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Introduction Rapid on-site evaluation (ROSE) is a technique used for immediate interpretation of transbronchial aspirates; there is debate as regards the contribution of ROSE to the diagnostic or staging process in patients with lung cancer undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Aim of the study The aim of this study was to evaluate the role of ROSE during EBUS-guided TBNA in the diagnosis of the nature of mediastinal/hilar lesions detected using thoracic computed tomography regardless of whether or not there is a known lung malignancy. Patients and methods All patients with hilar/mediastinal lymph nodes having short axis of at least 1 cmon new thoracic computed tomography scan were included. The target lymph node was examined using real-time EBUS B-mode, and then TBNA was performed by inserting a dedicated 22-G needle through the working channel of the bronchoscopy. The samples were examined using the ROSE technique and then compared with the results of the final pathologic diagnosis. Results The current study was conducted on 47 patients (29 male and 18 female) with a age (mean±SD) of 56±15.4 years. EBUS-TBNA was performed for 129 mediastinal lesions in different stations. Among them, 77 of them were diagnosed as malignant initially on performing ROSE. After final histopathological and immunological examination, 74 lesions were proved to be malignant, whereas three lesions turned out to be benign. 52 lesions were diagnosed as benign on ROSE, whereas four of them were proved to be malignant on the final diagnosis, giving ROSE a specificity of 94.12%, sensitivity of 94.87%, and diagnostic accuracy of 94.57%. Conclusion ROSE has add-on advantages to EBUS-TBNA in many aspects, increasing diagnostic accuracy of EBUS-TBNA, increasing safety, and providing sufficient samples for subsequent immunocytochemical and molecular analysis.

Introduction Mediastinal endosonography-guided aspiration has anteceded surgical staging as the step of choice for the diagnosis of mediastinal tissue disorders. Aim This study aimed to evaluate the diagnostic efficacy and safety of either endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA) or transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-FNA-B/E) in evaluating and biopsying the subcarinal region (station 7). Patients and methods Seventy-seven patients with enlarged subcarinal lymph nodes ‘short axis more than or equal to 1 cm’ as a preliminary station were divided randomly into two groups: group I included patients evaluated by EBUS-TBNA and group II included patients evaluated by EUS-FNA-B/E. The specimens were examined using the Rapid On Site Evaluation technique and then confirmed by the final histopathological and immunohistochemical evaluation. Results Fifty-one men and 26 women, mean±SD age (51.12±10.15 years), were divided into two groups. In group I, the mean±SD time spent during the procedure was 32.49±9.48 min, the mean±SD number of aspirations was 3.07±0.72, and the mean±SD O2 saturation was 83.59±4.34%; therefore, the mean±SD supplementary oxygen was 3.78±1.04 l/min. However, in group II, these values were 22.05±6.39 min, 2.00±0.67, 91.66±3.09%, and 1.71±1.19 l/min, respectively, with a significant difference. The sensitivity, negative predictive value, and diagnostic accuracy of EBUS-TBNA in diagnosing malignant lesions were 88, 67, and 90%, which were significantly less than those of EUS-FNA-B/E: 93, 86, and 95%, respectively. No severe complications were encountered with the use of both techniques. Conclusion The study recommends the usage of EUS-FNA-B/E than EBUS-TBNA in evaluating and biopsying the subcarinal region because of its better tolerability, higher diagnostic yield, and lower complication rate.