title: A randomized prospective trial of the utility of rapid on-site evaluation of transbronchial needle aspirate specimens.
abstract: BACKGROUND
  Previous studies have suggested an increased diagnostic yield for flexible bronchoscopic transbronchial needle aspirate (TBNA) specimens from lymph nodes when using rapid on-site evaluation by cytopathology but were limited by a lack of randomization, suggesting that selection bias may have contributed to its higher reported yield with TBNA.
  
  
  OBJECTIVE
  The purpose of our study was to determine the effect of rapid on-site evaluation (ROSE) on the diagnostic power of TBNA.
  
  
  METHODS
  The study is a prospective randomized controlled trial. Diagnoses made by procedures were recorded prospectively. The primary endpoint was diagnostic yield.
  
  
  RESULTS
  Thirty-four patients were randomized to the ROSE group and 34 patients to the no-ROSE group. Specimen adequacy was 94% in the ROSE group and 88% in the no-ROSE group (P=0.67). The TBNA diagnostic yield was similar in both groups: ROSE, 55%; no-ROSE, 53% (P=1.000). Neoplastic diagnoses were made in 59% and 50% of ROSE and no-ROSE patients, respectively (P=0.63). There were no significant differences in the number of needle passes, procedure duration, or amount of sedatives used. There was a trend toward a decrease in the number of transbronchial biopsies needed in the ROSE group.
  
  
  CONCLUSIONS
  Previous reports of increased diagnostic yield of ROSE were subject to selection bias. Routine use of ROSE in all TBNA procedures was not associated with a reduced procedure time or sedative use. ROSE may be beneficial by decreasing the need for transbronchial biopsy and the associated risk or if the probability of malignancy is likely. We recommend ROSE in selected patients over all TBNA procedures.
authors.affiliation: Division of Interventional Pulmonology, The Johns Hopkins Hospital, Baltimore, MD 21205, USA. lyarmus@jhmi.edu
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
authors.forename: Thomas
authors.initials: T
authors.lastname: Van der Kloot
authors.forename: Noah
authors.initials: N
authors.lastname: Lechtzin
authors.forename: Mark
authors.initials: M
authors.lastname: Napier
authors.forename: Douglas
authors.initials: D
authors.lastname: Dressel
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman