Value of Transbronchial Needle Aspiration Combined with Rapid on-Site Evaluation of Cytology in Diagnosis of Peripheral Pulmonary Lesions

doi:10.21203/rs.3.rs-1346257/v1

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Value of Transbronchial Needle Aspiration Combined with Rapid on-Site Evaluation of Cytology in Diagnosis of Peripheral Pulmonary Lesions

https://doi.org/10.21203/rs.3.rs-1346257/v1

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Background: The diagnostic value of rapid on-site evaluation (ROSE) of cytology during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains controversial. The purpose of this study was to validate the value of EUBS-TBNA combined with ROSE in the diagnosis of peripheral pulmonary lesions (PPLs).

Methods: Enrolled in this study were 260 patients with nodules, masses, cavities or inflammatory lesions on pulmonary CT images, and age ranged from 23 to 83 years old. They were assigned to undergo EBUS-TBNA with ROSE (n=134) or without ROSE (n=126). The diagnostic results of ROSE during EBUS-TBNA and the final pathologic reports were analyzed and compared by utilizing SPSS21.0 software to see whether the ROSE method during EBUS-TBNA would increase the risk of procedure-related complications, improve the diagnostic yield, and evaluate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Results: The number of punctures in ROSE group was significantly lower than that in non-ROSE group (P<0.001). There was no significant difference in hemoptysis between the two groups (P=0.402). The overall diagnostic yield of EBUS-TBNA for malignant diseases in the ROSE-group and the non-ROSE group was 29.9% and 11.1%, respectively. The sensitivity, specificity, PPV and NPV of ROSE during EBUS-TBNA were 97.4%, 96.9%, 92.5% and 98.90% respectively, showing a high agreement with the pathological results. Youden index reached 94.3%.

Conclusions: ROSE examination during EBUS-TBNA could effectively improve the diagnostic yield and reduce the number of intraoperative punctures with the diagnostic results in cytology well consistent with those of traditional pathology, and therefore is worth promoting and applying in clinical practice.

Rapid on-site evaluation (ROSE)

endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)

Peripheral pulmonary lesions

Diagnostic yield

Complications.

Peripheral pulmonary lesions (PPLs) refer to lesions located around the lung which could be solid and partially solid, benign or malignant. Pulmonary nodules are one of the common PPLs. Early lung cancer often appears in the form of malignant nodules. In recent years, the incidence of lung cancer has increased significantly worldwide ranking first among malignant diseases, and has become a major disease endangering people’s life and health¹.

Interventional bronchoscopy is one of the most extensively used clinical approach for the diagnosis of early lung cancer and other respiratory system-related diseases². Transbronchial needle aspiration (TBNA) has been widely used for the determination of focal properties adjacent to the trachea and bronchial walls, diagnosis of pulmonary hilar and mediastinal lymph nodes, and staging of lung cancer. Unfortunately, tissue lesions could not be visualized in a real-time manner during the conventional TBNA procedure, thus increasing the possibility of causing accidental injury to the normal organs around the airway³. The advent of the ultrasound probe installed at the front end of the microscope has made it possible to enter the airway for ultrasound scanning, thus achieving the integration of the respective advantages of the above two technologies, known as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)^4,5.

Traditional pathological evaluation remains the preferred method for accurate diagnosis of pathologies, especially malignant lesions. However, difficulty in sampling and time-consuming of the diagnostic procedure may delay the treatment, prolong the length of hospital stay and increase the medical cost, while ROSE of cytology during EBUS-TBNA can realize the rapid diagnosis of lesions obtained and avoid time-consuming defect of the traditional pathological examination.

Several studies have reported the joint use of ROSE based on EBUS-TBNA⁶, saying that combined use of the two technologies can provide the examiner with useful information about whether the puncture is successful, enable him/her to evaluate the quality of specimens in a real-time manner, and decide whether a repeated operation is necessary or not⁷. The aim of this retrospective study was to evaluate the consistency between the results of ROSE and traditional pathology, and further analyze whether ROSE could play a beneficial role in the surgical procedures.

