Clinical utility of rapid on-site evaluation of brush cytology during bronchoscopy using endobronchial ultrasound with a guide sheath

Abstract Previous studies have shown that rapid on-site evaluation (ROSE) improves the diagnostic yield of bronchoscopy using endobronchial ultrasonography with guided sheath (EBUS-GS) for peripheral pulmonary lesions (PPL). There are many reports on the ROSE of imprint cytology of forceps biopsy; however, there are few reports on the ROSE of brush cytology. We investigated the utility of ROSE in brushing PPL specimens during bronchoscopy. We retrospectively analyzed 214 patients who underwent bronchoscopy with EBUS-GS for PPL. Sensitivity to bronchoscopy was significantly higher in the ROSE group than in the non-ROSE group (96.8% vs. 83.3%, P = 0.002), wherein the sensitivity to brushing also significantly improved (92.9% vs. 75.0%, P < 0.001). Conversion of ROSE results from negative to positive was observed in 79.5% of first-time ROSE-negative cases. We also found that brush specimens containing high tumor cell counts increase with repeated ROSE (42.1–69.0%). This study suggests that ROSE of brush cytology improves bronchoscopy sensitivity and increases the collected tumor cell counts.