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Assessing ROSE for adequacy of EBUS-TBNA compared with a direct-to-cell block approach as a response to the COVID-19
Xing Zhao1, Paul Boothe2, Syeda Mahrukh Hussnain Naqvi3
1Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
Insights
Discontinuing rapid on-site evaluation (ROSE) during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) due to COVID-19 did not negatively impact cytopathology quality. The direct-to-cell block approach proved acceptable for maintaining cancer patient care during the pandemic.
Area of Science:
- Pulmonology
- Cytopathology
- Oncology
Background:
- Rapid on-site evaluation (ROSE) is standard practice for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
- The COVID-19 pandemic necessitated the discontinuation of ROSE at our institution, shifting to a direct-to-cell block approach.
- This change prompted an investigation into its effects on cytopathology quality.
Purpose of the Study:
- To evaluate the impact of discontinuing ROSE on the cytopathology quality of EBUS-TBNA procedures.
- To determine if the direct-to-cell block method is a viable alternative to ROSE during the pandemic.
Main Methods:
- Analysis of 1903 EBUS-TBNA cases from 734 patients, comparing those with ROSE (1097 cases) to those without ROSE using a direct-to-cell block approach (806 cases).
- Clinical and cytology data were statistically analyzed using SAS software (version 9.4).
- Key metrics included specimen adequacy, diagnostic yield for malignancy, and other conditions.
Main Results:
- Biopsy adequacy was slightly lower in the ROSE group (0.936 times less likely to be satisfactory), but this difference was not statistically significant (P = 0.785).
- The inadequacy rate for EBUS-TBNA was marginally higher with ROSE, though also not statistically significant.
- Proportions of biopsies diagnostic for malignancy and other conditions showed significant differences between the ROSE and no-ROSE groups (P = 0.036 and P = 0.012, respectively).
Conclusions:
- Discontinuing ROSE and adopting a direct-to-cell block approach did not compromise cytopathology quality.
- This modified practice is acceptable, particularly during the COVID-19 pandemic, addressing challenges like social distancing and staff shortages.
- The findings support the continued use of the direct-to-cell block method when ROSE is not feasible, ensuring uninterrupted cancer patient care.
Introduction:
Rapid on-site evaluation (ROSE) has been used during the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedure as standard practice. Because of the COVID-19 (coronavirus disease 2019) pandemic, our institute had had to discontinue ROSE and adopt a direct-to-cell block approach. In the present study, we aimed to determine whether this change has had significant effects on the cytopathology quality.
Materials And Methods:
A total of 1903 EBUS-TBNA cases from 734 patients were collected (1097 cases with ROSE for 452 patients; 806 cases without ROSE but with direct-to-cell block for 282 patients). The clinical and cytology data were analyzed using SAS, version 9.4, software to render calculated standardized residuals and a fitted multivariate generalized linear model.
Results:
On average, a biopsy from a patient with ROSE was 0.936 (=exp -0.066) times less likely to be reported as satisfactory compared with a biopsy from a patient without ROSE, although the difference was not statistically significant (P = 0.785). The inadequacy rate of EBUS-TBNA was 6.4% higher on average for cases with ROSE compared with a direct-to-cell block approach. However, this difference was also not statistically significant. The proportions of biopsies reported as diagnostic for malignancy and other were significantly different between the ROSE and no-ROSE groups with a standardized residual of 1.80 (P = 0.036) and -2.27 (P = 0.012), respectively.
Conclusions:
Discontinuing ROSE and using a direct-to-cell block approach had no negative effects on cytopathology quality. This practice can be considered acceptable during the COVID-19 pandemic when social distancing and the shortage of staff and supplies have resulted in challenges to delivering quality care to cancer patients whose treatment cannot be postponed.
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