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    "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41; is a technique that allows performing on &#8220;real time&#8221; TBNA&#44; under ultrasound imaging&#46; It is a minimally invasive procedure that was initially developed for lymph node staging of patients with non-small cell lung carcinoma and its use was rapidly extended for investigation of hilo-mediastinal adenopathy and masses&#46;<a href="&#35;bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib17" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a></p><p class="elsevierStylePara">Rapid on-site evaluation &#40;ROSE&#41; during EBUS-TBNA allows the assessment of the adequacy of the samples and whether there is sufficient material for definitive pathological diagnosis&#46;<a href="&#35;bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> Therefore ROSE has the potential to increase the diagnostic yield of EBUS-TBNA&#46;</p><p class="elsevierStylePara">Studies have reported a low rate of non-diagnostic sampling&#44; a high agreement between ROSE and definitive pathological diagnosis as well as a decrease in the number of punctures and in the procedure time&#44; with ROSE&#46;<a href="&#35;bib20" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> However&#44; the advantage of ROSE has been questioned because there is no remarkable difference in diagnostic yield between EBUS-TBNA results with or without ROSE&#46;<a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> Thus&#44; the role of ROSE during EBUS-TBNA remains controversial&#46;</p><p class="elsevierStylePara">In this study we evaluated the clinical impact of the availability of ROSE in EBUS-TBNA results&#46; Primary endpoints were to compare the adequacy of the samples and the diagnostic yield of EBUS-TBNA&#44; performed with and without ROSE&#44; in the diagnosis of hilo-mediastinal lesions and lung cancer staging&#46; Secondary endpoints were the evaluation of the number of punctures per exam and the complication rate&#44; with and without ROSE&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Materials and methods</span><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Patients</span><p class="elsevierStylePara">Over a 1-year period&#44; from January to December 2012&#44; 81 consecutive patients underwent EBUS-TBNA for lung cancer staging or diagnosis of hilo-mediastinal lesions in the Bronchology Department of <span class="elsevierStyleItalic">Centro Hospitalar de S&#227;o Jo&#227;o&#46;</span></p><p class="elsevierStylePara">A prospective cohort observational study was done&#46; The first 41 patients underwent EBUS-TBNA with ROSE &#40;ROSE group&#41; and the last 40 patients without ROSE &#40;non-ROSE group&#41;&#46;</p><p class="elsevierStylePara">EBUS-TBNA database was prospectively fulfilled and includes several variables for each patient&#58; demographic characteristics&#44; objective of EBUS-TBNA &#40;investigation of hilo-mediastinal lesion or lung cancer staging&#41;&#44; type of biopsied lesion &#40;lymph node and&#47;or mass&#41;&#44; diameter of the lesions&#44; number of punctures <span class="elsevierStyleItalic">per</span> procedure&#44; complication rate&#44; pathological results and microbiological analysis of EBUS-TBNA samples&#46; Clinical files were also analyzed for this study&#46;</p><p class="elsevierStylePara">The study was approved by the ethical committee of <span class="elsevierStyleItalic">Centro Hospitalar de S&#227;o Jo&#227;o</span>&#46; Being an observational study&#44; additional informed consent was not obtained&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Rapid on-site evaluation &#40;ROSE&#41;</span><p class="elsevierStylePara">Until August 2012&#44; ROSE was available for all patients &#40;ROSE group&#41;&#46; All the aspirated material was smeared onto glass slides&#44; air dried or fixed in 95&#37; alcohol and stained with May-Grunwald-Giemsa or hematoxylin eosin&#44; respectively&#44; for cytological evaluation&#46; In the last puncture&#44; needle was washed in a phosphate-buffered sucrose &#40;PBS&#41; solution&#44; including the remaining material in the needle with more probability of blood clot&#44; to perform subsequently a cytoblock for further ancillary techniques&#46; The sample was considered adequate if lymphocytes &#40;at least 40 lymphocytes in a high-power field<a href="&#35;bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a>&#41; or antracosis were identified or when a specific diagnosis was performed&#46; When no specific diagnosis was reached during ROSE&#44; a minimum of four punctures <span class="elsevierStyleItalic">per</span> lymph node was taken&#46; The definitive pathological diagnosis considered was the one achieved after the observation of the entire sample&#46; Immunocytochemical stains were done as needed&#46;</p><p class="elsevierStylePara">From August 2012 until the end of the year&#44; ROSE was not available and the whole sample was washed on the PBS solution and later included in paraffin block for diagnosis and further molecular studies&#46; In this period&#44; at least four punctures <span class="elsevierStyleItalic">per</span> lesion were taken in all the patients &#40;non-ROSE group&#41;&#46;</p><p class="elsevierStylePara">Samples obtained were classified as&#58; &#40;1&#41; malignant&#59; &#40;2&#41; specific benign diagnosis &#40;e&#46;g&#46; sarcoidosis&#41;&#59; &#40;3&#41; reactive lymphoid tissue&#59; &#40;4&#41; inconclusive &#40;e&#46;g&#46; suspicion of malignancy&#41; and &#40;5&#41; non-representative&#46; These two last types of samples were defined as non-diagnostic&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">EBUS-TBNA</span><p class="elsevierStylePara">All procedures were performed under general anesthesia using the rigid bronchoscope&#46; EBUS-TBNA was performed through a dedicated endoscope &#40;BF-UC180F&#44; Olympus&#41; using a convex probe with a 7&#46;5&#160;mHz transducer coupled on its tip which provides images parallel to the insertion of the bronchoscope&#46; A 22-gauge needle &#40;NA-201SX-4022&#44; Olympus&#41; was used to perform the aspirations&#46;</p><p class="elsevierStylePara">The exams were carried out by the same three pulmonologists with about 2 years of experience in performing EBUS-TBNA&#44; who had at least performed 40 or more procedures&#46;</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Final diagnosis</span><p class="elsevierStylePara">The final diagnosis was based on EBUS-TBNA definitive pathological and microbiological results&#46; In case of reactive lymphoid tissue or non-diagnostic samples&#44; the final diagnosis was established or confirmed through additional exams and&#47;or by clinical and radiographic follow-up for at least 6 months&#46;</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Statistical analysis</span><p class="elsevierStylePara">Data were analyzed with IBM<span class="elsevierStyleSup">&#174;</span> SPSS<span class="elsevierStyleSup">&#174;</span> Statistics version 19&#46;0 software&#46; We reported data for continuous variables as means &#40;with standard deviation&#41; and for categorical variables as percentages&#46; Unpaired <span class="elsevierStyleItalic">t</span> Student&#39;s test was used to compare age&#44; diameter of lesions and number of punctures between two groups&#46; Chi square test or Fisher&#39;s exact test were used to compare results of EBUS-TBNA &#40;adequacy of the aspirated material and diagnostic accuracy&#41; in the two groups&#46; Results were considered statistically significant when the <span class="elsevierStyleItalic">p</span> value was less than 0&#46;05&#46; Diagnostic sensitivity&#44; specificity&#44; positive predictive value &#40;PPV&#41;&#44; negative predictive value &#40;NPV&#41; and diagnostic accuracy were determined according to the standard definitions&#46; We calculated sensitivity&#44; NPV and accuracy with and without inclusion of non-diagnostic specimens &#40;adding to false negative samples&#41;&#46; Test performance measures were calculated as a combination of all samples per patient&#46;</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara">Between January and December 2012&#44; 81 patients who performed EBUS-TBNA were divided into two groups&#58; 41 patients in ROSE group and 40 patients in non-ROSE group&#46;</p><p class="elsevierStylePara">The indication for EBUS-TBNA was the investigation of hilo-mediastinal lesions in 29 patients &#40;71&#37;&#41; in ROSE group and in 32 patients &#40;80&#37;&#41; in non-ROSE group&#59; and lung cancer staging in 12 patients &#40;29&#37;&#41; in ROSE group and in 8 patients &#40;20&#37;&#41; in non-ROSE group&#46;</p><p class="elsevierStylePara">There was no statistically significant difference between the groups in respect to age&#44; gender&#44; type and diameter of the lesion &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#41;&#46;</p><p class="elsevierStylePara">Table 1&#46; Demographic characteristics and baseline data&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Characteristics</td><td>ROSE group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;41&#41;</td><td>Non-ROSE group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;40&#41;</td><td><span class="elsevierStyleItalic">p</span>-Value</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; mean &#40;&#177;SD&#41;</span></td><td>55&#46;6 &#40;&#177;15&#46;6&#41;</td><td>60&#46;3 &#40;&#177;14&#46;7&#41;</td><td>0&#46;16</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Males&#44; n &#40;&#37;&#41;</span></td><td>31 &#40;76&#41;</td><td>23 &#40;58&#41;</td><td>0&#46;08</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Investigation of mediastinal&#47;hilar lesions etiology&#44; n &#40;&#37;&#41;</span></td><td>29 &#40;71&#41;</td><td>32 &#40;80&#41;</td><td>0&#46;33</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Lung cancer staging&#44; n &#40;&#37;&#41;</span></td><td>12 &#40;29&#41;</td><td>8 &#40;20&#41;</td><td>&#160;</td></tr><tr align="left"><td colspan="4"><span class="elsevierStyleItalic">Type of biopsied lesion</span></td></tr><tr align="left"><td>Lymph node &#40;<span class="elsevierStyleItalic">n</span>&#41;</td><td>62</td><td>52</td><td>0&#46;32</td></tr><tr align="left"><td>Mass &#40;<span class="elsevierStyleItalic">n</span>&#41;</td><td>7</td><td>7</td><td>&#160;</td></tr><tr align="left"><td colspan="4"><span class="elsevierStyleItalic">Lymph node station &#40;n&#41;</span></td></tr><tr align="left"><td>2R</td><td>4</td><td>1</td><td>0&#46;32</td></tr><tr align="left"><td>2L</td><td>1</td><td>0</td><td>&#160;</td></tr><tr align="left"><td>4R</td><td>22</td><td>18</td><td>0&#46;32</td></tr><tr align="left"><td>4L</td><td>1</td><td>4</td><td>&#160;</td></tr><tr align="left"><td>7</td><td>29</td><td>19</td><td>&#160;</td></tr><tr align="left"><td>10R</td><td>4</td><td>3</td><td>&#160;</td></tr><tr align="left"><td>10L</td><td>1</td><td>2</td><td>&#160;</td></tr><tr