title: Rapid on-site evaluation improves needle aspiration sensitivity in the diagnosis of central lung cancers: a randomized trial.
abstract: BACKGROUND
  Few prospective studies have evaluated the role of endobronchial needle aspiration in diagnosing central airways neoplasms. Rapid on-site evaluation has long been used in transbronchial needle aspiration of adenopathies and peripheral lesions, but its role in sampling central malignancies has not been substantiated yet.
  
  
  OBJECTIVE
  In this study we evaluated if endobronchial needle aspiration may increase the sensitivity of bronchoscopy for diagnosing central airways neoplasms when added to conventional diagnostic methods (forceps biopsy, brushing and bronchial washing), and if rapid on-site evaluation may be beneficial in patients undergoing endobronchial needle aspiration.
  
  
  METHODS
  125 patients (77% males, aged 70 ± 7 years; mean ± SD) with central lung cancers were randomized to undergo bronchoscopy including conventional diagnostic methods and needle aspiration, with or without rapid on-site evaluation, stratifying the patients on the basis of the neoplasm growth pattern (exophytic and submucosal/peribronchial disease).
  
  
  RESULTS
  Needle aspiration significantly increased the sensitivity of bronchoscopy when added to conventional methods (from 76 to 91%; p < 0.001), primarily resulting from differences in submucosal/peribronchial diseases (68 vs. 90%; p < 0.001) and independently from the presence of rapid on-site evaluation; needle aspiration guided by rapid on-site evaluation guaranteed a higher improvement in bronchoscopy sensitivity than conventional needle aspiration (98 vs. 84%, respectively; p = 0.004). Needle aspiration guided by rapid on-site evaluation showed a significantly higher sensitivity than the conventional method (97 vs. 76%, respectively; p = 0.001).
  
  
  CONCLUSIONS
  Needle aspiration increases the sensitivity of bronchoscopy in diagnosing central airways malignancies when added to conventional diagnostic methods, with a further significant improvement when guided by rapid on-site evaluation.
authors.affiliation: Respiratory Unit, San Paolo Hospital, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy. michele.mondoni@ao-sanpaolo.it
authors.forename: Michele
authors.initials: M
authors.lastname: Mondoni
authors.forename: Paolo
authors.initials: P
authors.lastname: Carlucci
authors.forename: Fabiano
authors.initials: F
authors.lastname: Di Marco
authors.forename: Stefania
authors.initials: S
authors.lastname: Rossi
authors.forename: Pierachille
authors.initials: P
authors.lastname: Santus
authors.forename: Alice
authors.initials: A
authors.lastname: D'Adda
authors.forename: Giuseppe Francesco
authors.initials: GF
authors.lastname: Sferrazza Papa
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bulfamante
authors.forename: Stefano
authors.initials: S
authors.lastname: Centanni
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology*; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001980:Bronchi / Q000473:pathology; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis / Q000473:pathology*