The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: A prospective study

Martina Bonifazi, Michele Sediari, Maurizio Ferretti, Grazia Poidomani, Irene Tramacere, Federico Mei, Lina Zuccatosta, Stefano Gasparini

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Abstract

Background: Rapid on-site cytologic evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions. ROSE is not a widespread technique, however, because of a lack of time and resources. Our aim was to verify whether, in comparison with a board-certified cytopathologist, a pulmonologist could evaluate the adequacy of transbronchial needle aspiration (TBNA) specimens on-site to diagnose hilar/mediastinal adenopathies/masses after receiving training in cytopathology. Our secondary aim was to assess and compare the accuracy of ROSE as performed by both physicians. Methods: A pulmonologist and a cytopathologist, the latter deemed the gold standard, performed ROSE and classified specimens into five diagnostic categories. Agreement between clinicians was assessed through κ statistics. The accuracy of ROSE was established according to definitive cytologic assessment. Results: A total of 362 TBNAs were performed on 84 patients affected by hilar/mediastinal lymphadenopathies. There was an 81% overall substantial agreement between observers (κ, 0.73; 95% CI, 0.61-0.86; P, 0.001), which became excellent in cases of malignant disease (κ, 0.81; 95% CI, 0.70-0.90; P, 0.001). The accuracy of ROSE performed by the pulmonologist (80%; 95% CI, 77-90) was not statistically different from that provided by the cytopathologist (92%; 95% CI, 85-94). Conclusions: Our study provides the first evidence, to our knowledge, that a trained pulmonologist can assess the adequacy of cytologic smears on-site. Training pulmonologists to have a basic knowledge of cytopathology could obviate most difficulties related to the involvement of cytopathologists in routine diagnostic activities and may reduce the costs of the procedure.

Original languageEnglish
Pages (from-to)60-65
Number of pages6
JournalChest
Volume145
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Needles
Prospective Studies
Pulmonologists
Physicians
Costs and Cost Analysis
Lung
Lymphadenopathy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Bonifazi, M., Sediari, M., Ferretti, M., Poidomani, G., Tramacere, I., Mei, F., ... Gasparini, S. (2014). The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: A prospective study. Chest, 145(1), 60-65. https://doi.org/10.1378/chest.13-0756

The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration : A prospective study. / Bonifazi, Martina; Sediari, Michele; Ferretti, Maurizio; Poidomani, Grazia; Tramacere, Irene; Mei, Federico; Zuccatosta, Lina; Gasparini, Stefano.

In: Chest, Vol. 145, No. 1, 01.2014, p. 60-65.

Research output: Contribution to journalArticle

Bonifazi, M, Sediari, M, Ferretti, M, Poidomani, G, Tramacere, I, Mei, F, Zuccatosta, L & Gasparini, S 2014, 'The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: A prospective study', Chest, vol. 145, no. 1, pp. 60-65. https://doi.org/10.1378/chest.13-0756
Bonifazi, Martina ; Sediari, Michele ; Ferretti, Maurizio ; Poidomani, Grazia ; Tramacere, Irene ; Mei, Federico ; Zuccatosta, Lina ; Gasparini, Stefano. / The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration : A prospective study. In: Chest. 2014 ; Vol. 145, No. 1. pp. 60-65.
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abstract = "Background: Rapid on-site cytologic evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions. ROSE is not a widespread technique, however, because of a lack of time and resources. Our aim was to verify whether, in comparison with a board-certified cytopathologist, a pulmonologist could evaluate the adequacy of transbronchial needle aspiration (TBNA) specimens on-site to diagnose hilar/mediastinal adenopathies/masses after receiving training in cytopathology. Our secondary aim was to assess and compare the accuracy of ROSE as performed by both physicians. Methods: A pulmonologist and a cytopathologist, the latter deemed the gold standard, performed ROSE and classified specimens into five diagnostic categories. Agreement between clinicians was assessed through κ statistics. The accuracy of ROSE was established according to definitive cytologic assessment. Results: A total of 362 TBNAs were performed on 84 patients affected by hilar/mediastinal lymphadenopathies. There was an 81{\%} overall substantial agreement between observers (κ, 0.73; 95{\%} CI, 0.61-0.86; P, 0.001), which became excellent in cases of malignant disease (κ, 0.81; 95{\%} CI, 0.70-0.90; P, 0.001). The accuracy of ROSE performed by the pulmonologist (80{\%}; 95{\%} CI, 77-90) was not statistically different from that provided by the cytopathologist (92{\%}; 95{\%} CI, 85-94). Conclusions: Our study provides the first evidence, to our knowledge, that a trained pulmonologist can assess the adequacy of cytologic smears on-site. Training pulmonologists to have a basic knowledge of cytopathology could obviate most difficulties related to the involvement of cytopathologists in routine diagnostic activities and may reduce the costs of the procedure.",
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AU - Poidomani, Grazia

