INTRODUCTION. EBUS-TBNA has become a standard diagnostic tool in diagnosing malignancy in the hilar and mediastinal regions. Many studies suggest that coupling EBUS-TBNA with ROSE can increase diagnostic efficiency, reduce number of biopsy samples, reduce sedation doses and minimise complications.
AIMS. To evaluate the added value of ROSE in diagnostic EBUS-TBNA procedures for radiologically advanced stage IV lung cancer.
METHODS. Two-centre retrospective cohort study using a prospectively maintained database of patients who underwent a diagnostic EBUS in the years 2017-2018, where one centre used conventional EBUS-TBNA with ROSE and the other without. We compared number of sites sampled, days to pathology, sedation doses and diagnostic outcomes. Results are presented as (median [interquartile range]).
RESULTS. A total of 206 EBUS (with ROSE) and 123 EBUS (no ROSE) procedures were analysed. The number of sites sampled was lower with ROSE (1.0 [1.0,1.0]) than without (2.0 [1.0,2.0]), p<0.001. ROSE procedures showed less days to pathology (0.0 [0.0,0.0]) than without (3.0 [2.0,4.50]), p<0.001. Less sedation was used in ROSE for both medications ( Midazolam 2.0mg [2.0,3.0] vs 3.0mg [2.0,3.50] , p<0.001 and Fentanyl 25.0µg [25.0,50.0] vs 103.90µg [57.73,138,54] , p<0.001). The false negative rate was lower with ROSE (40.0%, n=2/5) than without (66.7%, n=10/15). Excluding true negative outcomes, pathological diagnosis was achieved in 99.01% of cases with ROSE, and 91.53% without, p=0.002.
CONCLUSIONS. Supplementing EBUS with ROSE technique increases diagnostic speed, efficacy, utilises less sedation, and improves procedure outcomes.