align="left"><td>11R</td><td>0</td><td>2</td><td>&#160;</td></tr><tr align="left"><td>11L</td><td>0</td><td>3</td><td>&#160;</td></tr><tr align="left"><td colspan="4"><span class="elsevierStyleItalic">Mass location &#40;n&#41;</span></td></tr><tr align="left"><td>Paratracheal</td><td>2</td><td>2</td><td>&#160;</td></tr><tr align="left"><td>Hilar</td><td>2</td><td>2</td><td>&#160;</td></tr><tr align="left"><td>Mediastinal</td><td>3</td><td>3</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Lymph node size &#40;mm&#41;&#44; mean &#40;&#177;SD&#41;</span></td><td>16&#46;3 &#40;&#177;11&#46;2&#41;</td><td>17&#46;3 &#40;&#177;7&#46;6&#41;</td><td>0&#46;70</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Mass size &#40;mm&#41;&#44; mean &#40;&#177;SD&#41;</span></td><td>36&#46;8 &#40;&#177;17&#46;0&#41;</td><td>41&#46;5&#40;&#177;25&#46;4&#41;</td><td>0&#46;73</td></tr></table><p class="elsevierStylePara">The percentage of patients with adequate samples was 93&#37; in ROSE group and 80&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#46;</p><p class="elsevierStylePara">When the objective of the procedure was investigation of hilo-mediastinal lesions&#44; 93&#37; of patients had adequate samples in ROSE group and 75&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;06&#41;&#46; When the purpose was lung cancer staging&#44; 92&#37; patients had adequate samples in ROSE group and 100&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;1&#46;00&#41; &#40;<a href="&#35;t0010" class="elsevierStyleCrossRefs">Table 2</a>&#41;&#46;</p><p class="elsevierStylePara">Table 2&#46; Adequacy of cytological samples&#46;</p><a name="t0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Patients</td><td colspan="3">Adequate sampling</td></tr><tr align="left"><td>&#160;</td><td>ROSE group</td><td>Non-ROSE group</td><td><span class="elsevierStyleItalic">p</span>-Value</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Total of patients&#44; n&#47;total &#40;&#37;&#41;</span></td><td>38&#47;41 &#40;93&#41;</td><td>32&#47;40 &#40;80&#41;</td><td>0&#46;10</td></tr><tr align="left"><td>Investigation of mediastinal&#47;hilar lesions etiology&#44; <span class="elsevierStyleItalic">n</span>&#47;total &#40;&#37;&#41;</td><td>27&#47;29 &#40;93&#41;</td><td>24&#47;32 &#40;75&#41;</td><td>0&#46;06</td></tr><tr align="left"><td>Lung cancer staging&#44; <span class="elsevierStyleItalic">n</span>&#47;total &#40;&#37;&#41;</td><td>11&#47;12 &#40;92&#41;</td><td>8&#47;8 &#40;100&#41;</td><td>1&#46;00</td></tr></table><p class="elsevierStylePara">EBUS-TBNA results and the final diagnosis in both groups are described in <a href="&#35;t0015" class="elsevierStyleCrossRefs">Table 3</a>&#46; Reactive lymphoid tissue or non-diagnostic samples occurred in 17 of 41 patients &#40;42&#37;&#41; in ROSE group and in 26 of 40 patients &#40;65&#37;&#41; in non-ROSE group&#46; These patients underwent additional diagnostic procedures and&#47;or were followed up clinically and radiographically at least during 6 months to establish the final diagnosis&#46; In ROSE group&#44; the final diagnosis was based on additional procedures in five patients&#58; two transthoracic needle aspiration&#44; one thoracotomy&#44; one mediastinoscopy and one bronchoalveolar lavage&#59; diagnosis of the remaining patients was based on follow-up &#40;except one patient &#8211; lost to follow-up&#41;&#46; In the non-ROSE group&#44; additional tests were required in 14 patients&#58; four thoracotomy&#44; two peripheral lymph node biopsy&#44; two EBUS-TBNA repetition&#44; one transthoracic needle aspiration&#44; one pleural biopsy&#44; one bronchial biopsy&#44; two bronchoalveolar lavage&#44; and one mediastinoscopy&#59; clinical and radiographical follow-up established the final diagnosis in eight patients&#59; the remaining four patients were lost to follow-up&#46;</p><p class="elsevierStylePara">Table 3&#46; Results of EBUS-TBNA and final diagnosis&#46;</p><a name="t0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>EBUS-TBNA findings</td><td colspan="4">Patients &#40;final diagnosis&#41;&#44;</td></tr><tr align="left"><td>&#160;</td><td colspan="2">ROSE &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;41&#41;</td><td colspan="2">Non-ROSE &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;40&#41;</td></tr><tr align="left"><td colspan="5"><span class="elsevierStyleBold">Malignant</span></td></tr><tr align="left"><td colspan="5"><span class="elsevierStyleItalic">Primary lung cancer</span></td></tr><tr align="left"><td>Adenocarcinoma</td><td>6</td><td>&#160;</td><td>4</td><td>&#160;</td></tr><tr align="left"><td>Squamous cell carcinoma</td><td>1</td><td>&#160;</td><td>1</td><td>&#160;</td></tr><tr align="left"><td>NSCLC-NOS</td><td>5</td><td>&#160;</td><td>1</td><td>&#160;</td></tr><tr align="left"><td>Small cell carcinoma</td><td>0</td><td>&#160;</td><td>2</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Metastatic carcinoma</span></td><td>0</td><td>&#160;</td><td>1</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Lymphoma</span></td><td>1</td><td>&#160;</td><td>0</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Malignant neoplasia</span></td><td>1</td><td>&#160;</td><td>2</td><td>&#160;</td></tr><tr align="left"><td colspan="5">&#160;</td></tr><tr align="left"><td colspan="5"><span class="elsevierStyleBold">Benign</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Sarcoidosis</span></td><td>8</td><td>&#160;</td><td>2</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Tuberculosis</span></td><td>0</td><td>&#160;</td><td>1</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Aspergillosis</span></td><td>1</td><td>&#160;</td><td>0</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Bronchogenic cyst</span></td><td>1</td><td>&#160;</td><td>0</td><td>&#160;</td></tr><tr align="left"><td colspan="5">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleBold">Negative for malignancy &#40;or reactive adenopathy&#41;</span></td><td>10</td><td>&#40;  3 FN &#58; 1 non-small cell carcinoma&#44; 2 sarcoidosis&#59;  7 TN &#58; 2 silicosis&#44; 5 unchanged with 6 months of follow-up&#41;</td><td>18</td><td>&#40;  5 FN &#58; 1 small cell carcinoma&#44; 1 occult carcinoma&#44; 1 lymphoma&#44; 1 sarcoidosis&#44; 1 granulomatous disease unspecified&#59;  11 TN &#58; unchanged with 6 months of follow-up&#59;  2 inconclusive &#58; lost to follow-up&#41;</td></tr><tr align="left"><td colspan="5">&#160;</td></tr><tr align="left"><td colspan="5"><span class="elsevierStyleBold">Nondiagnostic samples</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Inconclusive samples</span></td><td>4</td><td>&#40;1 small cell carcinoma&#44; 1 lymphoma&#44; 1 sarcoidosis&#44; 1 tuberculosis&#41;</td><td>0</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Nonrepresentative samples</span></td><td>3</td><td>&#40;2 sarcoidosis&#44; 1 inconclusive &#8211; lost to follow-up&#41;</td><td>8</td><td>&#40;1 lymphoma&#44; 1 sarcoidosis&#44; 2 bronchogenic cyst&#44; 2 unchanged with 6 months of follow-up&#44; 2 inconclusive &#8211; lost to follow-up&#41;</td></tr></table><p class="elsevierStylePara">NSCLC-NOS&#44; non-small cell lung carcinoma not otherwise specified&#59; FN&#44; false negatives&#59; TN&#44; true negatives&#46;<br></br></p><p class="elsevierStylePara">In the ROSE group&#44; on-site evaluation was discordant with definitive pathological diagnosis in four cases &#40;10&#37;&#41;&#46; Disagreement was due to ROSE sample misinterpretation&#59; the abnormality was not identified on-site&#44; but after the observation of the whole sample&#46;</p><p class="elsevierStylePara">The overall diagnostic performance of EBUS-TBNA per patient with and without ROSE is detailed in <a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a>&#46; Two patients of non-ROSE group&#44; with a diagnostic of reactive lymphoid tissue by EBUS-TBNA and lost to follow-up&#44; were excluded&#46; The diagnostic accuracy was 91&#37; in the ROSE group and 83&#37; in the non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;08&#41;&#46; There were seven and eight patients in ROSE and non-ROSE groups&#44; respectively&#44; with non-diagnostic samples&#46; Adding the non-diagnostic samples to false negative samples&#44; diagnostic accuracy decreased to 76&#37; in ROSE group and 66&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;20&#41;&#46;</p><p class="elsevierStylePara">Table 4&#46; Diagnostic performance of EBUS-TBNA with and without ROSE&#46;</p><a name="t0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>&#160;</td><td>ROSE &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;41&#41;</td><td>Non-ROSE &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;40&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Nondiagnostic cases</span></td><td>17 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;7&#41;</td><td>20 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;8&#41;</td></tr><tr align="left"><td>Mediastinal&#47;hilar lesions investigation</td><td>21 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;6&#41;</td><td>25 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;8&#41;</td></tr><tr align="left"><td>Lung cancer staging</td><td>8 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41;</td><td>0 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;0&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Sensitivity &#40;nondiagnostic included&#41;</span></td><td>89 &#40;71&#41;</td><td>74 &#40;52&#41;</td></tr><tr align="left"><td>Mediastinal&#47;hilar lesions investigation</td><td>85 &#40;65&#41;</td><td>69 &#40;46&#41;</td></tr><tr align="left"><td>Lung cancer staging</td><td>100 &#40;88&#41;</td><td>100 &#40;100&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Specificity</span></td><td>100</td><td>100</td></tr><tr align="left"><td><span class="elsevierStyleItalic">PPV</span></td><td>100</td><td>100</td></tr><tr align="left"><td><span class="elsevierStyleItalic">NPV &#40;nondiagnostic included&#41;</span></td><td>70 &#40;41&#41;</td><td>69 &#40;46&#41;</td></tr><tr align="left"><td>Mediastinal&#47;hilar lesions investigation</td><td>50 &#40;25&#41;</td><td>46 &#40;29&#41;</td></tr><tr align="left"><td>Lung cancer staging</td><td>100 &#40;80&#41;</td><td>100</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Accuracy &#40;nondiagnostic included&#41;</span><span class="elsevierStyleSup">a</span></td><td>91 &#40;76&#41;</td><td>83 &#40;66&#41;</td></tr><tr align="left"><td>Mediastinal&#47;hilar lesions investigation  <span class="elsevierStyleSup">b</span></td><td>87 &#40;69&#41;</td><td>77 &#40;57&#41;</td></tr><tr align="left"><td>Lung cancer staging  <span class="elsevierStyleSup">c</span></td><td>100 &#40;92&#41;</td><td>100 &#40;100&#41;</td></tr></table><p class="elsevierStylePara">Data are presented as &#37;&#46;<br></br></p><p class="elsevierStylePara">a <span class="elsevierStyleItalic">p</span>-Value&#160;&#61;&#160;0&#46;08 &#40;0&#46;20&#41;&#46;<br></br>b <span class="elsevierStyleItalic">p</span>-Value&#160;&#61;&#160;0&#46;10 &#40;0&#46;21&#41;&#46;<br></br>c <span class="elsevierStyleItalic">p</span>-Value&#160;&#61;&#160;NA &#40;0&#46;13&#41;&#46;<br></br></p><p class="elsevierStylePara">Performance measures of EBUS-TBNA according to the indication of the exam were separately calculated &#40;<a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a>&#41;&#58; for hilo-mediastinal lesions investigation&#44; diagnostic accuracy of EBUS-TBNA was 87&#37; in ROSE group vs&#46; 77&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#59; for lung cancer staging diagnostic accuracy was 100&#37; in both groups&#46;</p><p class="elsevierStylePara">The number of punctures per procedure was significantly lower in the ROSE group &#40;3&#46;4&#160;&#177;&#160;1&#46;7 vs&#46; 4&#46;5&#160;&#177;&#160;1&#46;7 punctures&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;002&#41;&#46;</p><p class="elsevierStylePara">In both groups there were no complications&#46;</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara">One of the main concerns of EBUS-TBNA is the quality of the sample obtained&#46; ROSE allows the immediate confirmation of the presence of lymph node tissue or the acquisition of a specific diagnosis and&#44; at the same time&#44; helps selecting additional studies such as immunocytochemistry&#44; microbiology&#44; flow cytometry and molecular studies&#46; The question is if this information substantially contributes to increase diagnostic accuracy of the test&#46;</p><p class="elsevierStylePara">In this study&#44; we found no statistically significant difference between the ROSE group and non-ROSE group in terms of sample adequacy&#46; However&#44; we found an important trend toward having more adequate samples with ROSE in patients for whom the purpose of the exam was the study of hilo-mediastinal lesions &#40;93&#37; of patients with adequate samples in ROSE group vs&#46; 75&#37; in non-ROSE group&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;06&#41;&#46;</p><p class="elsevierStylePara">In the non-ROSE group&#44; sample adequacy might have been improved by the performance of&#44; at least&#44; four punctures per lesion&#46; Studies have reported that three aspirates per lesion maximized the yield of EBUS-TBNA for the staging of lung cancer&#46;<a href="&#35;bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> For the acquisition of high-quality tissue for molecular profiling for lung cancer genotyping&#44; Yarmus et al&#46;<a href="&#35;bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a> showed that a minimum of four needle passes per lesion were needed&#46;</p><p class="elsevierStylePara">Regarding diagnostic accuracy&#44; despite the lack of statistical significance&#44; it was higher in ROSE group than in non-ROSE group in the investigation of hilo-mediastinal lesions &#40;87&#37; in ROSE group vs&#46; 77&#37; in non-ROSE group&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#46; Previous studies have suggested that on-site evaluation of TBNA specimens increase the diagnostic yield&#46;<a href="&#35;bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a> Gu et al&#46;&#44;<a href="&#35;bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a> in a meta-analysis&#44; also found this tendency to get better results with ROSE&#44; but the heterogeneity between the studies hampered obtaining satisfactory results&#46; On the other hand&#44; Oki et al&#46;&#44;<a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> in a randomized study&#44; and Griffin et al&#46;&#44;<a href="&#35;bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> in a retrospective study&#44; found that ROSE did not significantly increase the diagnostic yield of EBUS-TBNA&#46; Concerning conventional TBNA&#44; recent randomized studies of Trisolini et al&#46;<a href="&#35;bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a> and Yarmus et al&#46;<a href="&#35;bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">15</span></a> also showed no benefit on diagnostic yield related to the use of ROSE&#46;</p><p class="elsevierStylePara">Relatively to lung cancer staging&#44; we did not find advantages of ROSE either in sample adequacy or in diagnostic accuracy&#46; Therefore&#44; in this study&#44; ROSE was more useful for mediastinal lesions diagnosis than for lung cancer staging&#46; The lack of benefit of ROSE in lung cancer staging could be explained by the small sample size of this subgroup of patients&#46; Consequently&#44; these results need to be confirmed in larger samples&#46;</p><p class="elsevierStylePara">To achieve the final diagnosis&#44; the patients of non-ROSE group needed more additional procedures&#46; However&#44; this fact can be justified by the higher prevalence of reactive lymph nodes in this group that required additional investigation&#46;</p><p class="elsevierStylePara">ROSE during EBUS-TBNA decreased the number of punctures per procedure&#46; However&#44; the increase in the number of punctures in non-ROSE group was not associated to a higher complication rate&#46; These results are in accordance with other publications&#46;<a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">This study enrolled an unselected group of consecutive patients&#44; with various diagnostic suspicions&#44; who performed EBUS-TBNA&#46; Therefore&#44; it confirms the usefulness of EBUS-TBNA as the initial test not only for lung cancer diagnosis or staging but also for investigation of hilo-mediastinal lesions observed in computerized tomography &#40;e&#46;g&#46; in the diagnosis of sarcoidosis&#41;&#46;</p><p class="elsevierStylePara">Some limitations of this study have to be addressed&#46; The sample was heterogeneous and too small to demonstrate&#44; unequivocally&#44; the advantage of ROSE regarding adequacy of samples and diagnostic accuracy of EBUS-TBNA&#46; Therefore&#44; no statistical significant difference between the two groups was achieved&#46; There only was a trend to obtain better results in ROSE group when the purpose was the diagnosis of hilo-mediastinal lesions&#46; Being an observational study&#44; some confounding variables could not be controlled&#44; such as the fact that ROSE group had been evaluated before the non-ROSE group and the interventional pneumologists had acquired more experience&#46;</p><a name="sec0050" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStylePara">The adequacy of the samples and the diagnostic accuracy of EBUS-TBNA were not statistically influenced by the availability of ROSE&#46; Despite this&#44; there was a trend toward achieving more adequate samples and better diagnostic accuracy with ROSE in the investigation of hilo-mediastinal lesions&#46; For lung cancer staging this advantage was not evident&#46;</p><a name="sec0055" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflict of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><a name="sec0060" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0065" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study&#46;</p><a name="sec0070" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p><a name="sec0075" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article&#46;</p><a name="sec0080" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Authorship</span><p class="elsevierStylePara">All listed authors participated in the study conception and design&#44; in the data acquisition&#47;analysis and in the writing of the article&#46;</p><p class="elsevierStylePara">Received 26 September 2014 <br></br>Accepted 16 February 2015 </p><p class="elsevierStylePara">Corresponding author&#46; car&#95;veronica&#64;sapo&#46;pt</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><br/><p class="elsevierStylePara">Rapid on-site evaluation &#40;ROSE&#41; has the potential to increase endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41; accuracy in the diagnosis of mediastinal lesions and lung cancer staging&#46; However&#44; studies have reported controversial results&#46;</p><p class="elsevierStylePara">The purpose of our study was to evaluate the influence of ROSE on sample adequacy and diagnostic accuracy of EBUS-TBNA&#46;</p><span class="elsevierStyleSectionTitle">Methods</span><br/><p class="elsevierStylePara">Prospective observational study that enrolled 81 patients who underwent EBUS-TBNA for investigation of hilo-mediastinal lesions or lung cancer staging&#46; The first 41 patients underwent EBUS-TBNA with ROSE &#40;ROSE group&#41; and the last 40 patients without ROSE &#40;non-ROSE group&#41;&#46; Sample adequacy and diagnostic accuracy of EBUS-TBNA in both groups were compared&#46;</p><span class="elsevierStyleSectionTitle">Results</span><br/><p class="elsevierStylePara">Adequate samples were obtained in 93&#37; of the patients in the ROSE group and 80&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#46; The diagnostic accuracy of EBUS-TBNA was 91&#37; in ROSE group and 83&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;08&#41;&#46; Analyzing the EBUS-TBNA purpose&#44; in the subgroup of patients who underwent EBUS-TBNA for investigation of hilo-mediastinal lesions&#44; these differences between ROSE and non-ROSE group were higher compared to lung cancer staging&#44; 93&#37; of patients with adequate samples in the ROSE group vs&#46; 75&#37; in the non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;06&#41; and 87&#37; of diagnostic accuracy in ROSE group vs&#46; 77&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#46;</p><span class="elsevierStyleSectionTitle">Conclusions</span><br/><p class="elsevierStylePara">Despite the lack of statistical significance&#44; ROSE appears to be particularly useful in the diagnostic work-up of hilo-mediastinal lesions&#44; increasing the diagnostic yield of EBUS-TBNA&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Endobronchial ultrasound&#x002D;guided transbronchial needle aspiration cytology: a state of the art review. Cytopathology. 2010; 21:6&#x002D;26."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration cytology&#58; a state of the art review&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Cameron SE"
                            1 => "Andrade RS"
                            2 => "Pambuccian SE&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2303.2009.00722.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cytopathology. "
                        "fecha" => "2010"
                        "volumen" => "21"
                        "paginaInicial" => "6"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20015257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Effectiveness and safety of endobronchial ultrasound&#x002D;transbronchial needle aspiration: a systematic review. Eur Respir J. 2009; 33:1156&#x002D;64."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration&#58; a systematic review&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Varela-Lema L"
                            1 => "Fern&#225;ndez-Villar A"
