Molecular testing on endobronchial ultrasound (EBUS) fine needle aspirates (FNA): Impact of triage

Simon Sung, John P. Crapanzano, David DiBardino, David Swinarski, William A. Bulman, Anjali Saqi

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background: Endobronchial ultrasound (EBUS)-guided fine needle aspiration (FNA) is performed to diagnose and stage lung cancer. Multiple studies have described the value of Rapid On-Site Evaluation (ROSE), but often the emphasis is upon diagnosis than adequacy for molecular testing (MT). The aim was to identify variable(s), especially cytology-related, that can improve MT. Methods: A search for EBUS-FNAs with ROSE was conducted for lung adenocarcinomas or when this diagnosis could not be excluded. All such cases underwent reflex MT on cell blocks. The impact of cytology-related variables [i.e., number of pass(es), dedicated pass(es) directly into media, cytotechnologist (CT), laboratory technician (LT) and triage with 1 or >1 cytologist] was evaluated. The latter category was divided into Group A [ROSE, triage and slide preparation by cytopathologist (CP) and CT at start of the procedure] and Group B (ROSE only by CT or by CT/CP after start of procedure; triage and slide preparation by CT or clinical staff). The impact of all these variables on MT was assessed. Results: A total of 100 cases were identified, and 79 had sufficient tissue for MT. Of all variables evaluated, MT was positively affected by performing a direct dedicated pass (P = 0.013) and ROSE by Group A (P = 0.033). Conclusions: ROSE with appropriate triage, including performing a dedicated pass and proper slide preparation, improves MT, and this is enhanced by having >1 cytologist at the start of the procedure. In the era of personalized medicine, “adequate” should denote sufficient tissue for diagnosis and MT.

Original languageEnglish (US)
Pages (from-to)122-130
Number of pages9
JournalDiagnostic Cytopathology
Issue number2
StatePublished - Feb 2018
Externally publishedYes


  • ROSE
  • endobronchial ultrasound fine needle aspiration
  • lung
  • molecular testing
  • rapid on-site evaluation
  • triage and adequacy

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology


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