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ROSEs Are ReadROSEs Are Read

Atul C. Mehta, MBBS, FCCP; Joseph Cicenia, MD, FCCP
Author and Funding Information

From the Respiratory Institute, Cleveland Clinic.

Correspondence to: Atul C. Mehta, MBBS, FCCP, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: Mehtaa1@ccf.org


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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):7-9. doi:10.1378/chest.13-1710
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The use of rapid on-site cytologic evaluation (ROSE) of a fine needle aspiration specimen has been carried out for many years.1 The purported advantages of ROSE include improving sample adequacy, diagnostic accuracy, and efficient triaging of the specimens for postprocessing testing.2,3 Improving sample adequacy has an added benefit of decreasing the number of needle aspirates required to establish the diagnosis, which, in turn, can reduce both cost and procedure duration. This is especially important in mediastinal staging of lung cancer, where the finding of metastasis to a N3 lymph node would obviate the need for further sampling, even from the primary lesion.4 The efficient triaging of the specimens based on preliminary ROSE findings, in cases of lymphoma or lung cancer, also has an ability to reduce the cost and procedure duration, and may even prevent the need for a repeat bronchoscopy.5,6 Although the theoretical advantage of using ROSE during bronchoscopy, especially in the arena of mediastinal lymph node biopsy, seems obvious, the data have been equivocal, with some studies showing no improvement in adequacy or diagnostic ability.7 Simulation studies have suggested that ROSE will not offer an advantage where the core adequacy is 80% or better,8 and this has also been observed clinically in endoscopic ultrasound (EUS)-guided pancreatic biopsy.9 This would include situations where the bronchoscopist is highly skilled or in the situation of endobronchial ultrasound (EBUS)-guided needle aspirations where the sampling of the nodal tissue can be confirmed in real time. Thus, it has been suggested that the application of ROSE should be based on local expertise and outcomes.8,10

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