Concordance between rapid on-site evaluation (ROSE) and final diagnosis in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging

Introduction: In patients with non-small cell lung cancer (NSCLC) undergoing mediastinal staging through endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) clinical decision making is based in rapid on-site evaluation (ROSE) findings. We aimed to analyze the accuracy of ROSE determining the rate of concordance between ROSE and final diagnosis. Material and Methods: Prospective study that included patients undergoing EBUS-TBNA for NSCLC staging. Results of ROSE were compared with final diagnosis. Results: Sixty-four patients were included and 637 lymph nodes (LN) were sampled: a median of 10 (IQR 8-12) LNs and a median of 5 (IQR: 4-6) nodal stations per patient were sampled. The diagnoses of ROSE were concordant with the final diagnoses in 612 (96.1%) cases and non-concordant in 25 (3.9%). There were 7 (1.2%) LNs in which the diagnosis of ROSE was non-malignant with a final diagnosis of malignancy. On the contrary, there was a single case (0.2%) in which the diagnosis of ROSE was malignant with the final diagnosis being normal LN. Considering final diagnosis as the gold standard, the sensitivity, specificity and overall accuracy of ROSE were 98.6, 97.2 and 98.5% respectively. Conclusion: The preliminary diagnoses (ROSE) are concordant with the final diagnoses in a high percentage. Consequently, clinical decisions based on the ROSE can be taken with confidence.