The samples obtained by transbronchial needle aspiration (TBNA) during fiberoptic bronchoscopy (FOB) are suitable for rapid on-site evaluation (ROSE). Availability of on-site results may increase the effectiveness of FOB. This study prospectively investigated the diagnostic range, yield and practical value of this technique.
Methods and results: Consecutive patients with radiologically suitable mediastinal mass lesions or lymph nodes on conventional chest x-rays and lung CT scans were investigated with FOB. TBNA-ROSE was performed during FOB. A cytopathologist prepared unstained slides, stained them and evaluated the aspirates on-site and notified the bronchoscopist about the necessity of further sampling. If adequate diagnostic material was collected with TBNA, the provisional diagnosis was noted and the procedure ended. Fifty patients with mediastinal masses or lymph nodes were included. In 37 (74%) patients, the diagnosis was made on-site: non small cell lung cancer in 16, small cell lung cancer in 4, metastatic cancer in 6, granulomatous disease in 9 and lymphoma in 2 patients. TBNA was not diagnostic in 9 (18%) patients with reactive lymphoid hyperplasia that required additional studies. Overall, ROSE shortened bronchoscopic sampling in 74% of patients. The mean intervention time was 25 minutes. No side effects of TBNA were observed.
Conclusion: TBNA combined with ROSE is safe and highly effective. ROSE increased the sensitivity of TBNA.