Introduction EBUS guided trans-bronchial needle aspiration with ROSE ensures adequacy of specimen samples and provides preliminary cytological diagnosis. Few studies have explored the utility of ROSE in granulomatous mediastinal lymphadenopathy. This retrospective study looks to further assess the validity of ROSE in the setting of non-malignant granulomatous disease.

Methods We reviewed a prospectively maintained database of ROSE and laboratory cytology Results for all EBUS procedures performed during a 12 month period from 1 st January to 31 st December 2015 at our institute. We included all patients who had granuloma (including probable or possible granuloma) identified at ROSE or final cytology analysis, or both. We then reviewed clinico-radiological data to ascertain the final diagnosis and excluded those patients with malignant disease.

Results During the study period, 366 EBUS were performed, with granuloma identified in 51 patients. Three patients were found to have malignancy and were excluded therefore 48 were included in the final analysis. The final diagnoses for the 48 patients are shown in Table 1. Patients with TB were more likely to have at least one granuloma at ROSE (84%) than patients with sarcoidosis (67%). Patients with granuloma identified at ROSE had a slightly lower number of nodes sampled per patient compared to those with no granuloma at ROSE (mean 1.8 vs 2.4 nodes per patient). The positive predictive value of ROSE for granuloma in our cohort was 100%, with a sensitivity of 71%. This is comparable to other studies.

Conclusions In our cohort of patients, ROSE had a high positive predictive value and a sensitivity of over 70% for the diagnosis of granuloma in non-malignant disease. Our Results suggest that with the use of ROSE fewer nodes are sampled which may reduce procedure time and potential complications. This study is limited due to the small sample size but supports the use of ROSE in this context. We plan to carry out further work with larger data sets, and to look at the characteristics of those subsequently diagnosed with sarcoidosis or tuberculosis.