Diagnostic accuracy of rapid on-site evaluation (ROSE) during robotic bronchoscopy

Robotic bronchoscopy (RB) is increasingly used to sample peripheral pulmonary lesions due to its high diagnostic yield and low complication rate. Rapid on-site evaluation (ROSE) is often performed intra-procedurally to provide the proceduralist with qualitative and quantitative feedback on specimen quality. ROSE can be performed on fine needle aspiration (FNA) cytology specimens or via touch imprint cytology (TIC) of pathology specimens. Data about the utility of ROSE in RB is sparse. This study aimed to assess the concordance between ROSE and final cytology and pathology results.

We retrospectively reviewed all RB cases performed at the Anschutz Medical Campus of the University of Colorado from May 2021 to December 2024.

A total of 156 patients were included in the study. Of these 137 also had ROSE performed and were therefore included in the concordance assessment. The concordance between FNA-ROSE and final cytology was 83%, while the concordance between TIC-ROSE and final pathology was 81%. Overall concordance between ROSE and final cytology and pathology results was 88%, and the Pearson χ²-value was 174 (P<0.001). The concordance between linear EBUS-ROSE and final lymph node cytology was 80.1%. The overall diagnostic yield for RB in our study was 75%.

In our cohort of RB cases, FNA-ROSE and TIC-ROSE demonstrated high concordance with the final cytology and pathology results, respectively. ROSE can enable the proceduralist to make important intra-procedural decisions about the number of lesions that need sampling and the tools and techniques to use.