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Rapid on-site evaluation: what a microscope will add to the bronchoscopy unit? a concise review


Rapid on-site evaluation (ROSE) of samples obtained by transbronchial needle aspiration during flexible bronchoscopy or endobronchial ultrasound has been practised for more than two decades. Earlier studies evaluating its role have reported a magical impact on improving the diagnostic yield and the adequacy of samples produced by transbronchial needle aspiration. Subsequent studies with more rigorous methodologies failed to find a significant increase in sensitivity with ROSE but consistently demonstrated a trend toward performing shorter procedures with fewer complications when ROSE is utilized. There are new exciting fronts for ROSE, such as using it to direct molecular testing for lung cancer. In the future, we expect more centers to apply ROSE, now that pulmonologists have succeeded in doing so and telecytopathology has become reality.


  1. Schmidt RL, Witt BL, Lopez-Calderon LE, Layfield LJ. The influence of rapid onsite evaluation on the adequacy rate of fine-needle aspiration cytology: a systematic review and meta-analysis. Am J Clin Pathol 2013; 139:300–308.

    Article  Google Scholar 

  2. Xia Y, Wang KP. Transbronchial needle aspiration: where are we now? J Thorac Dis 2013; 5:678–682.

    PubMed  PubMed Central  Google Scholar 

  3. Diacon AH, Schuurmans MM, Theron J, Brundyn K, Louw M, Wright CA, Bolliger CT. Transbronchial needle aspirates: how many passes per target site? Eur Respir J 2007; 29:112–116.

    Article  CAS  Google Scholar 

  4. Davenport RD. Rapid on-site evaluation of transbronchial aspirates. Chest 1990; 98:59–61.

    Article  CAS  Google Scholar 

  5. Yasufuku K. Linear endobronchial ultrasound. In: Ernst A, Herth FJ, editors. Principles and practice of interventional pulmonology. New York, NY: Springer; 2013. 185–195. Available at: [Accessed 5 April 2016].

    Chapter  Google Scholar 

  6. Trisolini R, Cancellieri A, Tinelli C, de Biase D, Valentini I, Casadei G, et al. Randomized trial of endobronchial ultrasound-guided transbronchial needle aspiration with and without rapid on-site evaluation for lung cancer genotyping. Chest 2015; 148:1430–1437.

    Article  Google Scholar 

  7. Diette GB, White P Jr, Terry P, Jenckes M, Rosenthal D, Rubin HR. Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy. Chest 2000; 117:1186–1190.

    Article  CAS  Google Scholar 

  8. Chin R Jr, McCain TW, Lucia MA, Cappellari JO, Adair NE, Lovato JF, et al. Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed? Am J Respir Crit Care Med 2002; 166:377–381.

    Article  Google Scholar 

  9. Diacon AH, Schuurmans MM, Theron J, Louw M, Wright CA, Brundyn K, Bolliger CT. Utility of rapid on-site evaluation of transbronchial needle aspirates. Respiration 2005; 72:182–188.

    Article  Google Scholar 

  10. Baram D, Garcia RB, Richman PS. Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration. Chest 2005; 128:869–875.

    Article  Google Scholar 

  11. Cardoso AV, Neves I, Magalhães A, Sucena M, Barroca H, Fernandes G. The value of rapid on-site evaluation during EBUS-TBNA. Rev Port Pneumol (2006) 2015; 21:253–258.

    CAS  Google Scholar 

  12. Trisolini R, Cancellieri A, Tinelli C, Paioli D, Scudeller L, Casadei GP, et al. Rapid on-site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy: a randomized trial. Chest 2011; 139:395–401.

    Article  Google Scholar 

  13. Yarmus L, van der Kloot T, Lechtzin N, Napier M, Dressel D, Feller- Kopman D. A randomized prospective trial of the utility of rapid on-site evaluation of transbronchial needle aspirate specimens. J Bronchology Interv Pulmonol 2011; 18:121–127.

    Article  Google Scholar 

  14. Brundyn K, Koegelenberg CF, Diacon AH, Louw M, Schubert P, Bolliger CT, et al. Transbronchial fine needle aspiration biopsy and rapid on-site evaluation in the setting of superior vena cava syndrome. Diagn Cytopathol 2013; 41:324–329.

