The value of rapid on-site evaluation during conventional and endobronchial ultrasound needle aspiration in the diagnosis of mediastinal lymphadenopathy and lung cancer

The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has revolutionized pulmonology by identifying cancer spread in lung cancer patients. It is now used for diagnosing sarcoidosis, tuberculosis, and lymphoma. Rapid onsite evaluation (ROSE) is a crucial tool for pathologists, assisting in sample adequacy, accuracy, and prompt decision-making. This study aimed to evaluate the efficacy of ROSE in identifying mediastinal lymphadenopathy and lung cancer during EBUS-TBNA and cTBNA. Our research was a prospective study in which we examined sixty cases that were separated into two groups of similar size. The rapid onsite evaluation group and the non-rapid onsite evaluation group were subjected to either Conventional TBNA or endobronchial ultrasound-guided transbronchial needle aspiration. The total diagnostic yield of conventional and endobronchial ultrasound-guided transbronchial needle aspiration in both groups was 83.3% (50/60 cases). Twenty-eight cases (46.7%) were positive for malignancy, 22 cases (36.6%) were positive for benign lesions, and 10 cases (16.6%) were not conclusive. Regarding diagnostic accuracy, it was greater in the rapid onsite evaluation group than in the non-rapid onsite evaluation group (100% in the rapid onsite evaluation group vs. 66.7% in the non-ROSE group). Rapid onsite evaluation during conventional or endobronchial ultrasound-guided transbronchial needle aspiration improves diagnostic accuracy of mediastinal lesions by excluding suspicious or nondiagnostic specimens and can reduce unnecessary punctures or eliminate the need for additional bronchoscopy procedures when reaching preliminary diagnosis.