                            2 => "Ruano-Ravina A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00097908"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J. "
                        "fecha" => "2009"
                        "volumen" => "33"
                        "paginaInicial" => "1156"
                        "paginaFinal" => "1164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19407050"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Endobronchial ultrasound&#x002D;guided transbronchial needle aspiration. Int J Clin Pract. 2010; 64:1773&#x002D;83."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Medford ARL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-1241.2010.02454.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pract. "
                        "fecha" => "2010"
                        "volumen" => "64"
                        "paginaInicial" => "1773"
                        "paginaFinal" => "1783"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21070528"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Diagnostic difficulties and pitfalls in rapid on&#x002D;site evaluation of endobronchial ultrasound guided fine needle aspiration. Cytojournal. 2010; 7:9."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Diagnostic difficulties and pitfalls in rapid on-site evaluation of endobronchial ultrasound guided fine needle aspiration&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Monaco SE"
                            1 => "Schuchert MJ"
                            2 => "Khalbuss WE&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1742-6413.64385"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cytojournal. "
                        "fecha" => "2010"
                        "volumen" => "7"
                        "paginaInicial" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20607094"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rapid on&#x002D;site cytologic evaluation during endobronchial ultrasound&#x002D;guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg. 2013; 95:1695&#x002D;9."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Nakajima T"
                            1 => "Yasufuku K"
                            2 => "Saegusa F"
                            3 => "Fujiwara T"
                            4 => "Sakairi Y"
                            5 => "Hiroshima K"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2012.09.074"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg. "
                        "fecha" => "2013"
                        "volumen" => "95"
                        "paginaInicial" => "1695"
                        "paginaFinal" => "1699"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245441"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Improved laboratory resource utilization and patient care with the use of rapid on&#x002D;site evaluation for endobronchial ultrasound fine&#x002D;needle aspiration biopsy. Cancer Cytopathol. 2013; 10:544&#x002D;51."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Improved laboratory resource utilization and patient care with the use of rapid on-site evaluation for endobronchial ultrasound fine-needle aspiration biopsy&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Collins BT"
                            1 => "Chen AC"
                            2 => "Wang JF"
                            3 => "Bernadt CT"
                            4 => "Sanati S&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer Cytopathol. "
                        "fecha" => "2013"
                        "volumen" => "10"
                        "paginaInicial" => "544"
                        "paginaFinal" => "551"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rapid on&#x002D;site cytologic evaluation during endobronchial ultrasound&#x002D;guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration. 2013; 85:486&#x002D;92."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer&#58; a randomized study&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Oki M"
                            1 => "Saka H"
                            2 => "Kitagawa C"
                            3 => "Kogure Y"
                            4 => "Murata N"
                            5 => "Adachi T"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000346987"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration. "
                        "fecha" => "2013"
                        "volumen" => "85"
                        "paginaInicial" => "486"
                        "paginaFinal" => "492"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23571718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Utility of on&#x002D;site evaluation of endobronchial ultrasound&#x002D;guided transbronchial needle aspiration specimens. Cytojournal. 2011; 8:20."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Griffin AC"
                            1 => "Schwartz LE"
                            2 => "Baloch ZW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1742-6413.90081"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cytojournal. "
                        "fecha" => "2011"
                        "volumen" => "8"
                        "paginaInicial" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22145008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rapid on&#x002D;site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging. Ann Thorac Surg. 2013; 96:403&#x002D;10."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rapid on-site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Joseph M"
                            1 => "Jones T"
                            2 => "Lutterbie Y"
                            3 => "Maygarden SJ"
                            4 => "Feins RH"
                            5 => "Haithcock BE"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2013.04.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg. "
                        "fecha" => "2013"
                        "volumen" => "96"
                        "paginaInicial" => "403"
                        "paginaFinal" => "410"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23731611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Real&#x002D;time endobronchial ultrasound&#x002D;guided transbronchial needle aspiration in mediastinal staging of non&#x002D;small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008; 134:368&#x002D;74."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer&#58; how many aspirations per target lymph node station&#63;&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Lee HS"
                            1 => "Lee GK"
                            2 => "Lee HS"
                            3 => "Kim MS"
                            4 => "Lee LM"
                            5 => "Kim HY"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.07-2105"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest. "
                        "fecha" => "2008"
                        "volumen" => "134"
                        "paginaInicial" => "368"
                        "paginaFinal" => "374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18263688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Optimizing endobronchial ultrasound for molecular analysis: how many passes are needed. Ann Am Thorac Soc. 2013; 10:636&#x002D;43."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Optimizing endobronchial ultrasound for molecular analysis&#58; how many passes are needed&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Yarmus L"
                            1 => "Akulian J"
                            2 => "Gilbert C"
                            3 => "Feller-Kopman D"
                            4 => "Lee HJ"
                            5 => "Zarogoulidis P"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/AnnalsATS.201305-130OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Am Thorac Soc. "
                        "fecha" => "2013"
                        "volumen" => "10"
                        "paginaInicial" => "636"
                        "paginaFinal" => "643"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24079724"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed. Am J Respir Crit Care Med. 2002; 166:377&#x002D;81."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Transbronchial needle aspiration in diagnosing and staging lung cancer&#58; how many aspirates are needed&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Chin R"
                            1 => "McCain TW"
                            2 => "Lucia MA"
                            3 => "Cappellari JO"
                            4 => "Adair NE"
                            5 => "Lovato JF"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med. "
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "377"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12153974"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Endobronchial ultrasound&#x002D;guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta&#x002D;analysis. Eur J Cancer. 2009; 45:1389&#x002D;96."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer&#58; a systematic review and meta-analysis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gu P"
                            1 => "Zhao YZ"
                            2 => "Jiang LY"
                            3 => "Zhang W"
                            4 => "Xin Y"
                            5 => "Han BH&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejca.2008.11.043"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer. "
                        "fecha" => "2009"
                        "volumen" => "45"
                        "paginaInicial" => "1389"
                        "paginaFinal" => "1396"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19124238"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rapid on&#x002D;site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy: a randomized trial. Chest. 2011; 139:395&#x002D;401."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rapid on-site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy&#58; a randomized trial&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Trisolini R"
                            1 => "Cancellieri A"
                            2 => "Tinelli C"
                            3 => "Paioli D"
                            4 => "Scudeller L"
                            5 => "Casadei GP"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-1521"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest. "
                        "fecha" => "2011"
                        "volumen" => "139"
                        "paginaInicial" => "395"
                        "paginaFinal" => "401"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21030491"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "A randomized prospective trial of the utility of rapid on&#x002D;site evaluation of transbronchial needle aspirate specimens. J Bronchol Interv Pulmonol. 2011; 18:121&#x002D;7."