Patients

This research was approved by the ethics committee of Shanghai Tenth People’s Hospital affiliated to Tongji University (Shanghai, China; No. SHSY-IEC-4.1/20–21/01). All methods were carried out in accordance with the relevant guidelines and regulations. The study involved 260 patients who undergone EBUS-TBNA with ROSE (n = 134) or without ROSE (n = 126) in the bronchoscopy room of the said hospital between 2018 and 2020. The clinical data of the patients in the two groups including sex, age, smoking history, accompanying symptoms, underlying diseases and length of hospital stay are presented in Table 1. Contraindications to bronchoscopy were examined before operation in all patients. In addition, routine examinations including electrocardiography, coagulation time, electrolytes and infectious diseases were also performed before operation. The inclusion criteria were patients older than 18 years whose chest CT scan showed abrasive glass or ordinary nodules, masses, and hollow or inflammatory manifestations. The exclusion criteria were patients with major diseases such as malignancies, severe pneumonia, a recent history of bronchial or lung trauma, bronchial asthma, myocardial infarction, and hematological diseases. Patients with incomplete information regarding discharge, transfer, or failure to follow up were also excluded (Fig. 1).

Table 1

Baseline characteristics of patients
Characteristics	ROSE	Non-ROSE	P value
Patients	134	126
Male/female	79/55	73/53	0.900
Age (years, µ ± σ)	60.75 ± 12.75	60.56\(\pm\)12.75	0.904
Smoking history(no/yes)	101/33	91/35	0.575
Symptoms			0.274
Physical examination	42	48
Dyspnea	13	7
Cough	54	44
Fever	21	18
Joint pain	4	9
Basic diseases			0.355
Health	54	38
Hypertension	26	24
Diabetes	10	16
Hypertension + Diabetes	10	9
Others	34	39
Hospitalization days(µ ± σ)	9.03 ± 4.16	8.12 ± 3.55	0.059

Procedures

The patient was fasted 6 h before operation, laid in a supine position and locally anesthetized with lidocaine and intravenous injection of midazolam by a professional pulmonologist to achieve the effect of sober sedation. Oxygen was given to the patient through the nasal catheter, and the basic life indicators including blood pressure, pulse, respiratory frequency and oxygen saturation were monitored routinely during surgery. An endotracheal tube was placed gently to facilitate continuous insertion and removal of the bronchoscope for the convenience of exploring the location of the lesion. Under the guidance of virtual bronchoscopy navigation software (Direct Path V1.02, Cybernet Sems) and endoscopic ultrasound system (MAJ-935), the EBUS-TBNA procedure was carried out using an intracavitary ultrasound probe with an external diameter of 1.4 mm at a frequency of 20 MHz in combination with an ultra-fine bronchoscope of 4mm in outer diameter. The ultrasound probe was adjusted with the region of the lesion distribution. For lesions distributed in different areas of the lung, the probe was positioned in the respective main stem bronchi, upper or lower or middle lobar bronchus in order to identify a clearer view of the operation. A chest X-ray and routine blood examination were performed if uncomfortable symptoms or abnormal signs developed after surgery. For malignancies that failed to be detected by EBUS-TBNA, further CT-guided transthoracic puncture or open-chest surgery was required to obtain a reference pathology result.

