Jonathan D Marotti1, Kavitha P Rao2, Kathriel J Brister3, Edward J Gutmann2, Michael J Tsapakos4, Robert Sheiman5, Helen H Wang3, Paul A VanderLaan3. 1. Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: Jonathan.d.marotti@hitchcock.org. 2. Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. 3. Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts. 4. Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. 5. Department of Radiology, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abstract
INTRODUCTION: Cytologic rapid on-site evaluation (ROSE) during minimally invasive biopsy procedures is an increasingly important service provided by cytopathology to increase diagnostic yield and appropriately triage cellular material. Although ROSE can be performed by cytopathologists, cytotechnologists, or cytopathology fellows, few studies have directly compared both procedural and diagnostic outcome measures among different ROSE personnel. MATERIALS AND METHODS: We evaluated all transthoracic computed tomography (CT)-guided lung biopsies in which ROSE was performed during a 1-year period at 2 academic institutions with similar patient populations and procedural methods: Dartmouth-Hitchcock Medical Center (DHMC) (where ROSE is performed by cytopathologists) and the Beth Israel Deaconess Medical Center (BIDMC) (where ROSE is rendered by either cytotechnologists or cytopathology fellows). RESULTS: A total of 273 CT-guided transthoracic lung biopsies (190 DHMC, 83 BIDMC) were analyzed. There was no major difference in procedure time with respect to ROSE personnel. The repeat procedure rate for nondiagnostic biopsies was similar at DHMC (cytopathologists) and BIDMC (cytotechnologists or cytology fellows) (2.1% versus 2.3%, P = 1.0). Adequacy rates for cytopathologists, cytotechnologists, and cytopathology fellows were comparable (P = 0.23). ROSE assessments by cytopathologists were more concordant with the final diagnosis (87%) than those by cytotechnologists (82%) or cytopathology fellows (79%); this difference was not statistically significant (P = 0.28). CONCLUSIONS: ROSE procedural and diagnostic outcomes for transthoracic CT-guided lung biopsies were similar among cytopathologists, cytotechnologists, and cytopathology fellows.
INTRODUCTION: Cytologic rapid on-site evaluation (ROSE) during minimally invasive biopsy procedures is an increasingly important service provided by cytopathology to increase diagnostic yield and appropriately triage cellular material. Although ROSE can be performed by cytopathologists, cytotechnologists, or cytopathology fellows, few studies have directly compared both procedural and diagnostic outcome measures among different ROSE personnel. MATERIALS AND METHODS: We evaluated all transthoracic computed tomography (CT)-guided lung biopsies in which ROSE was performed during a 1-year period at 2 academic institutions with similar patient populations and procedural methods: Dartmouth-Hitchcock Medical Center (DHMC) (where ROSE is performed by cytopathologists) and the Beth Israel Deaconess Medical Center (BIDMC) (where ROSE is rendered by either cytotechnologists or cytopathology fellows). RESULTS: A total of 273 CT-guided transthoracic lung biopsies (190 DHMC, 83 BIDMC) were analyzed. There was no major difference in procedure time with respect to ROSE personnel. The repeat procedure rate for nondiagnostic biopsies was similar at DHMC (cytopathologists) and BIDMC (cytotechnologists or cytology fellows) (2.1% versus 2.3%, P = 1.0). Adequacy rates for cytopathologists, cytotechnologists, and cytopathology fellows were comparable (P = 0.23). ROSE assessments by cytopathologists were more concordant with the final diagnosis (87%) than those by cytotechnologists (82%) or cytopathology fellows (79%); this difference was not statistically significant (P = 0.28). CONCLUSIONS: ROSE procedural and diagnostic outcomes for transthoracic CT-guided lung biopsies were similar among cytopathologists, cytotechnologists, and cytopathology fellows.