                  "contribucion" => array:1 [
                    0 => array:3 [
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The value of rapid on-site evaluation during EBUS-TBNA
A.V.. Cardosoa,
Corresponding author
car_veronica@sapo.pt

Corresponding author. car_veronica@sapo.pt
, I.. Nevesa, A.. Magalhãesa, M.. Sucenaa, H.. Barrocab, G.. Fernandesa,c
a Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
b Pathology Department, Centro Hospitalar de São João, Porto, Portugal
c Faculty of Medicine of University of Porto, Porto, Portugal
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    "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41; is a technique that allows performing on &#8220;real time&#8221; TBNA&#44; under ultrasound imaging&#46; It is a minimally invasive procedure that was initially developed for lymph node staging of patients with non-small cell lung carcinoma and its use was rapidly extended for investigation of hilo-mediastinal adenopathy and masses&#46;<a href="&#35;bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib17" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a></p><p class="elsevierStylePara">Rapid on-site evaluation &#40;ROSE&#41; during EBUS-TBNA allows the assessment of the adequacy of the samples and whether there is sufficient material for definitive pathological diagnosis&#46;<a href="&#35;bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> Therefore ROSE has the potential to increase the diagnostic yield of EBUS-TBNA&#46;</p><p class="elsevierStylePara">Studies have reported a low rate of non-diagnostic sampling&#44; a high agreement between ROSE and definitive pathological diagnosis as well as a decrease in the number of punctures and in the procedure time&#44; with ROSE&#46;<a href="&#35;bib20" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> However&#44; the advantage of ROSE has been questioned because there is no remarkable difference in diagnostic yield between EBUS-TBNA results with or without ROSE&#46;<a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> Thus&#44; the role of ROSE during EBUS-TBNA remains controversial&#46;</p><p class="elsevierStylePara">In this study we evaluated the clinical impact of the availability of ROSE in EBUS-TBNA results&#46; Primary endpoints were to compare the adequacy of the samples and the diagnostic yield of EBUS-TBNA&#44; performed with and without ROSE&#44; in the diagnosis of hilo-mediastinal lesions and lung cancer staging&#46; Secondary endpoints were the evaluation of the number of punctures per exam and the complication rate&#44; with and without ROSE&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Materials and methods</span><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Patients</span><p class="elsevierStylePara">Over a 1-year period&#44; from January to December 2012&#44; 81 consecutive patients underwent EBUS-TBNA for lung cancer staging or diagnosis of hilo-mediastinal lesions in the Bronchology Department of <span class="elsevierStyleItalic">Centro Hospitalar de S&#227;o Jo&#227;o&#46;</span></p><p class="elsevierStylePara">A prospective cohort observational study was done&#46; The first 41 patients underwent EBUS-TBNA with ROSE &#40;ROSE group&#41; and the last 40 patients without ROSE &#40;non-ROSE group&#41;&#46;</p><p class="elsevierStylePara">EBUS-TBNA database was prospectively fulfilled and includes several variables for each patient&#58; demographic characteristics&#44; objective of EBUS-TBNA &#40;investigation of hilo-mediastinal lesion or lung cancer staging&#41;&#44; type of biopsied lesion &#40;lymph node and&#47;or mass&#41;&#44; diameter of the lesions&#44; number of punctures <span class="elsevierStyleItalic">per</span> procedure&#44; complication rate&#44; pathological results and microbiological analysis of EBUS-TBNA samples&#46; Clinical files were also analyzed for this study&#46;</p><p class="elsevierStylePara">The study was approved by the ethical committee of <span class="elsevierStyleItalic">Centro Hospitalar de S&#227;o Jo&#227;o</span>&#46; Being an observational study&#44; additional informed consent was not obtained&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Rapid on-site evaluation &#40;ROSE&#41;</span><p class="elsevierStylePara">Until August 2012&#44; ROSE was available for all patients &#40;ROSE group&#41;&#46; All the aspirated material was smeared onto glass slides&#44; air dried or fixed in 95&#37; alcohol and stained with May-Grunwald-Giemsa or hematoxylin eosin&#44; respectively&#44; for cytological evaluation&#46; In the last puncture&#44; needle was washed in a phosphate-buffered sucrose &#40;PBS&#41; solution&#44; including the remaining material in the needle with more probability of blood clot&#44; to perform subsequently a cytoblock for further ancillary techniques&#46; The sample was considered adequate if lymphocytes &#40;at least 40 lymphocytes in a high-power field<a href="&#35;bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a>&#41; or antracosis were identified or when a specific diagnosis was performed&#46; When no specific diagnosis was reached during ROSE&#44; a minimum of four punctures <span class="elsevierStyleItalic">per</span> lymph node was taken&#46; The definitive pathological diagnosis considered was the one achieved after the observation of the entire sample&#46; Immunocytochemical stains were done as needed&#46;</p><p class="elsevierStylePara">From August 2012 until the end of the year&#44; ROSE was not available and the whole sample was washed on the PBS solution and later included in paraffin block for diagnosis and further molecular studies&#46; In this period&#44; at least four punctures <span class="elsevierStyleItalic">per</span> lesion were taken in all the patients &#40;non-ROSE group&#41;&#46;</p><p class="elsevierStylePara">Samples obtained were classified as&#58; &#40;1&#41; malignant&#59; &#40;2&#41; specific benign diagnosis &#40;e&#46;g&#46; sarcoidosis&#41;&#59; &#40;3&#41; reactive lymphoid tissue&#59; &#40;4&#41; inconclusive &#40;e&#46;g&#46; suspicion of malignancy&#41; and &#40;5&#41; non-representative&#46; These two last types of samples were defined as non-diagnostic&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">EBUS-TBNA</span><p class="elsevierStylePara">All procedures were performed under general anesthesia using the rigid bronchoscope&#46; EBUS-TBNA was performed through a dedicated endoscope &#40;BF-UC180F&#44; Olympus&#41; using a convex probe with a 7&#46;5&#160;mHz transducer coupled on its tip which provides images parallel to the insertion of the bronchoscope&#46; A 22-gauge needle &#40;NA-201SX-4022&#44; Olympus&#41; was used to perform the aspirations&#46;</p><p class="elsevierStylePara">The exams were carried out by the same three pulmonologists with about 2 years of experience in performing EBUS-TBNA&#44; who had at least performed 40 or more procedures&#46;</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Final diagnosis</span><p class="elsevierStylePara">The final diagnosis was based on EBUS-TBNA definitive pathological and microbiological results&#46; In case of reactive lymphoid tissue or non-diagnostic samples&#44; the final diagnosis was established or confirmed through additional exams and&#47;or by clinical and radiographic follow-up for at least 6 months&#46;</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Statistical analysis</span><p class="elsevierStylePara">Data were analyzed with IBM<span class="elsevierStyleSup">&#174;</span> SPSS<span class="elsevierStyleSup">&#174;</span> Statistics version 19&#46;0 software&#46; We reported data for continuous variables as means &#40;with standard deviation&#41; and for categorical variables as percentages&#46; Unpaired <span class="elsevierStyleItalic">t</span> Student&#39;s test was used to compare age&#44; diameter of lesions and number of punctures between two groups&#46; Chi square test or Fisher&#39;s exact test were used to compare results of EBUS-TBNA &#40;adequacy of the aspirated material and diagnostic accuracy&#41; in the two groups&#46; Results were considered statistically significant when the <span class="elsevierStyleItalic">p</span> value was less than 0&#46;05&#46; Diagnostic sensitivity&#44; specificity&#44; positive predictive value &#40;PPV&#41;&#44; negative predictive value &#40;NPV&#41; and diagnostic accuracy were determined according to the standard definitions&#46; We calculated sensitivity&#44; NPV and accuracy with and without inclusion of non-diagnostic specimens &#40;adding to false negative samples&#41;&#46; Test performance measures were calculated as a combination of all samples per patient&#46;</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara">Between January and December 2012&#44; 81 patients who performed EBUS-TBNA were divided into two groups&#58; 41 patients in ROSE group and 40 patients in non-ROSE group&#46;</p><p class="elsevierStylePara">The indication for EBUS-TBNA was the investigation of hilo-mediastinal lesions in 29 patients &#40;71&#37;&#41; in ROSE group and in 32 patients &#40;80&#37;&#41; in non-ROSE group&#59; and lung cancer staging in 12 patients &#40;29&#37;&#41; in ROSE group and in 8 patients &#40;20&#37;&#41; in non-ROSE group&#46;</p><p class="elsevierStylePara">There was no statistically significant difference between the groups in respect to age&#44; gender&#44; type and diameter of the lesion &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#41;&#46;</p><p class="elsevierStylePara">Table 1&#46; Demographic characteristics and baseline data&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Characteristics</td><td>ROSE group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;41&#41;</td><td>Non-ROSE group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;40&#41;</td><td><span class="elsevierStyleItalic">p</span>-Value</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; mean &#40;&#177;SD&#41;</span></td><td>55&#46;6 &#40;&#177;15&#46;6&#41;</td><td>60&#46;3 &#40;&#177;14&#46;7&#41;</td><td>0&#46;16</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Males&#44; n &#40;&#37;&#41;</span></td><td>31 &#40;76&#41;</td><td>23 &#40;58&#41;</td><td>0&#46;08</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Investigation of mediastinal&#47;hilar lesions etiology&#44; n &#40;&#37;&#41;</span></td><td>29 &#40;71&#41;</td><td>32 &#40;80&#41;</td><td>0&#46;33</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Lung cancer staging&#44; n &#40;&#37;&#41;</span></td><td>12 &#40;29&#41;</td><td>8 &#40;20&#41;</td><td>&#160;</td></tr><tr align="left"><td colspan="4"><span class="elsevierStyleItalic">Type of biopsied lesion</span></td></tr><tr align="left"><td>Lymph node &#40;<span class="elsevierStyleItalic">n</span>&#41;</td><td>62</td><td>52</td><td>0&#46;32</td></tr><tr align="left"><td>Mass &#40;<span class="elsevierStyleItalic">n</span>&#41;</td><td>7</td><td>7</td><td>&#160;</td></tr><tr align="left"><td colspan="4"><span class="elsevierStyleItalic">Lymph node