could accurately assess an EBUS-TBB specimen on-site, and to evaluate the contribution of ROSE to EBUS-TBB. Methods: A retrospective chart review of patients who underwent EBUS-TBB for diagnosis of peripheral pulmonary lesions (PPLs) from January 2014 to June 2017 was performed. PPLs without a malignant diagnosis were excluded. The ROSE result determined by a pulmonologist was compared to the formal imprint cytologic report and pathologic report. The diagnostic accuracy of EBUS-TBB was also compared between those with and without ROSE. Results: Two hundred ninety-three patients who underwent 336 EBUS-TBB procedures for PPL diagnosis and were found to have proven malignancy were enrolled. Eighty-six procedures were performed with ROSE. With the formal imprint cytologic diagnosis as the standard, ROSE had 96.9% sensitivity, 68.2% specificity, 89.9% positive predictive value (PPV), 88.2% negative predictive value (NPV), and 89.5% diagnostic accuracy. With the formal pathologic result as the standard, ROSE had 88.2% sensitivity, 80% specificity, 97.1% PPV, 47.1% NPV, and 87.2% diagnostic accuracy, respectively. The diagnostic accuracy was significantly higher when ROSE was performed during EBUS-TBB (88.4% vs 68.0%, P < 0.001). Conclusion: A trained pulmonologist can interpret adequately cytologic smears on-site and effectively improve the accuracy of EBUS-TBB in the diagnosis of PPLs. ? 2020 Formosan Medical Association
SDGs
Other Subjects
bronchodilating agent; fentanyl; lidocaine; midazolam; adult; aged; Article; bronchospasm; cancer cytodiagnosis; cancer patient; conscious sedation; controlled study; cytodiagnosis; diagnostic accuracy; diagnostic test accuracy study; diagnostic value; disease severity; endobronchial ultrasonography; female; human; human tissue; hypoxia; interventional ultrasonography; local anesthesia; lung cancer; major clinical study; male; malignant neoplasm; medical record review; oxygen therapy; peripheral lung lesion; pleura effusion; pneumothorax; predictive value; pulmonologist; rapid on site cytologic evaluation; retrospective study; sensitivity and specificity; thorax drainage; transbronchial biopsy; tumor volume; biopsy; bronchoscopy; diagnostic imaging; interventional ultrasonography; lung tumor; Biopsy; Bronchoscopy; Humans; Lung Neoplasms; Pulmonologists; Retrospective Studies; Ultrasonography, Interventional
Publisher
Elsevier B.V.
Type
journal article