title: Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis.
abstract: Rapid on-site evaluation (ROSE) of endobronchial ultrasound-guided transbronchial needle aspirates (EBUS-TBNA) has not been compared to final detailed cytological analysis in patients with suspected sarcoidosis. To assess the diagnostic accuracy of EBUS-TBNA with ROSE in patients with suspected sarcoidosis, a prospective two-centre study performed EBUS-TBNA with ROSE of cellular material followed by transbronchial lung biopsy (TBLB) and endobronchial biopsy (EBB). The diagnostic accuracy of EBUS-TBNA with ROSE was compared to the final cytological assessment and to TBLB and EBB. Analysis confirmed 49 out of 60 cases of sarcoidosis. ROSE sensitivity was 87.8% (specificity 91%, positive predictive value 97.7%). ROSE slide interpretation in combination with the final fixed slide and cell block preparations had a sensitivity of 91.8% (specificity 100%, positive predictive value 100%). 67% of patients were confirmed as having sarcoidosis on TBLB and 29% on EBB. Interobserver agreement between cytotechnologists and pathologists was very good (κ=0.91, 95% CI 0.80-1.0 and κ=0.91, 95% CI 0.79-1.0, respectively). EBUS-TBNA with ROSE has high diagnostic accuracy and interobserver agreement and informs the bronchoscopist in theatre whether additional diagnostic procedures need to be undertaken. EBUS-TBNA with ROSE should therefore be considered as the first-line investigation of sarcoidosis.
authors.affiliation: St Vincent's Hospital, Sydney.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Plit
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Havryk
authors.forename: Alan
authors.initials: A
authors.lastname: Hodgson
authors.forename: Daniel
authors.initials: D
authors.lastname: James
authors.forename: Andrew
authors.initials: A
authors.lastname: Field
authors.forename: Sonia
authors.initials: S
authors.lastname: Carbone
authors.forename: Allan R
authors.initials: AR
authors.lastname: Glanville
authors.forename: Farzad
authors.initials: F
authors.lastname: Bashirzadeh
authors.forename: Anna M
authors.initials: AM
authors.lastname: Chay
authors.forename: Justin
authors.initials: J
authors.lastname: Hundloe
authors.forename: Rebecca
authors.initials: R
authors.lastname: Pearson
authors.forename: David
authors.initials: D
authors.lastname: Fielding
mesh_terms: D000328:Adult; D001706:Biopsy; D044963:Biopsy, Fine-Needle; D001980:Bronchi / Q000473:pathology*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology*; D012680:Sensitivity and Specificity; D014463:Ultrasonography