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Bronchoscopy |

Impact of Rapid On-Site Cytologic Evaluation During Transbronchial Needle Aspiration*

Daniel Baram, MD; Ruel B. Garcia, MD; Paul S. Richman, MD
Author and Funding Information

*From the Division of Pulmonary/Critical Care, Stony Brook University, Stony Brook, NY.

Correspondence to: Daniel Baram, MD, Assistant Professor of Medicine, Stony Brook University, Division of Pulmonary/Critical Care, T-17, 040 HSC, Stony Brook NY 11794-8172; e-mail: dbaram@notes.cc.sunysb.edu



Chest. 2005;128(2):869-875. doi:10.1378/chest.128.2.869
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Study objective: To determine the extent to which rapid on-site cytologic evaluation (ROSE) of transbronchial needle aspiration (TBNA) samples can safely and cost-effectively reduce the need for additional biopsy during bronchoscopy.

Setting: University Hospital in Long Island, NY.

Patient and methods: Forty-four bronchoscopies with TBNA, most of which utilized ROSE, were evaluated prospectively. The number and types of biopsies performed during each procedure were compared to a preprocedural algorithm to determine the impact of knowing ROSE results during the procedure. Bronchoscopies performed with and without ROSE were compared, as were bronchoscopies with diagnostic and nondiagnostic ROSE results. A cost analysis was performed comparing the Medicare reimbursement for ROSE to the savings of deferring multiple biopsies.

Results: Thirty-two bronchoscopies were performed with ROSE; 12 were performed without ROSE. Fewer biopsies were performed during bronchoscopies utilizing ROSE. Diagnostic yield, TBNA sensitivity and accuracy, and procedural time were similar between these two groups.

Conclusions: ROSE during TBNA allows for deferring additional biopsy without loss in diagnostic yield, likely lowers procedural risk, and is cost-effective.

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