How Rapid Can “Rapid On-Site Evaluation (ROSE)” Be - Our Experience with Toluidine Blue Staining - Concordance Between Rose and Final Cytological Diagnosis on Ebus TBNA Samples

Patients with Mediastinal Lymphadenopathy or Nodal Mass undergoing EBUS TBNA for diagnosis, decisions are based on rapid on-site evaluation (ROSE) findings. We aimed to analyze the clinical utility of Toluidine blue staining on EBUS TBNA samples and concordance rate between ROSE diagnosis and final HPE diagnosis. Methods: Diagnosis concordance was defined as cases where lymph nodes (LNs) presented the same diagnosis in ROSE and final diagnosis. The smear submitted for ROSE was stained using toluidine blue stain. The diagnosis and specimen adequacy in ROSE was compared with that of the final cytology report. Results: 320 patients were included and 1537 lymph nodes samples. ROSE diagnosis was concordant with final diagnosis in 1486 (96.68%) LNs and non-concordant in 51 (3.31%). Unsatisfactory ROSE diagnosis was more likely to be non-concordant (82.8 vs 17.1%) than a ROSE satisfactory diagnosis (97.4 vs 2.3%) or normal node diagnosis (98.1 vs 1.9%) (P < .0001). The sensitivity, specificity, NPV, PPV, and overall accuracy of ROSE were 0.84, 0.98, 0.97, 0.98, and 0.97, respectively. Differences in diagnosis concordance rate between pathologist (P < .023), cell block preparations (P < .03), number of passes and TBNA slides were seen. Conclusions: TBNA slides stained with Toluidine blue will give us cyto pathological diagnosis in less than 1 sec of microscopic examination which will diminish complications and helps to obtain adequate tissue rapidly in critically ill - hypoxic patient. ROSE diagnosis has a high concordance with the final diagnosis, reducing procedure time and optimizing sample for molecular profiling.