title: Diagnostic utility and accuracy of rapid on-site evaluation of bronchoscopic brushings.
abstract: The aim of the study was to determine the accuracy of rapid on-site examinations, performed on transbronchial brushings of peripheral pulmonary lesions, in determining final bronchoscopic diagnosis. In addition to determining if rapid on-site examination impacts procedural outcomes. A prospective cohort study of consecutive patients with peripheral pulmonary lesions, which had been located by radial endobronchial ultrasound, was undertaken. Bronchoscopy was terminated if rapid on-site examination demonstrated diagnostic malignant material. Non-diagnostic rapid on-site examination resulted in further bronchoscopic sampling, including transbronchial lung biopsy and/or sampling from different locations. 128 peripheral pulmonary lesions were located by endobronchial ultrasound in 118 patients. The final bronchoscopic diagnoses included nonsmall cell lung cancer (n=76), carcinoid (n=3), and metastatic malignancy (n=3). Procedure times were significantly shorter for procedures when rapid on-site examinations demonstrated malignancy compared to those where rapid on-site examination was non-diagnostic (19±8 min versus 31±11 min, respectively; p<0.0001). In four procedures, initial negative rapid on-site examination results prompted redirection of sampling from alternate bronchial segments, resulting in positive diagnostic tissue being obtained. Positive and negative predictive value of rapid on-site examination for a malignant bronchoscopic diagnosis was 63 (97%) out of 65, and 43 (68%) out of 63, respectively. Rapid on-site examination of brushing specimens has a very high, positive, predictive value for bronchoscopic diagnosis of cancer and shortens the bronchoscopy procedure times. It has the potential to reduce complications, improve cost-effectiveness, and may improve diagnostic performance via live feedback.
authors.affiliation: Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VC, Australia Dept of Medicine, University of Melbourne, Parkville, VC, Australia daniel.steinfort@mh.org.au.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Steinfort
authors.affiliation: Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VC, Australia.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Leong
authors.affiliation: Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VC, Australia.
authors.forename: Irena F
authors.initials: IF
authors.lastname: Laska
authors.affiliation: Dept Pathology, Royal Melbourne Hospital, Parkville, VC, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Beaty
authors.affiliation: Dept Pathology, Royal Melbourne Hospital, Parkville, VC, Australia.
authors.forename: Alpha
authors.initials: A
authors.lastname: Tsui
authors.affiliation: Dept of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VC, Australia.
authors.forename: Louis B
authors.initials: LB
authors.lastname: Irving
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001999:Bronchoscopy / Q000379:methods; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging / Q000473:pathology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D015331:Cohort Studies; D019160:Endosonography; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010338:Pathology, Clinical / Q000379:methods*; D011446:Prospective Studies