title: Establishment of an endobronchial ultrasound-guided transbronchial fine needle aspiration service with rapid on-site evaluation: 2 years experience of a single UK centre.
abstract: OBJECTIVE
  Endobronchial ultrasound (EBUS)-guided transbronchial fine needle aspiration (TBFNA) is now well established as a minimally invasive, effective investigation which can provide information on both diagnosis and stage of lung cancer and is also useful in the investigation of mediastinal lymphadenopathy of uncertain aetiology. The service can be provided with or without rapid on-site evaluation (ROSE) for specimen triage and provisional diagnosis. We outline our experience from the first 2 years of providing an EBUS service with ROSE, highlighting the practicalities of service provision, pitfalls encountered and lessons learned.
  
  
  METHODS
  Aspirates from all EBUS procedures performed during the first 2 years of our service from 16 October 2012 to 15 October 2014 are included. We describe the activities undertaken prior to each EBUS list, the EBUS TBFNA procedure, specimen handling and procedure for ROSE.
  
  
  RESULTS
  A total of 591 aspirates were performed from 352 patients, including 573 (97%) lymph node aspirates, 17 (2.9%) lung mass samples and one aspirate from a retrosternal thyroid cyst (0.1%). There were 498 (84.1%) adequate samples at ROSE, 82 (13.9%) inadequate, one (0.2%) abandoned and 11 (1.9%) where ROSE was not performed. Four hundred and seventy (79.5%) samples showed concordance between the ROSE and final diagnoses. No adequate samples were obtained for 11 patients (3.1%) after final cytological analysis, resulting in a final adequacy rate of 96.9%.
  
  
  CONCLUSIONS
  In our experience, ROSE provides a clear advantage in providing a patient-centred EBUS service by facilitating specimen triage, ensuring adequate sampling and providing a rapid provisional diagnosis, however, there is a learning curve for both the clinicians and cytopathologists involved.
authors.affiliation: Manchester Cytology Centre, Manchester Royal Infirmary, Manchester, UK. sakinah.thiryayi@cmft.nhs.uk.
authors.forename: S A
authors.initials: SA
authors.lastname: Thiryayi
authors.affiliation: Manchester Cytology Centre, Manchester Royal Infirmary, Manchester, UK.
authors.forename: D N
authors.initials: DN
authors.lastname: Rana
authors.affiliation: Manchester Cytology Centre, Manchester Royal Infirmary, Manchester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Narine
authors.affiliation: Respiratory Medicine Department, Manchester Royal Infirmary, Manchester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Najib
authors.affiliation: Respiratory Medicine Department, Manchester Royal Infirmary, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014463:Ultrasonography
keywords: Endobronchial ultrasound-guided transbronchial fine needle aspiration; lung cancer staging; mediastinal lymphadenopathy