title: Utility of rapid on-site evaluation of transbronchial needle aspirates.
abstract: BACKGROUND
  Rapid on-site evaluation has been proposed as a method to improve the yield of transbronchial needle aspiration.
  
  
  OBJECTIVE
  This study investigated whether on-site analysis facilitates routine diagnostic bronchoscopy in terms of sampling, yield and cost.
  
  
  METHODS
  Patients with lesions accessible for transbronchial needle aspiration on computed tomography were investigated. A cytopathologist screened the needle aspirates on site for the presence of diagnostic material. The bronchoscopic sampling process was adjusted according to the results. In 90 consecutive patients with neoplastic disease (n=70; 78%), non-neoplastic disease (n=16; 18%) or undiagnosed lesions (n=4; 4%) we aspirated 162 lung tumours or lymph node sites (mediastinal: 7%; tracheobronchial: 68%; other: 25%). In 90 consecutive patients with neoplastic disease (n=70; 78%), non-neoplastic disease (n=16; 18%) or undiagnosed lesions (n=4; 4%) we aspirated 162 lung lesions (paratracheal tumours or lymph nodes: 7%; tracheobronchial lymph nodes: 68%; other: 25%).
  
  
  RESULTS
  The diagnostic yield of needle aspiration was 77 and 25% in patients with neoplastic and non-neoplastic lesions, respectively. Sampling could be terminated in 64% of patients after needle aspiration had been performed as the only diagnostic modality, and on-site analysis identified diagnostic material from the first site aspirated in 50% of patients. Only in 2 patients (2%) diagnostic aspirates were not recognized on site. On-site analysis was cost effective due to savings for disposable diagnostic tools, which exceeded the extra expense for the on-site cytology service provided.
  
  
  CONCLUSIONS
  Rapid on-site analysis of transbronchial aspirates is a highly useful, accurate and cost-effective addition to routine diagnostic bronchoscopy.
authors.affiliation: Department of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa. ahd@sun.ac.za
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Diacon
authors.forename: Macé M
authors.initials: MM
authors.lastname: Schuurmans
authors.forename: Johan
authors.initials: J
authors.lastname: Theron
authors.forename: Mercia
authors.initials: M
authors.lastname: Louw
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Wright
authors.forename: Karen
authors.initials: K
authors.lastname: Brundyn
authors.forename: Chris T
authors.initials: CT
authors.lastname: Bolliger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D001980:Bronchi; D001999:Bronchoscopy; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors