C110-08 Rapid On-site Evaluation for Peripheral Nodule Diagnostics in Robotic-assisted Bronchoscopy

Abstract Rationale Robotic-assisted bronchoscopy (RaB) improves access to peripheral pulmonary lesions (PPL), but diagnostic yield and accuracy for malignancy remain under-reported. Rapid On-Site Evaluation (ROSE) is a cytopathologic assessment that provides proceduralists with real-time feedback on specimen quality during biopsy procedures. The primary goal of this project is to evaluate the concordance between ROSE findings and the final tissue diagnosis. Methods We conducted a multi-center, mixed retrospective and prospective observational study across three hospitals. Patients were included if they underwent RaB biopsy for PPLs measuring 5-60 mm between May 2020 and August 2025 with ROSE evaluation. ROSE was conducted by experienced cytopathology technicians or cytopathology fellows. Feedback from the ROSE procedure, including identification of malignancy, lymphoid tissue, or granuloma, was recorded and compared to the final diagnosis. The primary outcome was the incidence agreement between ROSE and final diagnosis. Diagnostic yield was calculated per recent consensus guidelines.1 Results 131 patients met inclusion criteria, with 117 having final data collection completed. The final diagnostic yield was 63.2% (74/117) with 73.0% (54/74) of those diagnoses being malignant, 16.2% (12/74) were granuloma, 6.8% (5/74) were organizing pneumonia, and 4.1% (3/74) were infectious. ROSE provided feedback of diagnostic material in 74.3% (55/74) of cases. The diagnoses of ROSE sufficient cases are as follows: Malignancy 85.5% (47/55); Granuloma 3.6% (2/55), Other 10.9% (6/55). The other diagnoses were lymph tissue, infection and necrosis. ROSE detected 87.0% of malignancies in this cohort (47/54) and 35.0% (7/20) of benign disease (Figure 1). Conclusions Rapid On-Site Evaluation (ROSE) alongside RaB demonstrates high sensitivity for detecting malignant lesions (87.0%) but shows limited sensitivity for evaluating benign disease (35.0%). Although its ability to identify benign disease remains limited, ROSE’s strong performance in detecting malignancy can expedite oncologic diagnosis and management in clinical practice. 1. Gonzalez AV, et al. Assessment of advanced diagnostic bronchoscopy outcomes for peripheral lung lesions: A Delphi consensus definition of diagnostic yield and recommendations for patient-centered study designs. An official American Thoracic Society/American College of Chest Physicians research statement. Am J Respir Crit Care Med. 2024;209(6):634-646. This abstract is funded by: None