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Predictors of Actionable Results in Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration
Muneeb Mohammed, Saswata Deb, Kamyar Soghrati, Abdollah Behzadi.
Trillium Health Partners, University of Toronto, Toronto, ON, Canada.

OBJECTIVE:
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for obtaining tissue samples of mediastinal lymph nodes and masses. Factors associated with actionability (subsequent management resulting from identification of diagnostic tissues in EBUS-TBNA) including utility of a rapid on-site evaluation (ROSE) are not clearly determined. The objective of this study is to determine predictors of actionability after performing EBUS-TBNA.
METHODS:
A single-centered retrospective chart review of patients undergoing EBUS-TBNA between April 2013 and May 2015 was performed. A multivariate model was used to determine the predictors of actionability. An a-priori sub-analysis was also performed to compare the association of ROSE with respect to final pathology and actionability.
RESULTS:
During the study period, 191 patients with a mean age of 61.5+15.0 years underwent EBUS-TBNA. Of these, 97 (50.5%) were females, and 138 (72.2%) had no previous history of cancer. Multivariate analysis revealed ROSE positive cytology (ROSE(+), adequate diagnostic tissues present in TBNA samples as determined by a cytotechnologist) as the sole predictor of actionability with an odds ratio of 228.3, p = 0.0007. Sub-analysis of the utility of ROSE showed that having a ROSE(+) compared to a ROSE negative cytology (ROSE(-), inadequate presence of diagnostic tissues in TBNA as determined by a cytotechnologist) was associated with superior proportion of actionability (ROSE(+): 153 (87.9%) versus ROSE(-): 1 (5.9%), p<0.0001). Furthermore, proportion of positive pathology (adequate tissue for diagnosis as determined by a pathologist) (ROSE(+): 158 (90.8%) versus ROSE(-): 3 (17.7%), p<0.0001)) and diagnostic pathology (pathological diagnosis of benign or malignant) (ROSE(+): 158 (90.8%) versus ROSE(-): 2 (11.8%), p<0.0001)) were also higher in the cohort with ROSE(+) cytology.
CONCLUSIONS:
A ROSE positive cytology is a strong predictor of actionability after EBUS-TBNA and is associated with a greater diagnostic yield from this technique. ROSE confirmation of tissue adequacy seems to be an important component of EBUS-TBNA. Other single or multi-centred studies are required to corroborate our findings.


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