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AU - Mei, Federico

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N2 - Background: Rapid on-site cytologic evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions. ROSE is not a widespread technique, however, because of a lack of time and resources. Our aim was to verify whether, in comparison with a board-certified cytopathologist, a pulmonologist could evaluate the adequacy of transbronchial needle aspiration (TBNA) specimens on-site to diagnose hilar/mediastinal adenopathies/masses after receiving training in cytopathology. Our secondary aim was to assess and compare the accuracy of ROSE as performed by both physicians. Methods: A pulmonologist and a cytopathologist, the latter deemed the gold standard, performed ROSE and classified specimens into five diagnostic categories. Agreement between clinicians was assessed through κ statistics. The accuracy of ROSE was established according to definitive cytologic assessment. Results: A total of 362 TBNAs were performed on 84 patients affected by hilar/mediastinal lymphadenopathies. There was an 81% overall substantial agreement between observers (κ, 0.73; 95% CI, 0.61-0.86; P, 0.001), which became excellent in cases of malignant disease (κ, 0.81; 95% CI, 0.70-0.90; P, 0.001). The accuracy of ROSE performed by the pulmonologist (80%; 95% CI, 77-90) was not statistically different from that provided by the cytopathologist (92%; 95% CI, 85-94). Conclusions: Our study provides the first evidence, to our knowledge, that a trained pulmonologist can assess the adequacy of cytologic smears on-site. Training pulmonologists to have a basic knowledge of cytopathology could obviate most difficulties related to the involvement of cytopathologists in routine diagnostic activities and may reduce the costs of the procedure.

AB - Background: Rapid on-site cytologic evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions. ROSE is not a widespread technique, however, because of a lack of time and resources. Our aim was to verify whether, in comparison with a board-certified cytopathologist, a pulmonologist could evaluate the adequacy of transbronchial needle aspiration (TBNA) specimens on-site to diagnose hilar/mediastinal adenopathies/masses after receiving training in cytopathology. Our secondary aim was to assess and compare the accuracy of ROSE as performed by both physicians. Methods: A pulmonologist and a cytopathologist, the latter deemed the gold standard, performed ROSE and classified specimens into five diagnostic categories. Agreement between clinicians was assessed through κ statistics. The accuracy of ROSE was established according to definitive cytologic assessment. Results: A total of 362 TBNAs were performed on 84 patients affected by hilar/mediastinal lymphadenopathies. There was an 81% overall substantial agreement between observers (κ, 0.73; 95% CI, 0.61-0.86; P, 0.001), which became excellent in cases of malignant disease (κ, 0.81; 95% CI, 0.70-0.90; P, 0.001). The accuracy of ROSE performed by the pulmonologist (80%; 95% CI, 77-90) was not statistically different from that provided by the cytopathologist (92%; 95% CI, 85-94). Conclusions: Our study provides the first evidence, to our knowledge, that a trained pulmonologist can assess the adequacy of cytologic smears on-site. Training pulmonologists to have a basic knowledge of cytopathology could obviate most difficulties related to the involvement of cytopathologists in routine diagnostic activities and may reduce the costs of the procedure.

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