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Impact of rapid on-site cytological evaluation (ROSE) on the diagnostic yield of transbronchial needle aspiration during mediastinal lymph node sampling: systematic review and meta-analysis.

Research paper by Inderpaul Singh IS Sehgal, Sahajal S Dhooria, Ashutosh Nath AN Aggarwal, Ritesh R Agarwal

Indexed on: 21 Nov '17Published on: 21 Nov '17Published in: CHEST®



Abstract

Whether the use of rapid onsite cytological evaluation (ROSE) increases the diagnostic yield of transbronchial needle aspiration (TBNA) remains unclear. Herein, we perform a systematic review of studies describing the utility of ROSE in subjects undergoing TBNA.Systematic review of PubMed, EmBase and Scopus databases for RCTs investigating the diagnostic yield of conventional TBNA (c-TBNA) or endobronchial ultrasound (EBUS)-TBNA, with or without ROSE, in subjects with mediastinal lymphadenopathy.Five (618 subjects; two EBUS-TBNA, two c-TBNA, one both) studies were identified. Overall, the studies were of good quality. The pooled risk difference (95% CI) of the diagnostic yield of EBUS-TBNA and c-TBNA was 0.04 (-0.01, 0.09) and 0.12 (-0.08, 0.33), respectively suggesting no added benefit with ROSE. The use of ROSE during EBUS-TBNA (but not c-TBNA) resulted in a significantly lesser number of needle passes (mean difference, [95% CI], -1.1 [-2.2, -0.005; p<0.001]). There was no difference in the procedure time during EBUS-TBNA. The complication rate was significantly lower (OR [95% CI], 0.26 [0.10, 0.71], p=0.009]), when ROSE was used during c-TBNA, due to fewer additional procedures required to make a diagnosis. There was evidence of heterogeneity in the studies involving c-TBNA but not EBUS-TBNA. There was no publication bias.The use of ROSE neither improved the diagnostic yield nor reduced the procedure time during TBNA. However, the use of ROSE was associated with lesser number of needle passes during EBUS-TBNA, and overall fewer requirement of additional bronchoscopy procedures during TBNA to make a final diagnosis.