Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration.
OBJECTIVE
To determine the extent to which rapid on-site cytologic evaluation (ROSE) of transbronchial needle aspiration (TBNA) samples can safely and cost-effectively reduce the need for additional biopsy during bronchoscopy.


METHODS
University Hospital in Long Island, NY.


METHODS
Forty-four bronchoscopies with TBNA, most of which utilized ROSE, were evaluated prospectively. The number and types of biopsies performed during each procedure were compared to a preprocedural algorithm to determine the impact of knowing ROSE results during the procedure. Bronchoscopies performed with and without ROSE were compared, as were bronchoscopies with diagnostic and nondiagnostic ROSE results. A cost analysis was performed comparing the Medicare reimbursement for ROSE to the savings of deferring multiple biopsies.


RESULTS
Thirty-two bronchoscopies were performed with ROSE; 12 were performed without ROSE. Fewer biopsies were performed during bronchoscopies utilizing ROSE. Diagnostic yield, TBNA sensitivity and accuracy, and procedural time were similar between these two groups.


CONCLUSIONS
ROSE during TBNA allows for deferring additional biopsy without loss in diagnostic yield, likely lowers procedural risk, and is cost-effective.
Baram
Daniel
D
Division of Pulmonary/Critical Care, Stony Brook University, T-17, 040 HSC, Stony Brook, NY 11794-8172, USA. dbaram@notes.cc.sunysb.edu
Garcia
Ruel B
RB
Richman
Paul S
PS
D000465:Algorithms; D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy; D006801:Humans; D008168:Lung / Q000473:pathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors