A randomized controlled trial comparing the diagnostic yield of using Rapid On-Site Cytology Evaluation (ROSE) and without using ROSE in Radial Probe Endobronchial Ultrasound (R-EBUS) guided sheath transbronchial lung biopsy with bronchial brushing in peripheral pulmonary lesions

Abstract

BACKGROUND: Radial Probe Endobronchial Ultrasonography (RP-EBUS) guided transbronchial biopsy with bronchial brushing is an effective way of tissue assessment for evaluating peripheral lung lesion combined with Rapid on-site Evaluation (ROSE). Our study aimed to evaluate the efficacy of ROSE add on RP-EBUS guided sheath transbronchial lung biopsy to improve the overall diagnostic yield.

OBJECTIVES: The purpose of this study was to compare the diagnosis yield of peripheral lung lesions or nodules from the ROSE add on Radial Probe Endobronchial Ultrasonography (RP-EBUS) guided sheath transbronchial biopsy with bronchial brushing compared to the control group.

METHODS: In this prospective randomized controlled trial study. All patients age > 18 years old who diagnosed with peripheral lung lesions size < 3 cm. from chest computed tomography are randomized into 2 subgroups underwent RP-EBUS guided sheath transbronchial lung biopsy with bronchial brushing with and without using ROSE. The diagnostic yield was compared.

RESULTS : 68 patients were enrolled. 34 patients were randomized equally to ROSE group and control group. The diagnostic yield was similar in both groups without statistically significant. There was no significant differences in baseline characteristic. There was a trend toward reduce the procedure durations and amount of sedatives used in the ROSE group with statistically significance difference (P=0.015 and P<0.001 respectively). Complications rates in both groups are not different.

CONCLUSION: The diagnostic yield of peripheral lung lesions was similar in ROSE add on RP-EBUS and RP-EBUS alone. However routine use of ROSE in RP-EBUS guided sheath transbronchial biopsy with bronchial brushing associated with a reducing in procedure times and decreased amount of sedative use. We recommended ROSE add on RP-EBUS in selected cases. Our study could be applicable only in experienced center which available intervention pulmonologists and cytologists.