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

Abstract

PURPOSE: Rapid on-site evaluation (ROSE) of cytology samples serves several purposes: to determine sample adequacy and to triage subsequent samples for further testing. Although data regarding the efficacy of ROSE to impact the number of samples or diagnostic yield is contradictory, most of this data is in the area of malignant disease, specifically mediastinal staging in lung cancer. Furthermore, there has been little data on the utility of ROSE in benign mediastinal diseases such as sarcoidosis or histoplasmosis. It was our intent to retrospectively evaluate the utility of ROSE in mediastinal granulomatous disease, and whether it could impact bronchoscopic diagnosis of granulomatous lung disease. METHODS: We retrospectively analyzed all patients with a cytologic diagnosis of granuloma made from EBUS-TBNA samples during a nine-month period from July 2012 to March 2013. Preliminary ROSE findings were compared with final cytologic diagnoses. Number of nodal stations biopsied per patient, number of passes per node, and concordance rates within nodes and patients were recorded and analyzed. RESULTS: There were 218 nodes sampled in 81 patients. An average of 2.7 nodes were sampled per patient, and the median number of biopsy attempts per node was 3. Overall there were 37 nodes (17%) in which ROSE findings were discordant with their corresponding final diagnosis; in all the discordant samples the ROSE findings were negative and the final diagnosis demonstrated granulomas. There were 6 patients (7.4%) in which ROSE was negative in all nodal stations while the final cytology demonstrated granulomas in at least one of those nodal stations. CONCLUSIONS: The use of ROSE in EBUS-TBNA for the detection of granulomas in mediastinal lymph nodes has a high concordance rate with the final diagnosis. When more than one lymph node is adequately sampled, sensitivity of ROSE for detection of granulomas in a patient is 93% and specificity is 100%.