Specimen Processing

The specimen absorbed into the needle cavity was gently pushed by the central tube core needle and spread over the slide as evenly as possible in a circle about 1cm in diameter. A portion of the visible tissue fragment collected on the glass slide was transferred into a single container containing formalin for later histological examination, making sure that the tissue was immersed completely in formalin; the basic information of the specimen was marked on the surface of the bottle. The remaining specimen was divided into two sections and smeared onto two slides. The specimen remaining in the needle cavity and catheter cavity was washed down with normal saline and collected for microbiological analysis. The specimens in ROSE and non-ROSE groups were treated differently. One of the slides in ROSE group was stained with Diff-quick cell staining solution AB (Zhuhai Beso Biotechnology Co., Ltd., Zhuhai, China) to observe the cell morphology and composition under the microscope by two experienced pathologists, who then decided whether sampling was completed successfully, or should be re-performed elsewhere. The other slide was placed in a bottle containing 95% alcohol for subsequent Papanicolaou staining and cytological examination. If abnormal cells were detected by ROSE, 2–3 more tissues needed to be taken at the same site. Otherwise, sampling would be continued in other sites to find whether there were diagnostic specimens that we needed. All non-ROSE specimens were fixed with 95% alcohol for cytological examination. The above processes are shown in Fig. 2.

Diagnosis

The histological and cytological specimens were interpreted by two experienced pathologists. The final diagnostic results were determined by the pathological results of histological biopsy. For suspicious cases or non-specific diagnostic results, thoracoscopic examination, mediastinal examination or other surgical procedures were carried out according to the patient's wishes. For patients who were temporarily unwilling to undergo invasive examinations, preliminary conclusions could be obtained after considering the clinical symptoms, imaging findings and laboratory examinations. Follow-up examination was performed once at least within 6 months after EBUS-TBNA to further verify the original judgment according to the therapeutic effect. The diagnostic yield, sensitivity, specificity, PPV, NPV and Youden index were calculated according to ROSE and pathological results.

Statistical analysis

The SPSS21.0 software was used for statistical analysis. Statistical data with a positive distribution were expressed by x ± s; continuous variables were analyzed using t test; and dichotomous variables were analyzed using Pearson's χ² test or Fisher's exact test. Results were considered statistically significant only when the P value was less than 0.05.

Baseline characteristics of the patients

Our statistics showed no significant difference in sex (P = 0.900) and age (P = 0.904) between the two groups, and the number of smokers was approximately the same (33 vs. 35, P = 0.575). The main symptoms were cough (54 vs. 44), fever (21 vs.18), dyspnea (13 vs.7) and combined chest pain (4 vs. 9), while the rest were found in routine physical examinations (42 vs.48). There was no significant difference in symptoms between the two groups (P = 0.274). The most common underlying diseases in both groups were hypertension and diabetes. No significant difference in terms of underlying diseases between the two groups (P = 0.355). There were 34.3% (46/134) patients with hypertension or diabetes in ROSE group, vs. 49 38.9% (49/126) in non-ROSE group, showing no significant difference between the two groups. The average length of hospital stay were 9.03 days in ROSE group and 8.12 days in non-ROSE group, showing no significant difference between the two groups (P = 0.059) (Table 1). Data showed no significant difference in the baseline characteristics including sex, age, smoking history, symptoms, associated underlying diseases and hospitalization days between ROSE and non-ROSE group.

Characteristics Of Lesions

We further analyzed the size, nature and location of the lesions in the two groups. The specific distribution of lesions involved the right upper, right middle, right lower, left upper, left lingual, left lower, left pulmonary valve, lower or upper lobe of both lungs and all lungs. There was no significant difference in the size (P = 0.669) and distribution (P = 0.139) of the lesions between the two groups. According to the nature, the lesions were divided into five categories: grinding nodules, common nodules, bumps, cavities and inflammatory exudations, which were significantly different between the two groups (P = 0.008) (Table 2).

Table 2

Characteristics of lesions
Characteristics	ROSE	Non-ROSE	P value
Lesion size (cm, µ ± σ)	1.51 ± 2.15	1.40 ± 1.82	0.669
Nature of lesion			0.008
Grinding lesion	18	31
Nodules	42	47
Bump	20	19
Cavity	5	0
Inflammation	49	29
Location of lesion			0.139
Right Upper Lobe	27	36
Right Middle Lobe	12	12
Right Lower Lobe	26	19
Left Upper Division	20	27
Left Lingual Lobe	7	4
Left Lower Lobe	14	18
Left pulmonary valve	1	1
Lower lobe of both Lungs	4	1
Upper lobe of both lungs	6	2
Both lungs	17	6

