title: Efficacy and cost effectiveness of rapid on site examination (ROSE) in management of patients with mediastinal lymphadenopathies.
abstract: BACKGROUND
  The diagnostic and staging approach for the mediastinal lymphadenopathies, with or whithout pulmonary lesions endoscopically visible, is based on transbronchial needle aspiration (TBNA) during fiberoptic bronchoscopy and on mediastinoscopy. One important factor impacting on TBNA sensitivity is the rapid on site cytological examination (ROSE).
  
  
  OBJECTIVE
  The aim of this study was to evaluate the economic impact of TBNA and TBNA + ROSE, in the diagnosis of these lesions.
  
  
  METHODS
  120 patients, affected by mediastinal lymphadenopathies suspected for lung cancer, underwent TBNA during fiberoptic bronchoscopy: 60 patients without ROSE (group A) and other 60 with ROSE (group B). Whenever needle aspirations failed to provide diagnosis, the patient underwent mediastinoscopy. The economic impact of the diagnostic process was performed.
  
  
  RESULTS
  In group A, 39 patients (65%) obtained a diagnosis with TBNA while 21 patients (35%) required mediastinoscopy. In group B, 48 patients (80%) obtained a diagnosis with TBNA + ROSE, while 12 patients (20%) required mediastinoscopy. With regards to the costs of the procedures performed in the diagnostic process, the use of TBNA with ROSE as first diagnostic approach has saved a considerable amount of euros (19,413) compared to the use of TBNA without ROSE and the combined procedure increased (p < 0.02; chi square test) the sensitivity of TBNA by 15%.
  
  
  CONCLUSIONS
  ROSE significantly impacts on the diagnostic yield, as well as on the overall management costs of patients with mediastinal lymphadenopathy, suspected for lung cancer.
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bruno
authors.forename: A
authors.initials: A
authors.lastname: Ricci
authors.forename: M C
authors.initials: MC
authors.lastname: Esposito
authors.forename: D
authors.initials: D
authors.lastname: Scozzi
authors.forename: L
authors.initials: L
authors.lastname: Tabbì
authors.forename: B
authors.initials: B
authors.lastname: Sposato
authors.forename: C
authors.initials: C
authors.lastname: Falasca
authors.forename: E
authors.initials: E
authors.lastname: Giarnieri
authors.forename: M R
authors.initials: MR
authors.lastname: Giovagnoli
authors.forename: S
authors.initials: S
authors.lastname: Mariotta
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000191:economics; D001999:Bronchoscopy / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis* / Q000473:pathology; D008481:Mediastinoscopy / Q000191:economics; D008875:Middle Aged