title: The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: a prospective study.
abstract: BACKGROUND
  Rapid on-site cytologic evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions. ROSE is not a widespread technique, however, because of a lack of time and resources. Our aim was to verify whether, in comparison with a board-certified cytopathologist, a pulmonologist could evaluate the adequacy of transbronchial needle aspiration (TBNA) specimens on-site to diagnose hilar/mediastinal adenopathies/masses after receiving training in cytopathology. Our secondary aim was to assess and compare the accuracy of ROSE as performed by both physicians.
  
  
  METHODS
  A pulmonologist and a cytopathologist, the latter deemed the gold standard, performed ROSE and classified specimens into five diagnostic categories. Agreement between clinicians was assessed through κ statistics. The accuracy of ROSE was established according to definitive cytologic assessment.
  
  
  RESULTS
  A total of 362 TBNAs were performed on 84 patients affected by hilar/mediastinal lymphadenopathies. There was an 81% overall substantial agreement between observers (κ, 0.73; 95% CI, 0.61-0.86; P , 0.001), which became excellent in cases of malignant disease (κ, 0.81; 95% CI, 0.70-0.90; P , 0.001). The accuracy of ROSE performed by the pulmonologist (80%; 95% CI, 77-90) was not statistically different from that provided by the cytopathologist (92%; 95% CI, 85-94).
  
  
  CONCLUSIONS
  Our study provides the first evidence, to our knowledge, that a trained pulmonologist can assess the adequacy of cytologic smears on-site. Training pulmonologists to have a basic knowledge of cytopathology could obviate most difficulties related to the involvement of cytopathologists in routine diagnostic activities and may reduce the costs of the procedure.
authors.affiliation: Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona.
authors.forename: Martina
authors.initials: M
authors.lastname: Bonifazi
authors.affiliation: Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona.
authors.forename: Michele
authors.initials: M
authors.lastname: Sediari
authors.affiliation: Department of Immunoallergic and Respiratory Diseases, and the Cytopathology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferretti
authors.affiliation: Pulmonary Diseases Unit, Department of Clinical and Molecular Biomedicine, University of Catania, Catania.
authors.forename: Grazia
authors.initials: G
authors.lastname: Poidomani
authors.affiliation: Neuroepidemiology Operating Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Tramacere
authors.affiliation: Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona.
authors.forename: Federico
authors.initials: F
authors.lastname: Mei
authors.affiliation: Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona.
authors.forename: Lina
authors.initials: L
authors.lastname: Zuccatosta
authors.affiliation: Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona. Electronic address: s.gasparini@fastnet.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Gasparini
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000473:pathology*; D008297:Male; D008477:Mediastinal Diseases / Q000473:pathology*; D008482:Mediastinum; D010336:Pathology / Q000592:standards*; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000592:standards*; D012507:Sarcoidosis / Q000473:pathology; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000473:pathology