Distribution Of The Malignant And Benign Lesions

In ROSE groups, 40 (29.9%) malignant nodules were detected, including 26 cases of adenocarcinoma (AD), 12 cases of squamous cell carcinoma (SCC), and 2 cases of small cell lung cancer (SCLC). In addition, 2 cases of hamartoma, 1 case of synovial sarcoma, 1 case of tuberculosis, 3 cases of pulmonary abscesses and 5 cases of fungal infections were detected as benign lesions. In non-ROSE group, 14 patients (11.1%) were diagnosed with malignant nodules by pathology, including 5 cases of AD, 4 cases of SCC, 4 cases of SCLC, 1 case of cancer in situ. In addition, 1 case of dysplasia, 3 cases of lung abscess and 3 cases of fungal infections were diagnosed as benign lesions in this group. Inflammatory nodules occupied a very large proportion in both the ROSE and non-ROSE groups (82 vs. 105) (Table 3).

Table 3

Final diagnosis and classification of benign and malignant diseases
Characteristics	ROSE(n = 134)	Non-ROSE(n = 126)
Malignant(n, %)	40(29.9%)	14(11.1%)
Adenocarcinoma	26	5
Squamous-cell carcinoma	12	4
Small cell lung cancer	2	4
Tis	0	1
Benign(n, %)	94(70.1%)	112(88.9%)
Hamartoma	2	0
Dysplasia	0	1
Synovial sarcoma	1	0
Tuberculosis	1	0
Abscess	3	3
Mycotic infection	5	3
Nonrepresentative samples	82	105

Complications

The number of punctures for major target lesions in ROSE group was significantly lower than that in non-ROSE group (P < 0.001). No pneumothorax occurred in ROSE group vs. 2 cases in non-ROSE group. Hemoptysis occurred in 86 cases in ROSE group vs. 84 in non-ROSE group, accounting for about 75% of all cases in both groups and showing no significant difference between the two groups (Table 4). All patients did not received further intensive care after the procedure.

Table 4

Comparison of complications between ROSE-group and Non-ROSE group
Complications	ROSE(n)	Non-ROSE(n) P value
Pneumothorax	no	2 /
Hemoptysis	86	84 0.402
Number of punctures (µ ± σ)	2.07 ± 0.26	3.23 ± 0.42 0.000

Accuracy Of Diagnosis

The overall diagnostic yield of EBUS-TBNA for malignant diseases in the ROSE-group and the non-ROSE group was 29.9% and 11.1%, respectively (Table 3). It fully demonstrates that ROSE technology during EBUS-TBNA has an advantage in improving the diagnostic yield of malignant diseases comparing to non-ROSE group. The diagnostic accuracy of ROSE in PPLs relative to the pathological results was calculated. The results showed that the sensitivity, specificity, PPV and NPV of ROSE during EBUS-TBNA were 97.4%, 96.9%, 92.5% and 98.9% respectively and the Youden index was 94.3%, showing good agreement with the pathological diagnosis (Fig. 3).

Morphological Characteristics Of Different Types Of Lung Cancer Cells

Different lung cancers showing their unique cytological features under the microscope. Based on the cytomorphologic features, ROSE could achieve accurate subtyping of lung cancer, especially in well-differentiated tumors. The general microscopic cytology morphology of SCC and AD are shown in Fig. 4. The characteristics of tumor cells are as follows: SCC cells adhered closely and showed clusters, with abnormal morphology of cancer cells and nuclei. AD cells gathered into closely distributed small cell clumps, with clear nucleoli and abundant cytoplasm. Figure 5 presents typical poorly differentiated morphological features of SCC by HE staining. The tumor cells were large and flat, with fusiform deeply stained nuclei and abundant cytoplasm. The diagnosis was confirmed by the immunoreactivity for P40 and P63 expression. Microscopically, HE staining under the microscope demonstrated that AD cells were mainly composed of cubic and columnar cells with large or irregular nuclear nuclei. Tumor tissues showed positive cytokeratin 7 and TTF-1 immunoreactivity (Fig. 6). HE staining presented the following morphological features of SCLC tumor cells: small in size and round or oval in shape, mimicking lymphocytes, with rare cytoplasm and deeply stained nuclei. Abnormal cells were positive for TTF-1 immunoreactivity, and negative for CD56 (Fig. 7). Histological biopsy of pulmonary AD derived from metastatic gastrointestinal neoplasms is shown in Fig. 8. Tumor cells were distributed in clusters and positive for Brg-1 and Claudin-4. The impossibility to afford rapid evaluation and analysis is the main disadvantage of using histological materials for pathological diagnosis. Conversely, the advantages are more attractive in that it can provide more tissue materials for immunohistochemical analysis, thus ensuring more convincing diagnostic results of certain tumor types.

