Comments on non-utilising of rapid onsite evaluation with transbronchial needle aspiration.

Sir,

This communication is regarding an article e-published in the July-September 2014 issue of your journal. The article is entitled ‘Diagnostic utility of conventional transbronchial needle aspiration without rapid onsite evaluation in patients with lung cancer,’ by Ritika Walia et al.

Our comments are with regard to non-utilization of rapid onsite cytology (ROSE) with transbronchial needle aspiration (TBNA) in your study. It is understandable that despite many studies on the efficacy of ROSE with TBNA, it is largely underutilized in most of the bronchoscopy suites in India, be it a secondary or tertiary care center. This underutilization of ROSE is likely due to factors like non-familiarity with the procedure, lack of cytopathologists for bronchoscopy suites, and so on. However, in a study done at our center, which is a teaching institute in the Himalayan region of north India, it has been proved that ROSE is feasible, cost-effective, and patient-friendly in terms of reduction in the number and repetition of bronchoscopy procedures.[1]

In tertiary care centers with attached teaching institutes, where postgraduate programs for Pathology are being run, there is availability of trainees of Pathology. In our study, we utilized the second and third year residents of Pathology as resource persons and they were able to bring good yield of ROSE. In our study, we have also assessed the cost-effectiveness of ROSE in terms of reduction of repeat procedures in case of negative first results and we found that 45% of the patients would have required a repeat procedure in the absence of ROSE. Similar results have been reported in other studies as well.[234]

Hence, ROSE should be promoted in bronchoscopy centers in India and studies on TBNA or other procedures used for getting cytological material should be performed with ROSE, so that the message about the feasibility of ROSE is passed on to the pulmonologists of our country.