station &#40;n&#41;</span></td></tr><tr align="left"><td>2R</td><td>4</td><td>1</td><td>0&#46;32</td></tr><tr align="left"><td>2L</td><td>1</td><td>0</td><td>&#160;</td></tr><tr align="left"><td>4R</td><td>22</td><td>18</td><td>0&#46;32</td></tr><tr align="left"><td>4L</td><td>1</td><td>4</td><td>&#160;</td></tr><tr align="left"><td>7</td><td>29</td><td>19</td><td>&#160;</td></tr><tr align="left"><td>10R</td><td>4</td><td>3</td><td>&#160;</td></tr><tr align="left"><td>10L</td><td>1</td><td>2</td><td>&#160;</td></tr><tr align="left"><td>11R</td><td>0</td><td>2</td><td>&#160;</td></tr><tr align="left"><td>11L</td><td>0</td><td>3</td><td>&#160;</td></tr><tr align="left"><td colspan="4"><span class="elsevierStyleItalic">Mass location &#40;n&#41;</span></td></tr><tr align="left"><td>Paratracheal</td><td>2</td><td>2</td><td>&#160;</td></tr><tr align="left"><td>Hilar</td><td>2</td><td>2</td><td>&#160;</td></tr><tr align="left"><td>Mediastinal</td><td>3</td><td>3</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Lymph node size &#40;mm&#41;&#44; mean &#40;&#177;SD&#41;</span></td><td>16&#46;3 &#40;&#177;11&#46;2&#41;</td><td>17&#46;3 &#40;&#177;7&#46;6&#41;</td><td>0&#46;70</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Mass size &#40;mm&#41;&#44; mean &#40;&#177;SD&#41;</span></td><td>36&#46;8 &#40;&#177;17&#46;0&#41;</td><td>41&#46;5&#40;&#177;25&#46;4&#41;</td><td>0&#46;73</td></tr></table><p class="elsevierStylePara">The percentage of patients with adequate samples was 93&#37; in ROSE group and 80&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#46;</p><p class="elsevierStylePara">When the objective of the procedure was investigation of hilo-mediastinal lesions&#44; 93&#37; of patients had adequate samples in ROSE group and 75&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;06&#41;&#46; When the purpose was lung cancer staging&#44; 92&#37; patients had adequate samples in ROSE group and 100&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;1&#46;00&#41; &#40;<a href="&#35;t0010" class="elsevierStyleCrossRefs">Table 2</a>&#41;&#46;</p><p class="elsevierStylePara">Table 2&#46; Adequacy of cytological samples&#46;</p><a name="t0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Patients</td><td colspan="3">Adequate sampling</td></tr><tr align="left"><td>&#160;</td><td>ROSE group</td><td>Non-ROSE group</td><td><span class="elsevierStyleItalic">p</span>-Value</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Total of patients&#44; n&#47;total &#40;&#37;&#41;</span></td><td>38&#47;41 &#40;93&#41;</td><td>32&#47;40 &#40;80&#41;</td><td>0&#46;10</td></tr><tr align="left"><td>Investigation of mediastinal&#47;hilar lesions etiology&#44; <span class="elsevierStyleItalic">n</span>&#47;total &#40;&#37;&#41;</td><td>27&#47;29 &#40;93&#41;</td><td>24&#47;32 &#40;75&#41;</td><td>0&#46;06</td></tr><tr align="left"><td>Lung cancer staging&#44; <span class="elsevierStyleItalic">n</span>&#47;total &#40;&#37;&#41;</td><td>11&#47;12 &#40;92&#41;</td><td>8&#47;8 &#40;100&#41;</td><td>1&#46;00</td></tr></table><p class="elsevierStylePara">EBUS-TBNA results and the final diagnosis in both groups are described in <a href="&#35;t0015" class="elsevierStyleCrossRefs">Table 3</a>&#46; Reactive lymphoid tissue or non-diagnostic samples occurred in 17 of 41 patients &#40;42&#37;&#41; in ROSE group and in 26 of 40 patients &#40;65&#37;&#41; in non-ROSE group&#46; These patients underwent additional diagnostic procedures and&#47;or were followed up clinically and radiographically at least during 6 months to establish the final diagnosis&#46; In ROSE group&#44; the final diagnosis was based on additional procedures in five patients&#58; two transthoracic needle aspiration&#44; one thoracotomy&#44; one mediastinoscopy and one bronchoalveolar lavage&#59; diagnosis of the remaining patients was based on follow-up &#40;except one patient &#8211; lost to follow-up&#41;&#46; In the non-ROSE group&#44; additional tests were required in 14 patients&#58; four thoracotomy&#44; two peripheral lymph node biopsy&#44; two EBUS-TBNA repetition&#44; one transthoracic needle aspiration&#44; one pleural biopsy&#44; one bronchial biopsy&#44; two bronchoalveolar lavage&#44; and one mediastinoscopy&#59; clinical and radiographical follow-up established the final diagnosis in eight patients&#59; the remaining four patients were lost to follow-up&#46;</p><p class="elsevierStylePara">Table 3&#46; Results of EBUS-TBNA and final diagnosis&#46;</p><a name="t0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>EBUS-TBNA findings</td><td colspan="4">Patients &#40;final diagnosis&#41;&#44;</td></tr><tr align="left"><td>&#160;</td><td colspan="2">ROSE &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;41&#41;</td><td colspan="2">Non-ROSE &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;40&#41;</td></tr><tr align="left"><td colspan="5"><span class="elsevierStyleBold">Malignant</span></td></tr><tr align="left"><td colspan="5"><span class="elsevierStyleItalic">Primary lung cancer</span></td></tr><tr align="left"><td>Adenocarcinoma</td><td>6</td><td>&#160;</td><td>4</td><td>&#160;</td></tr><tr align="left"><td>Squamous cell carcinoma</td><td>1</td><td>&#160;</td><td>1</td><td>&#160;</td></tr><tr align="left"><td>NSCLC-NOS</td><td>5</td><td>&#160;</td><td>1</td><td>&#160;</td></tr><tr align="left"><td>Small cell carcinoma</td><td>0</td><td>&#160;</td><td>2</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Metastatic carcinoma</span></td><td>0</td><td>&#160;</td><td>1</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Lymphoma</span></td><td>1</td><td>&#160;</td><td>0</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Malignant neoplasia</span></td><td>1</td><td>&#160;</td><td>2</td><td>&#160;</td></tr><tr align="left"><td colspan="5">&#160;</td></tr><tr align="left"><td colspan="5"><span class="elsevierStyleBold">Benign</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Sarcoidosis</span></td><td>8</td><td>&#160;</td><td>2</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Tuberculosis</span></td><td>0</td><td>&#160;</td><td>1</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Aspergillosis</span></td><td>1</td><td>&#160;</td><td>0</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Bronchogenic cyst</span></td><td>1</td><td>&#160;</td><td>0</td><td>&#160;</td></tr><tr align="left"><td colspan="5">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleBold">Negative for malignancy &#40;or reactive adenopathy&#41;</span></td><td>10</td><td>&#40;  3 FN &#58; 1 non-small cell carcinoma&#44; 2 sarcoidosis&#59;  7 TN &#58; 2 silicosis&#44; 5 unchanged with 6 months of follow-up&#41;</td><td>18</td><td>&#40;  5 FN &#58; 1 small cell carcinoma&#44; 1 occult carcinoma&#44; 1 lymphoma&#44; 1 sarcoidosis&#44; 1 granulomatous disease unspecified&#59;  11 TN &#58; unchanged with 6 months of follow-up&#59;  2 inconclusive &#58; lost to follow-up&#41;</td></tr><tr align="left"><td colspan="5">&#160;</td></tr><tr align="left"><td colspan="5"><span class="elsevierStyleBold">Nondiagnostic samples</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Inconclusive samples</span></td><td>4</td><td>&#40;1 small cell carcinoma&#44; 1 lymphoma&#44; 1 sarcoidosis&#44; 1 tuberculosis&#41;</td><td>0</td><td>&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Nonrepresentative samples</span></td><td>3</td><td>&#40;2 sarcoidosis&#44; 1 inconclusive &#8211; lost to follow-up&#41;</td><td>8</td><td>&#40;1 lymphoma&#44; 1 sarcoidosis&#44; 2 bronchogenic cyst&#44; 2 unchanged with 6 months of follow-up&#44; 2 inconclusive &#8211; lost to follow-up&#41;</td></tr></table><p class="elsevierStylePara">NSCLC-NOS&#44; non-small cell lung carcinoma not otherwise specified&#59; FN&#44; false negatives&#59; TN&#44; true negatives&#46;<br></br></p><p class="elsevierStylePara">In the ROSE group&#44; on-site evaluation was discordant with definitive pathological diagnosis in four cases &#40;10&#37;&#41;&#46; Disagreement was due to ROSE sample misinterpretation&#59; the abnormality was not identified on-site&#44; but after the observation of the whole sample&#46;</p><p class="elsevierStylePara">The overall diagnostic performance of EBUS-TBNA per patient with and without ROSE is detailed in <a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a>&#46; Two patients of non-ROSE group&#44; with a diagnostic of reactive lymphoid tissue by EBUS-TBNA and lost to follow-up&#44; were excluded&#46; The diagnostic accuracy was 91&#37; in the ROSE group and 83&#37; in the non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;08&#41;&#46; There were seven and eight patients in ROSE and non-ROSE groups&#44; respectively&#44; with non-diagnostic samples&#46; Adding the non-diagnostic samples to false negative samples&#44; diagnostic accuracy decreased to 76&#37; in ROSE group and 66&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;20&#41;&#46;</p><p class="elsevierStylePara">Table 4&#46; Diagnostic performance of EBUS-TBNA with and without ROSE&#46;</p><a name="t0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>&#160;</td><td>ROSE &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;41&#41;</td><td>Non-ROSE &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;40&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Nondiagnostic cases</span></td><td>17 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;7&#41;</td><td>20 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;8&#41;</td></tr><tr align="left"><td>Mediastinal&#47;hilar lesions investigation</td><td>21 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;6&#41;</td><td>25 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;8&#41;</td></tr><tr align="left"><td>Lung cancer staging</td><td>8 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41;</td><td>0 &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;0&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Sensitivity &#40;nondiagnostic included&#41;</span></td><td>89 &#40;71&#41;</td><td>74 &#40;52&#41;</td></tr><tr align="left"><td>Mediastinal&#47;hilar lesions investigation</td><td>85 &#40;65&#41;</td><td>69 &#40;46&#41;</td></tr><tr align="left"><td>Lung cancer staging</td><td>100 &#40;88&#41;</td><td>100 &#40;100&#41;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Specificity</span></td><td>100</td><td>100</td></tr><tr align="left"><td><span class="elsevierStyleItalic">PPV</span></td><td>100</td><td>100</td></tr><tr align="left"><td><span class="elsevierStyleItalic">NPV &#40;nondiagnostic included&#41;</span></td><td>70 &#40;41&#41;</td><td>69 &#40;46&#41;</td></tr><tr align="left"><td>Mediastinal&#47;hilar lesions investigation</td><td>50 &#40;25&#41;</td><td>46 &#40;29&#41;</td></tr><tr align="left"><td>Lung cancer staging</td><td>100 &#40;80&#41;</td><td>100</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Accuracy &#40;nondiagnostic included&#41;</span><span class="elsevierStyleSup">a</span></td><td>91 &#40;76&#41;</td><td>83 &#40;66&#41;</td></tr><tr