The impact of rapid on site evaluation of cytological specimens on a new endobronchial ultrasound (EBUS) service

Background: Mediastinal lymph node sampling using endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) has a proven role in the staging and diagnosis of lung cancer. It may also have a role in the diagnosis of benign diseases (e.g sarcoidosis). For many experienced bronchoscopists EBUS TBNA is a new technique with a steep learning curve. We introduced an EBUS service at our institution in January 2010. Whenever possible we undertook the procedure with a consultant cytopathologist which allowed rapid on site evaluation (ROSE) of specimens and real time feedback on specimen quality. Aims: To assess the impact of ROSE in a newly established EBUS service. Methods: We reviewed the impact of ROSE on the procedure duration, amount of lidocaine local anaesthetic (LLA), amount of intravenous sedation (midazolam and alfentanyl) and the diagnostic procedure rate in our first 30 EBUS cases. Results: ROSE of cytological specimens was available for 22 (73.3%) of our first 30 cases. The availability of ROSE resulted in a significantly shorter procedure time (39.7 (SD ± 3.8) minutes Vs 57.3 (± 4.4) minutes, p = 0.01), and significantly lower amounts of sedation with midazolam (5.8 (± 2.2) mg Vs 9.0 (± 2.4) mg, p=0.002) and alfentanyl (522.7 (± 187.5) μg Vs 781.3 (± 311.6) μg, p=0.01). There was no difference in the amount of LLA or in the percentage of cases in which diagnostic material was obtained (82.8% with ROSE and 87.5% without ROSE). Conclusions: ROSE of TBNA samples results in a significant reduction in length of procedure and the amount of sedation required for EBUS. The provision of ROSE is an important consideration in the development of an EBUS service.