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Original Research: Pulmonary procedures |

The Role of the Pulmonologist in Rapid On-site Cytologic Evaluation of Transbronchial Needle AspirationOn-site Cytologic Evaluation by the Pulmonologist: A Prospective Study

Martina Bonifazi, MD; Michele Sediari, MD; Maurizio Ferretti, MD; Grazia Poidomani, MD; Irene Tramacere, PhD; Federico Mei, MD; Lina Zuccatosta, MD, FCCP; Stefano Gasparini, MD, FCCP
Author and Funding Information

From the Pulmonary Diseases Unit (Drs Bonifazi, Sediari, Mei, Zuccatosta, and Gasparini), Department of Immunoallergic and Respiratory Diseases, and the Cytopathology Unit (Dr Ferretti), Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona; the Pulmonary Diseases Unit (Dr Poidomani), Department of Clinical and Molecular Biomedicine, University of Catania, Catania; and the Neuroepidemiology Operating Unit (Dr Tramacere), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Correspondence to: Stefano Gasparini, MD, FCCP, Pulmonary Diseases Unit, Department of Immunoallergic and Respiratory Diseases, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60120, Ancona, Italy; e-mail: s.gasparini@fastnet.it


For editorial comment see page 7

Funding/Support: Dr Bonifazi was partly supported by Fondazione di Medicina Molecolare e Terapia Cellulare (Università Politecnica delle Marche, Ancona).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(1):60-65. doi:10.1378/chest.13-0756
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Background:  Rapid on-site cytologic evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions. ROSE is not a widespread technique, however, because of a lack of time and resources. Our aim was to verify whether, in comparison with a board-certified cytopathologist, a pulmonologist could evaluate the adequacy of transbronchial needle aspiration (TBNA) specimens on-site to diagnose hilar/mediastinal adenopathies/masses after receiving training in cytopathology. Our secondary aim was to assess and compare the accuracy of ROSE as performed by both physicians.

Methods:  A pulmonologist and a cytopathologist, the latter deemed the gold standard, performed ROSE and classified specimens into five diagnostic categories. Agreement between clinicians was assessed through κ statistics. The accuracy of ROSE was established according to definitive cytologic assessment.

Results:  A total of 362 TBNAs were performed on 84 patients affected by hilar/mediastinal lymphadenopathies. There was an 81% overall substantial agreement between observers (κ, 0.73; 95% CI, 0.61-0.86; P , 0.001), which became excellent in cases of malignant disease (κ, 0.81; 95% CI, 0.70-0.90; P , 0.001). The accuracy of ROSE performed by the pulmonologist (80%; 95% CI, 77-90) was not statistically different from that provided by the cytopathologist (92%; 95% CI, 85-94).

Conclusions:  Our study provides the first evidence, to our knowledge, that a trained pulmonologist can assess the adequacy of cytologic smears on-site. Training pulmonologists to have a basic knowledge of cytopathology could obviate most difficulties related to the involvement of cytopathologists in routine diagnostic activities and may reduce the costs of the procedure.

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