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It Is Time for This ‘ROSE’ to Flower

2005; Karger Publishers; Volume: 72; Issue: 2 Linguagem: Inglês

10.1159/000084041

1423-0356

Stefano Gasparini,

Salivary Gland Tumors Diagnosis and Treatment

tochemistry or microbiological studies, or to repeat the sample using histology needles, if histological material is considered useful for perfecting the diagnosis. A ‘ROSE’ is a fl ower, but it is also the acronym frequently employed to indicate Rapid On-Site Evaluation of the material obtained by needle aspiration techniques; other authors use the less romantic acronym ICA, which stands for Immediate Cytological Assessment [3] . In recent years, in an effort to improve the sensitivity and the diagnostic yield of the needle aspiration techniques, new technologies of guidance have been proposed (endobronchial ultrasound, virtual bronchoscopy, CT fl uoroscopy, 3D navigation systems) [4–6] , but only few papers have focused on the role of correct management, preparation and examination of the sampled material which is an essential point to achieve good results. In 1993, analyzing data from 55 patients who underwent percutaneous fi ne-needle aspiration from a lung lesion suspected for cancer, Austin and Cohen [7] obtained a sensitivity of 100% in 25 cases performed with ROSE and of 80% in 30 cases where the biopsy was performed without the cytopathologist. In the same paper, the metaanalysis of the previously published data showed that the immediate cytological assessment was associated with a statistically signifi cant increase in diagnostic accuracy compared with the procedures performed when a cytopathologist was not present. In 1998, in a series of 207 TBNA performed on 161 patients, comparing 73 aspirates using ROSE with 134 routinely processed samples, Davenport [8] showed that the percentage of specimens containing malignant cells increased from 31 to 56% and that the inadequate TBNA decreased from 56 to 18% In the last decades, needle aspiration techniques have gained ground in respiratory medicine, especially for the diagnosis and staging of lung cancer. Techniques such as percutaneous fi ne-needle aspiration and transbronchial needle aspiration (TBNA) have been demonstrated to be reliable sampling tools in clinical practice. Their use allows cytohistological diagnosis of malignancy and numerous benign conditions with good sensitivity and excellent specifi city, avoiding more invasive surgical procedures such as mediastinoscopy, video-assisted thoracoscopic surgery or thoracotomy [1, 2] . One of the advantages of the cytological aspiration techniques is the possibility to immediately evaluate the material with rapid stain methods to defi ne the adequacy of the sample and to obtain a preliminary diagnosis, if the cytopathologist is present in the diagnostic room. The presence of a cytopathologist during the needle aspiration procedures also ensures that the material will be treated and prepared in the best way. The results obtained by the immediate cytological assessment provides the operator with invaluable information on how to carry on with the procedure that can be stopped if the material is diagnostic, avoiding further and useless passes with the needle, thereby reducing time and risks. On the contrary, if the sample is not diagnostic, other needle passes can be performed by the operator who, on the basis of the information provided by the cytopathologist, could modify the technique of sampling or the point of punction. Furthermore, if required by the immediate assessment and deemed necessary by the cytopathologist, the operator could be invited to sample additional material for ancillary techniques, such as electron microscopy, immunocy-