Adequacy Criteria of Rapid On-Site Evaluation for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Simple Algorithm to Assess the Adequacy.

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Adequacy Criteria of Rapid On-Site Evaluation for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Simple Algorithm to Assess the Adequacy of ROSE Sun Mi Choi, MD, Ae-Ra Lee, MD, Ji-Young Choe, MD, Soo Jeong Nam, MD, PhD, Doo Hyun Chung, MD, PhD, Jinwoo Lee, MD, Chang-Hoon Lee, MD, PhD, Sang-Min Lee, MD, PhD, Jae-Joon Yim, MD, PhD, Chul-Gyu Yoo, MD, PhD, Young Whan Kim, MD, PhD, Sung Koo Han, Young Sik Park, MD The Annals of Thoracic Surgery Volume 101, Issue 2, Pages 444-450 (February 2016) DOI: 10.1016/j.athoracsur.2015.06.086 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Tissue Preparation of Specimens Procured by EBUS-TBNA. The entire aspirate was expelled on a glass slide, and the tissue core was separated from the aspirate. The tissue core was processed for histologic evaluation, and the remaining aspirate was smeared for rapid on-site evaluation (ROSE) and cytologic evaluation. The cytologic and histologic specimens were evaluated routinely, and ROSE slides were evaluated independently by two pathologists. (EBUS-TBNA = endobronchial ultrasound-guided transbronchial needle aspiration; H & E = hematoxylin and eosin.) The Annals of Thoracic Surgery 2016 101, 444-450DOI: (10.1016/j.athoracsur.2015.06.086) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Representative Microscopic Grading Using ROSE. Microscopic anthracotic pigments (scattered [A], conglomerated [B]), malignant cells (background lymphocytes [C], tumor cells only [D]), and mean lymphocyte density per 10 fields at 40× (<40 cells [E], 40–200 [F], >200 [G]). (ROSE = rapid on-site evaluation.) The Annals of Thoracic Surgery 2016 101, 444-450DOI: (10.1016/j.athoracsur.2015.06.086) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Proposed Algorithm to Evaluate the Adequacy of ROSE. A sequential approach comprising four criteria (core size ≥ 2 cm, presence of malignant cells, presence of microscopic anthracotic pigments [MAP], and mean lymphocyte density [LD] ≥ 40 cells/10 fields at 40×) resulted in a high diagnostic accuracy of 97% for rapid on-site evaluation (ROSE). The Annals of Thoracic Surgery 2016 101, 444-450DOI: (10.1016/j.athoracsur.2015.06.086) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions