Endobronchial/ Endoscopic Ultrasound Examination and Rapid On-Site Evaluation- Experience In A UK Centre

Abstract

Introduction: Endobronchial ultrasound (EBUS) / Endoscopic ultrasound (EUS) has become an essential investigation tool in lung malignancy. In our centre we use Rapid on-site evaluation (ROSE), which is performed by our Cytopathology team comprising a trained Biomedical Scientist and, a Cytopathologist, allows rapid assessment of adequacy, provisional diagnosis and appropriate triage of EBUS/EUS specimens. We have audited our data in our centre since the establishment of EBUS/EUS TBNA and ROSE. Methods and Results: We present here a cohort of patients with suspected lung malignancy who underwent EBUS /EUS TBNA and ROSE in our centre between from October 2013 to June 2018. A total of 295 aspirates sites from 249 patients with suspected lung malignancy were collected during this period. Mean number passes for diagnoses on ROSE was 1.4 and mean number of total nodal passes was 3.2. Mean number of nodal sites biopsied per patient was 1.18. In 253 aspirates, malignancy was confirmed as per initial ROSE assessment. 34 aspirates were suggestive of malignancy, 4 aspirates were equivocal and 4 were assessed as benign, and the final outcome of these aspirates were malignant on cell block. 26 of these patients had Next Generation Sequencing (NGS) of cytological samples and we had a success rate of 21 /26 ( 77%). 5 patient had repeat procedure for molecular analysis. Conclusion: EBUS/EUS with ROSE is effective in achieving diagnoses with fewer needle passes and reduces inadequate rate and therefore the need for repeat procedures. The samples obtained with the aid of ROSE can be maximised so that the majority of the sample can be made into a cell block for further studies.