Comparison of the Diagnostic Yield of Cytology and Concurrent Surgical Pathology Specimens by Novel Electromagnetic Navigation Bronchoscopy

Introduction: Rapid on-site evaluation of specimen adequacy is used at many institutions to enhance diagnostic yield. Cytology personnel began routinely performing ROSE at our institution in 2010. The aim of this study is to determine the effect of ROSE on diagnostic yield at our institution. Materials and Methods: Two 4 month time periods in which the majority of bronchoscopic cytology samples were obtained either with or without ROSE were selected. All bronchoscopic procedures were included whether or not real time image guidance was used. Image-guided modalities including fluoroscopy, endobronchial ultrasound-guided FNA (EBUS) and electromagnetic navigation bronchoscopy (ENB) were used during both periods. The pre-ROSE time period was 1/1/09-4/30/09 and the postROSE time period was 1/1/12 4/30/12. The following data were collected: final diagnosis, number of non-diagnostic samples, number of slides per case, use of ancillary testing and number of patients requiring additional procedures. Unsatisfactory/non-diagnostic samples and all atypical categories were considered non-diagnostic. All procedures after the initial procedure were considered additional until a conclusive diagnosis was rendered. Pearson’s Chi-squared test with Yates’ continuity correction was used to determine statistical significances. Results: A total of 151 procedures were performed pre-ROSE and 246 procedures post-ROSE. Specific diagnostic categories and use of ancillary testing are summarized in Table 1. Comparison of diagnostic and non-diagnostic cases and additional diagnostic procedures performed are summarized in Table 2. Conclusions: There were significantly fewer non-diagnostic bronchoscopic samples in the post-ROSE period. Use of ancillary studies increased significantly in the post-ROSE period with more malignancies given a specific cell type. The number of additional procedures performed for definitive diagnosis decreased in the post-ROSE time period. Correlation of impact of ROSE on specific imaging modalities used in bronchoscopy is warranted