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Ritesh Agarwal, MD, DM, FCCP; Ashutosh N. Aggarwal, MD, DM, FCCP; Dheeraj Gupta, MD, DM, FCCP
Author and Funding Information

From the Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER).

CORRESPONDENCE TO: Dheeraj Gupta, MD, DM, FCCP, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India 160012; e-mail: dheeraj1910@gmail.com


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;146(3):e97-e98. doi:10.1378/chest.14-0496
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To the Editor:

We thank Drs Kumar and Chandra for their interest in our article.1 We agree that the application of rapid on-site cytologic evaluation (ROSE) would have negated the need for transbronchial lung biopsy and, hence, its antecedent complications.2,3 The use of ROSE has been shown to reduce the number of lymph node passes without loss in procedural yield in some,4-7 but not all,8 studies. Despite its purported benefits, ROSE is not a widely used technique because of a lack of time and availability of certified cytologists. In fact, some pulmonologists have trained themselves to assess the adequacy of cytologic smears on-site.7 Thus, if ROSE is available, it should be used routinely during endobronchial ultrasound-guided transbronchial needle aspiration procedures. However, if ROSE is not available, transbronchial lung biopsy should always be performed along with endobronchial ultrasound-guided transbronchial needle aspiration in patients with suspected sarcoidosis to maximize the diagnostic yield.

References

Gupta D, Dadhwal DS, Agarwal R, Gupta N, Bal A, Aggarwal AN. Endobronchial ultrasound-guided transbronchial needle aspiration vs conventional transbronchial needle aspiration in the diagnosis of sarcoidosis. Chest. 2014;146(3):547-556.
 
Yarmus L, Van der Kloot T, Lechtzin N, Napier M, Dressel D, Feller-Kopman D. A randomized prospective trial of the utility of rapid on-site evaluation of transbronchial needle aspirate specimens. J Bronchology Interv Pulmonol. 2011;18(2):121-127. [CrossRef] [PubMed]
 
Plit ML, Havryk AP, Hodgson A, et al. Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis. Eur Respir J. 2013;42(5):1302-1308. [CrossRef] [PubMed]
 
Joseph M, Jones T, Lutterbie Y, et al. Rapid on-site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging. Ann Thorac Surg. 2013;96(2):403-410. [CrossRef] [PubMed]
 
Nakajima T, Yasufuku K, Saegusa F, et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg. 2013;95(5):1695-1699. [CrossRef] [PubMed]
 
Oki M, Saka H, Kitagawa C, et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration. 2013;85(6):486-492. [CrossRef] [PubMed]
 
Bonifazi M, Sediari M, Ferretti M, et al. The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: a prospective study. Chest. 2014;145(1):60-65. [CrossRef] [PubMed]
 
Griffin AC, Schwartz LE, Baloch ZW. Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens. Cytojournal. 2011;8:20. [CrossRef] [PubMed]
 

Figures

Tables

References

Gupta D, Dadhwal DS, Agarwal R, Gupta N, Bal A, Aggarwal AN. Endobronchial ultrasound-guided transbronchial needle aspiration vs conventional transbronchial needle aspiration in the diagnosis of sarcoidosis. Chest. 2014;146(3):547-556.
 
Yarmus L, Van der Kloot T, Lechtzin N, Napier M, Dressel D, Feller-Kopman D. A randomized prospective trial of the utility of rapid on-site evaluation of transbronchial needle aspirate specimens. J Bronchology Interv Pulmonol. 2011;18(2):121-127. [CrossRef] [PubMed]
 
Plit ML, Havryk AP, Hodgson A, et al. Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis. Eur Respir J. 2013;42(5):1302-1308. [CrossRef] [PubMed]
 
Joseph M, Jones T, Lutterbie Y, et al. Rapid on-site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging. Ann Thorac Surg. 2013;96(2):403-410. [CrossRef] [PubMed]
 
Nakajima T, Yasufuku K, Saegusa F, et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg. 2013;95(5):1695-1699. [CrossRef] [PubMed]
 
Oki M, Saka H, Kitagawa C, et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration. 2013;85(6):486-492. [CrossRef] [PubMed]
 
Bonifazi M, Sediari M, Ferretti M, et al. The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: a prospective study. Chest. 2014;145(1):60-65. [CrossRef] [PubMed]
 
Griffin AC, Schwartz LE, Baloch ZW. Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens. Cytojournal. 2011;8:20. [CrossRef] [PubMed]
 
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