Rapid onsite evaluation: A comparison of cytopathologist and pulmonologist performance.
BACKGROUND
Rapid onsite evaluation (ROSE) has several potential benefits but also can prolong procedures if one must wait for a cytopathologist, and it can involve a considerable time commitment on the part of the cytopathologist. At the University of Arkansas for Medical Sciences, interventional pulmonologists have routinely reviewed cytology specimens. This study was performed to determine prospectively how accurately pulmonologists could perform ROSE and whether they could contribute to the efficiency of the process.


METHODS
For sequential cases, the procedural pulmonologist documented a ROSE reading before the reading by the cytopathologist. Readings were compared between the two for agreement and for accuracy. The time commitment for the cytopathologist was also recorded.


RESULTS
One hundred sixty-four sites were biopsied in 102 patients. With respect to onsite adequacy, there was a high level of concordance between pulmonology and cytopathology as evidenced by the κ score ( ± standard error) of 0.72 ± 0.15 and by disagreement in only 3 cases (2%). For the diagnostic category, there was once again a high level of concordance; there was agreement in 141 of the 164 cases (86%), and the weighted κ score was 0.89 ± 0.02. The cytopathologist's time in the endoscopy suite averaged 4.02 ± 6.9 minutes per procedure.


CONCLUSIONS
Procedural pulmonologists can effectively learn enough cytology to be able to make ROSE a collaborative process and to greatly increase the efficiency of the cytopathologist.
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Nikhil
N
Meena
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Susanne
S
Jeffus
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Nicole
N
Massoll
Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Eric R
ER
Siegel
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Soheila
S
Korourian
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Chien
C
Chen
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Thaddeus
T
Bartter
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003581:Cytodiagnosis / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000191:economics / Q000379:methods*; D012680:Sensitivity and Specificity; D055815:Young Adult
cytopathology; fine-needle aspiration; rapid onsite evaluation (ROSE)