We collected multiple sample types in this study, including grinding glass lesions, nodules, masses, cavities and inflammation. There were no significant differences in age, gender, smoking history, symptoms and underlying diseases between ROSE and non-ROSE group patients. Our research led to the conclusion that the number of punctures in ROSE group was significantly lower than that in non-ROSE group. There was no significant difference in hemoptysis between the two groups. Our data suggest that there was a trend toward a higher diagnostic yield in the ROSE group comparing to non-ROSE group. And we arrived at the conclusion that the diagnostic yield of ROSE method during the EBUS-TBNA procedure for PPLs was close to the result of pathological diagnosis. The report of our study effectively demonstrated that ROSE during EBUS-TBNA was a useful diagnostic method to determine the nature of lung cancer lesions.

Our findings have also been validated in several reports abroad. Some scholars have demonstrated a high rate of agreement between ROSE combined with EBUS-TBNA and the final pathological result and proved the effectiveness of ROSE in determining the quality and quantity of specimens^8,9. Davenport et al¹⁰ reported that ROSE could increase the detection rate of specimens containing malignant cells by comparing 73 aspirates using the technique with 134 routinely processed aspirates. Diette et al¹¹ demonstrated that ROSE technique could significantly improve the diagnostic yield in the evaluation of lung nodules or masses and/or hilar or mediastinal lymphadenopathies. Also, the application value of ROSE in other interventional diagnosis for pulmonary malignant diseases should also be appreciated. A randomized trial performed by Mondoni et al¹² showed that ROSE method increased the cytological diagnostic sensitivity of TBLB from 76–97%. Lin et al¹³ collected information from 336 patients undergoing EBUS-TBB surgery, and the application of ROSE method significantly improved diagnostic accuracy compared with EBUS-TBB without ROSE (88.4% vs. 68.0%, P < 0.001). Another study¹⁴ showed a better diagnostic yield from 89.2% without ROSE to 92.1% with ROSE in sampling hilar–mediastinal lymphadenopathies in lung cancer. The utility of ROSE during EBUS-TBNA for lymph node staging and the mode of surgical resection in lung cancer has also been demonstrated in relevant studies^15,16. This is mainly due to the stable and rapid diagnostic pattern of ROSE and the small demand for sample size. The occurrence of early cancer is often accompanied by the phenomenon of adjacent lymph adenopathy¹⁷, and the clinical value of ROSE is to take full advantage of its less sampling and fast diagnosis to achieve rapid identification of abnormal cells in lymph nodes. ROSE enables rapid and accurate interpretation of cancerous tissues and surrounding cancerous tissues, and then instructs clinicians to adjust the direction of puncture, which can to some extent reduce intraoperative trauma and facilitate the detection of diseased tissues and the choice of surgical methods.

Although the clinical utility of ROSE has been reported in many literatures, it is still controversial whether can be popularized in clinical practice. Some argue that ROSE does not benefit to improving the diagnostic yield and is limited in its clinical application value due to the complexity of its procedures^18,19. Our study mainly showed that the application of ROSE did not increase the risk of complications;instead, it significantly reduced the frequency of punctures, eliminate unnecessary surgical trauma and bring more benefits to patients compared with the non-ROSE group. The good agreement between the ROSE diagnosis and the final pathological results is also well demonstrated, laying the theoretical basis for the clinical application of ROSE.

