Accuracy of Rapid On-Site Evaluation in Robotic-Assisted Bronchoscopy Fine Needle Aspirations of Lung Nodules

Shape-sensing robotic-assisted bronchoscopy (ssRAB) is an emerging technique for sampling lung nodules. When evaluating the value of pairing ssRAB with rapid on-site evaluation (ROSE), other studies have only looked at diagnostic yield. This study aims to assess the diagnostic concordance of ROSE and histopathologic biopsies in ssRAB sampling.

We analyzed lung nodules sampled by ssRAB fine needle aspiration (FNA) and had ROSE. The following parameters were recorded: preliminary and final cytology diagnoses, concurrent histopathology biopsy diagnosis, tool type, number of passes for ROSE, lesion size, and location. A χ2 test was performed for categorical variables, and one-way analysis of variance was used to compare means for continuous variables. A P-value <0.05 was considered statistically significant.

A total of 249 FNA cytology specimens from 234 patients were obtained, with 202 concurrent histopathologic biopsies. The lesion size, location, and proceduralist experience did not affect cytology diagnosis; however, the diagnostic yield improved with increasing lesion size. Diagnostic yield plateaued after 3 passes (P=0.01). Forceps biopsies had a lower diagnostic yield (74%) than cryoprobe biopsies (87%), and forceps were more likely to yield a nondiagnostic sample than cryobiopsies (P=0.04). A positive ROSE preliminary diagnosis for malignancy correlated highly with a positive histopathology biopsy (86% correlation).

A positive result for malignancy on ROSE correlated highly with a positive histopathology biopsy. Three fine needle passes were sufficient for diagnostic results, with a plateau in subsequent biopsies. Histopathologic tissue diagnosis was superior with the cryoprobe than with tissue obtained using conventional forceps.