align="left"><td>Mediastinal&#47;hilar lesions investigation  <span class="elsevierStyleSup">b</span></td><td>87 &#40;69&#41;</td><td>77 &#40;57&#41;</td></tr><tr align="left"><td>Lung cancer staging  <span class="elsevierStyleSup">c</span></td><td>100 &#40;92&#41;</td><td>100 &#40;100&#41;</td></tr></table><p class="elsevierStylePara">Data are presented as &#37;&#46;<br></br></p><p class="elsevierStylePara">a <span class="elsevierStyleItalic">p</span>-Value&#160;&#61;&#160;0&#46;08 &#40;0&#46;20&#41;&#46;<br></br>b <span class="elsevierStyleItalic">p</span>-Value&#160;&#61;&#160;0&#46;10 &#40;0&#46;21&#41;&#46;<br></br>c <span class="elsevierStyleItalic">p</span>-Value&#160;&#61;&#160;NA &#40;0&#46;13&#41;&#46;<br></br></p><p class="elsevierStylePara">Performance measures of EBUS-TBNA according to the indication of the exam were separately calculated &#40;<a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a>&#41;&#58; for hilo-mediastinal lesions investigation&#44; diagnostic accuracy of EBUS-TBNA was 87&#37; in ROSE group vs&#46; 77&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#59; for lung cancer staging diagnostic accuracy was 100&#37; in both groups&#46;</p><p class="elsevierStylePara">The number of punctures per procedure was significantly lower in the ROSE group &#40;3&#46;4&#160;&#177;&#160;1&#46;7 vs&#46; 4&#46;5&#160;&#177;&#160;1&#46;7 punctures&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;002&#41;&#46;</p><p class="elsevierStylePara">In both groups there were no complications&#46;</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara">One of the main concerns of EBUS-TBNA is the quality of the sample obtained&#46; ROSE allows the immediate confirmation of the presence of lymph node tissue or the acquisition of a specific diagnosis and&#44; at the same time&#44; helps selecting additional studies such as immunocytochemistry&#44; microbiology&#44; flow cytometry and molecular studies&#46; The question is if this information substantially contributes to increase diagnostic accuracy of the test&#46;</p><p class="elsevierStylePara">In this study&#44; we found no statistically significant difference between the ROSE group and non-ROSE group in terms of sample adequacy&#46; However&#44; we found an important trend toward having more adequate samples with ROSE in patients for whom the purpose of the exam was the study of hilo-mediastinal lesions &#40;93&#37; of patients with adequate samples in ROSE group vs&#46; 75&#37; in non-ROSE group&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;06&#41;&#46;</p><p class="elsevierStylePara">In the non-ROSE group&#44; sample adequacy might have been improved by the performance of&#44; at least&#44; four punctures per lesion&#46; Studies have reported that three aspirates per lesion maximized the yield of EBUS-TBNA for the staging of lung cancer&#46;<a href="&#35;bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> For the acquisition of high-quality tissue for molecular profiling for lung cancer genotyping&#44; Yarmus et al&#46;<a href="&#35;bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a> showed that a minimum of four needle passes per lesion were needed&#46;</p><p class="elsevierStylePara">Regarding diagnostic accuracy&#44; despite the lack of statistical significance&#44; it was higher in ROSE group than in non-ROSE group in the investigation of hilo-mediastinal lesions &#40;87&#37; in ROSE group vs&#46; 77&#37; in non-ROSE group&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#46; Previous studies have suggested that on-site evaluation of TBNA specimens increase the diagnostic yield&#46;<a href="&#35;bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a> Gu et al&#46;&#44;<a href="&#35;bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a> in a meta-analysis&#44; also found this tendency to get better results with ROSE&#44; but the heterogeneity between the studies hampered obtaining satisfactory results&#46; On the other hand&#44; Oki et al&#46;&#44;<a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> in a randomized study&#44; and Griffin et al&#46;&#44;<a href="&#35;bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> in a retrospective study&#44; found that ROSE did not significantly increase the diagnostic yield of EBUS-TBNA&#46; Concerning conventional TBNA&#44; recent randomized studies of Trisolini et al&#46;<a href="&#35;bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a> and Yarmus et al&#46;<a href="&#35;bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">15</span></a> also showed no benefit on diagnostic yield related to the use of ROSE&#46;</p><p class="elsevierStylePara">Relatively to lung cancer staging&#44; we did not find advantages of ROSE either in sample adequacy or in diagnostic accuracy&#46; Therefore&#44; in this study&#44; ROSE was more useful for mediastinal lesions diagnosis than for lung cancer staging&#46; The lack of benefit of ROSE in lung cancer staging could be explained by the small sample size of this subgroup of patients&#46; Consequently&#44; these results need to be confirmed in larger samples&#46;</p><p class="elsevierStylePara">To achieve the final diagnosis&#44; the patients of non-ROSE group needed more additional procedures&#46; However&#44; this fact can be justified by the higher prevalence of reactive lymph nodes in this group that required additional investigation&#46;</p><p class="elsevierStylePara">ROSE during EBUS-TBNA decreased the number of punctures per procedure&#46; However&#44; the increase in the number of punctures in non-ROSE group was not associated to a higher complication rate&#46; These results are in accordance with other publications&#46;<a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">This study enrolled an unselected group of consecutive patients&#44; with various diagnostic suspicions&#44; who performed EBUS-TBNA&#46; Therefore&#44; it confirms the usefulness of EBUS-TBNA as the initial test not only for lung cancer diagnosis or staging but also for investigation of hilo-mediastinal lesions observed in computerized tomography &#40;e&#46;g&#46; in the diagnosis of sarcoidosis&#41;&#46;</p><p class="elsevierStylePara">Some limitations of this study have to be addressed&#46; The sample was heterogeneous and too small to demonstrate&#44; unequivocally&#44; the advantage of ROSE regarding adequacy of samples and diagnostic accuracy of EBUS-TBNA&#46; Therefore&#44; no statistical significant difference between the two groups was achieved&#46; There only was a trend to obtain better results in ROSE group when the purpose was the diagnosis of hilo-mediastinal lesions&#46; Being an observational study&#44; some confounding variables could not be controlled&#44; such as the fact that ROSE group had been evaluated before the non-ROSE group and the interventional pneumologists had acquired more experience&#46;</p><a name="sec0050" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStylePara">The adequacy of the samples and the diagnostic accuracy of EBUS-TBNA were not statistically influenced by the availability of ROSE&#46; Despite this&#44; there was a trend toward achieving more adequate samples and better diagnostic accuracy with ROSE in the investigation of hilo-mediastinal lesions&#46; For lung cancer staging this advantage was not evident&#46;</p><a name="sec0055" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflict of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><a name="sec0060" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0065" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study&#46;</p><a name="sec0070" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p><a name="sec0075" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article&#46;</p><a name="sec0080" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Authorship</span><p class="elsevierStylePara">All listed authors participated in the study conception and design&#44; in the data acquisition&#47;analysis and in the writing of the article&#46;</p><p class="elsevierStylePara">Received 26 September 2014 <br></br>Accepted 16 February 2015 </p><p class="elsevierStylePara">Corresponding author&#46; car&#95;veronica&#64;sapo&#46;pt</p>"
    "pdfFichero" => "320v21n05a90436494pdf001.pdf"
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    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec640972"
          "palabras" => array:4 [
            0 => "EBUS-TBNA"
            1 => "ROSE"
            2 => "Sample adequacy"
            3 => "Diagnostic accuracy"
          ]
        ]
      ]
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    "resumen" => array:1 [
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><br/><p class="elsevierStylePara">Rapid on-site evaluation &#40;ROSE&#41; has the potential to increase endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41; accuracy in the diagnosis of mediastinal lesions and lung cancer staging&#46; However&#44; studies have reported controversial results&#46;</p><p class="elsevierStylePara">The purpose of our study was to evaluate the influence of ROSE on sample adequacy and diagnostic accuracy of EBUS-TBNA&#46;</p><span class="elsevierStyleSectionTitle">Methods</span><br/><p class="elsevierStylePara">Prospective observational study that enrolled 81 patients who underwent EBUS-TBNA for investigation of hilo-mediastinal lesions or lung cancer staging&#46; The first 41 patients underwent EBUS-TBNA with ROSE &#40;ROSE group&#41; and the last 40 patients without ROSE &#40;non-ROSE group&#41;&#46; Sample adequacy and diagnostic accuracy of EBUS-TBNA in both groups were compared&#46;</p><span class="elsevierStyleSectionTitle">Results</span><br/><p class="elsevierStylePara">Adequate samples were obtained in 93&#37; of the patients in the ROSE group and 80&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#46; The diagnostic accuracy of EBUS-TBNA was 91&#37; in ROSE group and 83&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;08&#41;&#46; Analyzing the EBUS-TBNA purpose&#44; in the subgroup of patients who underwent EBUS-TBNA for investigation of hilo-mediastinal lesions&#44; these differences between ROSE and non-ROSE group were higher compared to lung cancer staging&#44; 93&#37; of patients with adequate samples in the ROSE group vs&#46; 75&#37; in the non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;06&#41; and 87&#37; of diagnostic accuracy in ROSE group vs&#46; 77&#37; in non-ROSE group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;10&#41;&#46;</p><span class="elsevierStyleSectionTitle">Conclusions</span><br/><p class="elsevierStylePara">Despite the lack of statistical significance&#44; ROSE appears to be particularly useful in the diagnostic work-up of hilo-mediastinal lesions&#44; increasing the diagnostic yield of EBUS-TBNA&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Endobronchial ultrasound&#x002D;guided transbronchial needle aspiration cytology: a state of the art review. Cytopathology. 2010; 21:6&#x002D;26."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration cytology&#58; a state of the art review&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Cameron SE"