The application value of the ROSE method has been demonstrated in our study. Similarly, Baram et al²⁰ reported that they reduced the frequency of biopsy during bronchoscopies in ROSE group vs. non-ROSE group. Several studies have demonstrated that the application of ROSE during surgery can not only improve the diagnostic rate but also effectively prevent angle inappropriate puncture procedures or unnecessary duplication of the sampling process^21–23. Trisolini et al²² collected 168 patients with lymph adenopathy who underwent TBNA surgery combined with ROSE or without ROSE and found no significant difference in the diagnostic yield between the two groups, but the number of biopsies and the incidence of complications were reduced significantly in ROSE group. Our study demonstrated a high level of agreement between ROSE manipulation and pathological diagnosis, which further weakens the question about the diagnostic value and popularity of ROSE in the current clinical treatment. Another difference between our study and other related reports is that we received different specimen types such as grinding glass focus, nodules, masses, cavities and inflammatory lesions, while the vast majority of specimens previously reported in the literature were pulmonary nodules.

There are still some shortcomings in our study. First, the study was conducted in a single center, which may affect the universality of the conclusion. In addition, this is a retrospective study, which may bring about bias in data collection and reliability of the results. Finally, the number of cases included in this study is relatively small.

In conclusion, combined use of ROSE and EBUS-TBNA is expected to upgrade the level of interventional bronchoscopy to a new profile, and help to further meet the patients' needs for high-quality and accurately targeted medical services and to promote the development of medical undertakings around the world.

ROSE

Rapid On-site Cytologic Evaluation

EBUS-TBNA

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Computerized Tomography

PPV

Positive Predictive Value

NPV

Negative Predictive Value.

Ethics approval and consent to participate

All experiments performed in this study are in accordance with the approved ethical standards by the ethics committee of Shanghai Tenth People’s Hospital affiliated to Tongji University (No. SHSY-IEC-4.1/20–21/01). As this is a retrospective study, the consent was waived by the ethics committee of the said hospital (No. SHSY-IEC-4.1/20-21/01).

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Please contact Shuanshuan Xie, Email: [email protected].

Competing interests

The authors declare that they have no competing interests.

Funding

None.

Authors’ contributions

Conception and design: L.L., H.X.D., S.S.X., and C.H.W. Acquisition, statistical analysis or interpretation of the data: all authors. Drafting of the manuscript: L.L., H.X.D., S.S.X., and C.H.W. All authors reviewed and approved the final version of the manuscript.

Acknowledgements

We would like to thank all the patients who donated their biological samples.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

1 Bade, B. C. & Dela Cruz, C. S. Lung Cancer 2020: Epidemiology, Etiology, and Prevention. Clin Chest Med41, doi:10.1016/j.ccm.2019.10.001 (2020).

2 Groitl, H. The flexible bronchofiberscope in the intensive care unit (ICU)--the optimal postoperative care for the bronchial system. Endoscopy13, 100-103 (1981).

3 Mehta, A. C., Hood, K. L., Schwarz, Y. & Solomon, S. B. The Evolutional History of Electromagnetic Navigation Bronchoscopy: State of the Art. Chest154, 935-947, doi:10.1016/j.chest.2018.04.029 (2018).

4 Dei Poli, G., Andolfi, F. & Baggi, G. [Comparative evaluation of fibrobronchoscopy and bronchoscopy in pulmonary diagnosis]. Minerva Med65, 3881-3887 (1974).

5 Gupta, D. et al. Endobronchial ultrasound-guided transbronchial needle aspiration vs conventional transbronchial needle aspiration in the diagnosis of sarcoidosis. Chest146, 547-556, doi:10.1378/chest.13-2339 (2014).

