title: The utility of ROSE (rapid on-site evaluation) in endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA): Is the picture rosy?
abstract: BACKGROUND
  Mediastinal lymphadenopathy (ML) presents a diagnostic challenge. The technique to sample the lymph nodes has evolved from conventional "blind" transbronchial needle aspiration (TBNA) to the present day endobronchial ultrasound (EBUS)-guided procedure that improves the accuracy of sampling.
  
  
  OBJECTIVE
  This study was undertaken to evaluate the utility of "rapid on-site evaluation" (ROSE) in EBUS-guided TBNA (EBUS-TBNA) for the diagnosis of ML.
  
  
  METHODS
  This prospective study included 80 patients who underwent EBUS-TBNA for computed tomography/positron emission tomography (CT/PET) diagnosed ML over a 4-month period at a single tertiary care center. All 80 of these patients underwent histopathological evaluation (HPE) in addition to cytology. Three out of these 80 (3.7%) patients were excluded in view of inadequate material on EBUS-TBNA. After the sampling of nodes was done, the slides were stained with rapid hematoxylin and eosin (H&E) and then on-site evaluation was done. The tissue derived was also processed for HPE in all cases.
  
  
  RESULTS
  ROSE revealed granuloma in 27 patients and malignancy in 14 patients, and the remaining patients showed nonspecific inflammation. Concomitant histopathology revealed granuloma in 34 patients and malignancy in 14 patients. Considering HPE as gold standard, the overall sensitivity and specificity of EBUS-TBNA for diagnosis were 85.4% and 89.6%, respectively. For malignancy alone, the sensitivity and specificity were 100% and 98.4%, respectively.
  
  
  CONCLUSIONS
  This novel approach is safe, has good diagnostic yield, and has an excellent potential in assisting safe and accurate diagnostic interventional bronchoscope.
authors.affiliation: Department of Pathology, Dr. BR Ambedkar Medical College, Bengaluru, Karnataka, India.
authors.forename: Varuna
authors.initials: V
authors.lastname: Mallya
authors.affiliation: Department of Pathology, Dr. BR Ambedkar Medical College, Bengaluru, Karnataka, India.
authors.forename: Sandeep P
authors.initials: SP
authors.lastname: Kumar
authors.affiliation: Department of Pathology, Apollo Hospital, Bengaluru, Karnataka, India.
authors.forename: Prabhu
authors.initials: P
authors.lastname: Meganathan
authors.affiliation: Department of Pathology, Apollo Hospital, Bengaluru, Karnataka, India.
authors.forename: Swarna
authors.initials: S
authors.lastname: Shivkumar
authors.affiliation: Department of Pulmonology, Apollo Hospital, Bengaluru, Karnataka, India.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Mehta
keywords: Endobronchial ultrasound (EBUS); mediastinoscopy; rapid on-site evaluation (ROSE); transbronchial needle aspiration (TBNA)
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