The use of ROSE does not improve diagnostic yield in TBNA

Having rapid onsite cytological evaluation (ROSE) present on endobronchial ultrasound (EBUS) or conventional transbronchial needle aspiration (TBNA) should, in theory, reduce the number of needle passes required for diagnosis, procedure time and complication rates. In some smaller studies, ROSE has been shown to increase diagnostic yield. However, the cost of ROSE has limited its clinical use.

The systematic review by Sehgal et al (Chest. doi:10.1016/j.chest.2017.11.004) looked at five good-quality but heterogeneous randomised control trials examining ROSE in EBUS-TBNA and conventional TBNA to ascertain the effect of ROSE on procedure time and quality. The studies were looking at TBNA in suspected cancer, sarcoidosis and lymphadenopathy of unknown cause. While overall diagnostic yield, complication rate and procedure time were unaffected, there was a reduction in the need for additional procedures when ROSE was added to TBNA. However, this only translated to a reduction in complications in conventional TBNA but not EBUS-TBNA. The lack of a clear diagnostic benefit argues against the blanket use of …