PURPOSE: To determine the diagnostic value of rapid on site evaluation (ROSE) during transbronchial needle aspiration (TBNA) for the diagnosis of hilar and/or mediastinal lymphadenopathy and assess its impact on time to diagnosis and cost to the health medical system.
METHODS: In a county hospital affiliated to an academic center, data from all patients that underwent bronchoscopy with TBNA during 2005 was reviewed retrospectively.
RESULTS: TBNA was performed in 34 patients with hilar and/or mediastinal lymphadenopathy/mass. The mean age was 53.58 ± 11.82 years, 14 women and 20 men. TBNA with ROSE was performed in 9 cases. A specific diagnosis was established in all but one patient. Six had non small cell carcinoma, 1 small cell carcinoma and 1 sarcoidosis. One patient had atypical cells suspicious for malignancy but was non diagnostic after 2 bronchospies and underwent mediastinoscopy. Of the 25 TBNA without ROSE, 2 had TBNA positive for malignancy and 23 TBNA were not diagnostic, although diagnosis was obtained in 15 by endobronchial biopsies, transbronchial biopsies or cytology brushing performed during the bronchoscopy. For the patients with endobronchial lesions, TBNA was diagnostic only 2 patients. The other 8 patients required another procedure (mediastinoscopy, pleural fluid analysis, extrathoracic biopsies). Of the 34 patients, 15 (44%) required a second procedure (7 bronchoscopies, 2 mediastinoscopies, 1 pleural biopsy and 2 neck biopsies). When TBNA with ROSE was performed during the second procedure, the TBNA was diagnostic. The delay in diagnosis ranged from 3 to 69 days in TBNA without ROSE. Sensitivity of TBNA with ROSE was 89 % and specificity was 92%.
CONCLUSION: In patients with hilar and/or mediastinal lymphadenopathy/mass TBNA with ROSE improves the diagnostic yield avoiding a second procedure. This decreased cost and decreased delay in diagnosis. In patients with endobronchial lesions or infectious processes, TBNA did not add to the diagnosis.
CLINICAL IMPLICATIONS: TBNA with ROSE provides earlier diagnosis, avoids second procedures thus decreasing costs.
DISCLOSURE: Rosa Estrada-Y-Martin, None.