Pulmonary Procedures |

The Utility of Rapid On-Site Evaluation (ROSE) in the Detection of Granulomas in Mediastinal Lymph Nodes FREE TO VIEW

Haala Rokadia; Joseph Cicenia; Francisco Almeida; Thomas Gildea; Michael Machuzak; Sonali Sethi; Atul Mehta
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Cleveland Clinic, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):752A. doi:10.1378/chest.1994936
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM

PURPOSE: EBUS-TBNA has emerged as an ideal procedure for sampling mediastinal lymph nodes in the setting of granulomatous disease; however the ability of ROSE to predict a final diagnosis in this setting has not yet been well characterized. Therefore, we aim to perform a retrospective evaluation of the utility of ROSE in the diagnosis of granulomatous disease and establish the procedure characteristics that would optimize the concordance between ROSE and a final diagnosis of granuloma. .

METHODS: We performed a retrospective analysis of all patients having a cytologic diagnosis of granuloma made by EBUS-TBNA during a 57-month period at our institution between June 2008 and March 2013. Preliminary ROSE findings and final cytologic diagnosis were compared. Patient demographics and procedure variables were assessed using means and standard deviations for all continuous variables and frequencies and percentages for all categorical variables. Those variables collected were considered in a logistic regression analysis using concordance as the outcome.

RESULTS: There were 255 EBUS-TBNA procedures performed which sampled 625 lymph node stations in which the final diagnosis showed the presence of granuloma. An average of 2.4(±1.2) lymph node stations were biopsied per procedure with a mean(SD) size of 14.4(7.9) mm. The overall concordance between ROSE and final diagnosis per procedure was 81.6%. Concordance was not impacted by needle size, lymph node size, lymph node station, number of stations biopsied, or number of passes per lymph node station. Test of trend demonstrated that concordance did not improve as the lymph node size increased. The presence of an experienced proceduralist compared to an inexperienced proceduralist was associated with an increased concordance(p<0.001), however there was no statisitically significant difference amongst the concordance rates achieved between experienced proceduralists(p=0.57).

CONCLUSIONS: In this large series we found a high concordance between ROSE and final cytologic diagnosis in EBUS-TBNA samples of lymph nodes with granulomas, which may serve to reduce procedure time, enhance sample triaging, and obviate the need for further intraprocedural invasive testing. The only variable associated with increased concordance was an experienced operator

CLINICAL IMPLICATIONS: ROSE can impart an important clinical advantage in situations where identification of nodal granulomas would be a significant diagnostic finding, such as in sarcoidosis or histoplasmosis.

DISCLOSURE: Michael Machuzak: Consultant fee, speaker bureau, advisory committee, etc.: Olympus America The following authors have nothing to disclose: Haala Rokadia, Joseph Cicenia, Francisco Almeida, Thomas Gildea, Sonali Sethi, Atul Mehta

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