Sample adequacy in bronchoscopic ROSE: comparison between laboratory specialist and pathologist

Area of Science:

• Pulmonology
• Cytopathology
• Clinical Biochemistry

Background:

• Rapid on-site evaluation (ROSE) during bronchoscopy is crucial for assessing sample adequacy and enabling timely diagnosis.
• Traditionally, cytopathologists perform ROSE, but this is not always feasible due to resource constraints.
• This study explores the role of a clinical biochemist in performing ROSE at a university institution.

Purpose of the Study:

• To compare the effectiveness of ROSE evaluations conducted by a laboratory specialist (clinical biochemist) versus a cytopathologist.
• To assess the agreement and diagnostic performance of ROSE smears evaluated by both professionals.
• To determine if a laboratory specialist can serve as a viable alternative for ROSE.

Main Methods:

• Retrospective analysis of 78 lymph node samples obtained via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transbronchial needle aspiration (TBNA).
• Smears were evaluated for adequacy by a clinical biochemist (laboratory specialist) and a pathologist team simultaneously.
• Agreement was measured using Cohen's kappa and Gwet's AC1 statistics.

Main Results:

• A high agreement rate of 92.3% was observed between the laboratory specialist and the pathologist team.
• Cohen's kappa value was 0.71 (strong agreement) and Gwet's AC1 was 0.90 (almost perfect agreement).
• Both methods demonstrated excellent diagnostic performance.

Conclusions:

• Rapid on-site evaluation performed by a laboratory specialist is a suitable and reliable alternative to evaluation by a cytopathologist.
• This approach can help alleviate shortages of interventional pulmonologists and cytopathologists.
• Utilizing clinical biochemists for ROSE can improve the efficiency and accessibility of diagnostic procedures during bronchoscopy.