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Original Research: INTERVENTIONAL PULMONOLOGY |

Rapid On-site Evaluation of Transbronchial Aspirates in the Diagnosis of Hilar and Mediastinal Adenopathy: A Randomized Trial

Rocco Trisolini, MD, FCCP; Alessandra Cancellieri, MD; Carmine Tinelli, MD; Daniela Paioli, MD; Luigia Scudeller, MD; Gian Piero Casadei, MD; Sergio Forti Parri, MD; Vanina Livi, MD; Arrigo Bondi, MD; Maurizio Boaron, MD; Marco Patelli, MD, FCCP
Author and Funding Information

From the Thoracic Endoscopy and Pulmonology Unit (Drs Trisolini, Paioli, Livi, and Patelli), the Pathology Unit (Drs Cancellieri, Casadei, and Bondi), and the Thoracic Surgery Unit (Drs Forti Parri and Boaron), Maggiore Hospital, Bologna; and the Clinical Epidemiology and Biometry Service (Drs Tinelli and Scudeller), IRCCS Policlinico San Matteo, Pavia, Italy.

Correspondence to: Rocco Trisolini, MD, FCCP, Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Largo B. Nigrisoli 2, 40133 Bologna, Italy; e-mail: rocco.trisolini@ausl.bologna.it


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(2):395-401. doi:10.1378/chest.10-1521
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Background:  Rapid on-site evaluation (ROSE) of transbronchial needle aspirates has long been used during flexible bronchoscopy, but its usefulness in the diagnosis of hilar and mediastinal adenopathy is controversial. The aim of the present study was to evaluate the extent to which ROSE can be valuable in patients undergoing transbronchial needle aspiration (TBNA) for the diagnosis of hilar and mediastinal adenopathy.

Methods:  A total of 168 consecutive patients with enlarged lymph nodes were randomized to undergo TBNA with or without ROSE. The primary outcome measure of the study was the diagnostic yield of TBNA on a per-patient basis. Secondary outcome measures included the percentage of adequate specimens on a per-lymph node basis, the number of biopsy sites on a per-patient basis, and the complication rate of bronchoscopy on a per-patient basis.

Results:  We found no significant difference between the TBNA group and the ROSE group in terms of diagnostic yield (75.3% vs 78.3%, respectively; P = .64), and percentage of adequate specimens (86.5% vs 78.4%, respectively; P = .11). The median (interquartile range) number of biopsy sites was significantly lower in the ROSE group (1 [1-2] vs 2 [1-2], respectively; P = .0005). The complication rate of bronchoscopy was significantly lower in patients undergoing on-site review (6% vs 20%; P = .01), whereas the complication rate of TBNA was similar among the study groups.

Conclusions:  ROSE of transbronchial aspirates from hilar and mediastinal nodes enables avoidance of additional biopsy without loss in diagnostic yield and reduces the complication rate of bronchoscopy.

Trial registry:  ClinicalTrials.gov; No.: NCT00915330; URL: www.clinicaltrials.gov

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