                            1 => "Andrade RS"
                            2 => "Pambuccian SE&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2303.2009.00722.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cytopathology. "
                        "fecha" => "2010"
                        "volumen" => "21"
                        "paginaInicial" => "6"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20015257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Effectiveness and safety of endobronchial ultrasound&#x002D;transbronchial needle aspiration: a systematic review. Eur Respir J. 2009; 33:1156&#x002D;64."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration&#58; a systematic review&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Varela-Lema L"
                            1 => "Fern&#225;ndez-Villar A"
                            2 => "Ruano-Ravina A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00097908"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J. "
                        "fecha" => "2009"
                        "volumen" => "33"
                        "paginaInicial" => "1156"
                        "paginaFinal" => "1164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19407050"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Endobronchial ultrasound&#x002D;guided transbronchial needle aspiration. Int J Clin Pract. 2010; 64:1773&#x002D;83."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Medford ARL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-1241.2010.02454.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pract. "
                        "fecha" => "2010"
                        "volumen" => "64"
                        "paginaInicial" => "1773"
                        "paginaFinal" => "1783"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21070528"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Diagnostic difficulties and pitfalls in rapid on&#x002D;site evaluation of endobronchial ultrasound guided fine needle aspiration. Cytojournal. 2010; 7:9."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Diagnostic difficulties and pitfalls in rapid on-site evaluation of endobronchial ultrasound guided fine needle aspiration&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Monaco SE"
                            1 => "Schuchert MJ"
                            2 => "Khalbuss WE&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1742-6413.64385"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cytojournal. "
                        "fecha" => "2010"
                        "volumen" => "7"
                        "paginaInicial" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20607094"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rapid on&#x002D;site cytologic evaluation during endobronchial ultrasound&#x002D;guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg. 2013; 95:1695&#x002D;9."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Nakajima T"
                            1 => "Yasufuku K"
                            2 => "Saegusa F"
                            3 => "Fujiwara T"
                            4 => "Sakairi Y"
                            5 => "Hiroshima K"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2012.09.074"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg. "
                        "fecha" => "2013"
                        "volumen" => "95"
                        "paginaInicial" => "1695"
                        "paginaFinal" => "1699"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245441"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Improved laboratory resource utilization and patient care with the use of rapid on&#x002D;site evaluation for endobronchial ultrasound fine&#x002D;needle aspiration biopsy. Cancer Cytopathol. 2013; 10:544&#x002D;51."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Improved laboratory resource utilization and patient care with the use of rapid on-site evaluation for endobronchial ultrasound fine-needle aspiration biopsy&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Collins BT"
                            1 => "Chen AC"
                            2 => "Wang JF"
                            3 => "Bernadt CT"
                            4 => "Sanati S&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer Cytopathol. "
                        "fecha" => "2013"
                        "volumen" => "10"
                        "paginaInicial" => "544"
                        "paginaFinal" => "551"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rapid on&#x002D;site cytologic evaluation during endobronchial ultrasound&#x002D;guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration. 2013; 85:486&#x002D;92."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer&#58; a randomized study&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Oki M"
                            1 => "Saka H"
                            2 => "Kitagawa C"
                            3 => "Kogure Y"
                            4 => "Murata N"
                            5 => "Adachi T"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000346987"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration. "
                        "fecha" => "2013"
                        "volumen" => "85"
                        "paginaInicial" => "486"
                        "paginaFinal" => "492"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23571718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Utility of on&#x002D;site evaluation of endobronchial ultrasound&#x002D;guided transbronchial needle aspiration specimens. Cytojournal. 2011; 8:20."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Griffin AC"
                            1 => "Schwartz LE"
                            2 => "Baloch ZW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1742-6413.90081"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cytojournal. "
                        "fecha" => "2011"
                        "volumen" => "8"
                        "paginaInicial" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22145008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rapid on&#x002D;site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging. Ann Thorac Surg. 2013; 96:403&#x002D;10."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rapid on-site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Joseph M"
                            1 => "Jones T"
                            2 => "Lutterbie Y"
                            3 => "Maygarden SJ"
                            4 => "Feins RH"
                            5 => "Haithcock BE"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2013.04.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg. "
                        "fecha" => "2013"
                        "volumen" => "96"
                        "paginaInicial" => "403"
                        "paginaFinal" => "410"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23731611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Real&#x002D;time endobronchial ultrasound&#x002D;guided transbronchial needle aspiration in mediastinal staging of non&#x002D;small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008; 134:368&#x002D;74."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer&#58; how many aspirations per target lymph node station&#63;&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Lee HS"
                            1 => "Lee GK"
                            2 => "Lee HS"
                            3 => "Kim MS"
                            4 => "Lee LM"
                            5 => "Kim HY"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.07-2105"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest. "
                        "fecha" => "2008"
                        "volumen" => "134"
                        "paginaInicial" => "368"
                        "paginaFinal" => "374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18263688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Optimizing endobronchial ultrasound for molecular analysis: how many passes are needed. Ann Am Thorac Soc. 2013; 10:636&#x002D;43."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Optimizing endobronchial ultrasound for molecular analysis&#58; how many passes are needed&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Yarmus L"
                            1 => "Akulian J"
                            2 => "Gilbert C"
                            3 => "Feller-Kopman D"
                            4 => "Lee HJ"
                            5 => "Zarogoulidis P"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/AnnalsATS.201305-130OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Am Thorac Soc. "
                        "fecha" => "2013"
                        "volumen" => "10"
                        "paginaInicial" => "636"
                        "paginaFinal" => "643"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24079724"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed. Am J Respir Crit Care Med. 2002; 166:377&#x002D;81."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Transbronchial needle aspiration in diagnosing and staging lung cancer&#58; how many aspirates are needed&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Chin R"
                            1 => "McCain TW"
                            2 => "Lucia MA"
                            3 => "Cappellari JO"
                            4 => "Adair NE"
                            5 => "Lovato JF"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med. "
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "377"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12153974"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Endobronchial ultrasound&#x002D;guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta&#x002D;analysis. Eur J Cancer. 2009; 45:1389&#x002D;96."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer&#58; a systematic review and meta-analysis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gu P"
                            1 => "Zhao YZ"
                            2 => "Jiang LY"
                            3 => "Zhang W"
                            4 => "Xin Y"
                            5 => "Han BH&#46;"
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                  "referenciaCompleta" => "A randomized prospective trial of the utility of rapid on&#x002D;site evaluation of transbronchial needle aspirate specimens. J Bronchol Interv Pulmonol. 2011; 18:121&#x002D;7."
                  "contribucion" => array:1 [
                    0 => array:3 [
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Article information
ISSN: 08732159
Original language: English
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