6 Griffin, A. C., Schwartz, L. E. & Baloch, Z. W. Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens. Cytojournal8, 20, doi:10.4103/1742-6413.90081 (2011).

7 Oki, M. et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration85, 486-492, doi:10.1159/000346987 (2013).

8 Yuan, M. et al. Efficacy of rapid on-site cytological evaluation (ROSE) by a pulmonologist in determining specimen adequacy and diagnostic accuracy in interventional diagnosis of lung lesions. J Int Med Res49, 300060520982687, doi:10.1177/0300060520982687 (2021).

9 Nakajima, T. et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg95, 1695-1699, doi:10.1016/j.athoracsur.2012.09.074 (2013).

10 Davenport, R. D. Rapid on-site evaluation of transbronchial aspirates. Chest98, 59-61 (1990).

11 Diette, G. B. et al. Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy. Chest117, 1186-1190 (2000).

12 Mondoni, M. et al. Rapid on-site evaluation improves needle aspiration sensitivity in the diagnosis of central lung cancers: a randomized trial. Respiration86, 52-58, doi:10.1159/000346998 (2013).

13 Lin, C.-K. et al. Rapid on-site cytologic evaluation by pulmonologist improved diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy. J Formos Med Assoc119, 1684-1692, doi:10.1016/j.jfma.2020.01.001 (2020).

14 Guo, H. et al. Rapid on-site evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of hilar and mediastinal lymphadenopathy in patients with lung cancer. Cancer Lett371, 182-186, doi:10.1016/j.canlet.2015.11.038 (2016).

15 Wada, H. et al. Lymph node staging by endobronchial ultrasound-guided transbronchial needle aspiration in patients with small cell lung cancer. Ann Thorac Surg90, 229-234, doi:10.1016/j.athoracsur.2010.03.106 (2010).

16 Chen, X. et al. Efficacy of rapid on-site evaluation for diagnosing pulmonary lesions and mediastinal lymph nodes: a systematic review and meta-analysis. Transl Lung Cancer Res8, 1029-1044, doi:10.21037/tlcr.2019.12.13 (2019).

17 Kim, E. S. & Bosquée, L. The importance of accurate lymph node staging in early and locally advanced non-small cell lung cancer: an update on available techniques. J Thorac Oncol2 Suppl 2, S59-S67 (2007).

18 Yarmus, L. et al. A randomized prospective trial of the utility of rapid on-site evaluation of transbronchial needle aspirate specimens. J Bronchology Interv Pulmonol18, 121-127, doi:10.1097/LBR.0b013e31821707ee (2011).

19 Gu, P. et al. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. Eur J Cancer45, 1389-1396, doi:10.1016/j.ejca.2008.11.043 (2009).

20 Baram, D., Garcia, R. B. & Richman, P. S. Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration. Chest128, 869-875 (2005).

21 Shikano, K. et al. Feasibility and accuracy of rapid on-site evaluation of touch imprint cytology during transbronchial biopsy. J Thorac Dis12, 3057-3064, doi:10.21037/jtd-20-671 (2020).

22 Trisolini, R. et al. Rapid on-site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy: a randomized trial. Chest139, 395-401, doi:10.1378/chest.10-1521 (2011).

23 Medford, A. R. L. Rapid on-site evaluation of transbronchial aspirates in mediastinal adenopathy diagnosis. Chest140, 559-560, doi:10.1378/chest.11-0508 (2011).

No competing interests reported.

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Value of Transbronchial Needle Aspiration Combined with Rapid on-Site Evaluation of Cytology in Diagnosis of Peripheral Pulmonary Lesions

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Abstract

Figures

Introduction

Patients And Methods

Patients

Procedures

Specimen Processing

Diagnosis

Statistical analysis

Results

Baseline characteristics of the patients

Characteristics Of Lesions

Distribution Of The Malignant And Benign Lesions

Complications

Accuracy Of Diagnosis

Morphological Characteristics Of Different Types Of Lung Cancer Cells

Discussion

Abbreviations

Declarations

References

Additional Declarations

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