    Article  CAS  Google Scholar 

  15. Griffin AC, Schwartz LE, Baloch ZW. Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens. Cytojournal 2011; 8:20.

    Article  Google Scholar 

  16. Plit ML, Havryk AP, Hodgson A, James D, Field A, Carbone S, et al. Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis. Eur Respir J 2013; 42:1302–1308.

    Article  Google Scholar 

  17. Nakajima T, Yasufuku K, Saegusa F, Fujiwara T, Sakairi Y, Hiroshima K, et al. Rapid on-site cytologic evaluation during endobronchial ultrasoundguided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg 2013; 95:1695– 1699.

    Article  Google Scholar 

  18. Eapen GA, Shah AM, Lei X, Jimenez CA, Morice RC, Yarmus L, et al. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE registry. Chest 2013; 143:1044–1053.

    Article  Google Scholar 

  19. Joseph M, Jones T, Lutterbie Y, Maygarden SJ, Feins RH, Haithcock BE, et al. Rapid on-site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging. Ann Thorac Surg 2013; 96:403–410.

    Article  Google Scholar 

  20. Bruno P, Ricci A, Esposito MC, Scozzi D, Tabbì L, Sposato B, et al. Efficacy and cost effectiveness of rapid on site examination (ROSE) in management of patients with mediastinal lymphadenopathies. Eur Rev Med Pharmacol Sci 2013; 17:1517–1522.

    PubMed  CAS  Google Scholar 

  21. Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ando M. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration 2013; 85:486–492.

    Article  Google Scholar 

  22. Sindhwani G, Rawat J, Chandra S, Kusum A, Rawat M. Transbronchial needle aspiration with rapid on-site evaluation: a prospective study on efficacy, feasibility and cost effectiveness. Indian J Chest Dis Allied Sci 2013; 55:141–144.

    PubMed  Google Scholar 

  23. Khurana KK, Kovalovsky A, Wang D, Lenox R. Feasibility of dynamic telecytopathology for rapid on-site evaluation of endobronchial ultrasoundguided transbronchial fine needle aspiration. Telemed J E Health 2013; 19:265–271.

    Article  Google Scholar 

  24. Bonifazi M, Sediari M, Ferretti M, Poidomani G, Tramacere I, Mei F, et al. The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: a prospective study. Chest 2014; 145:60–65.

    Article  Google Scholar 

  25. Minami D, Takigawa N, Inoue H, Hotta K, Tanimoto M, Kiura K. Rapid onsite evaluation with BIOEVALUATOR(®) during endobronchial ultrasoundguided transbronchial needle aspiration for diagnosing pulmonary and mediastinal diseases. Ann Thorac Med 2014; 9:14–17.

    Article  Google Scholar 

  26. Murakami Y, Oki M, Saka H, Kitagawa C, Kogure Y, Ryuge M, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of small cell lung cancer. Respir Investig 2014; 52:173–178.

    Article  Google Scholar 

  27. Jeffus SK, Joiner AK, Siegel ER, Massoll NA, Meena N, Chen C, et al. Rapid on-site evaluation of EBUS-TBNA specimens of lymph nodes: comparative analysis and recommendations for standardization. Cancer Cytopathol 2015; 123:362–372.

    Article  Google Scholar 

  28. Mallya V, Kumar SP, Meganathan P, Shivkumar S, Mehta R. The utility of ROSE (rapid on-site evaluation) in endobronchial ultrasound (EBUS)- guided transbronchial needle aspiration (TBNA): Is the picture rosy? J Cytol 2015; 32:230–233.

    Article  Google Scholar 

  29. Guo H, Liu S, Guo J, Li B, Li W, Lu Z, et al. Rapid on-site evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of hilar and mediastinal lymphadenopathy in patients with lung cancer. Cancer Lett 2016; 371:182–186.

    Article  CAS  Google Scholar 

  30. Madan NK, Madan K, Jain D, Walia R, Mohan A, Hadda V, et al. Utility of conventional transbronchial needle aspiration with rapid on-site evaluation (c-TBNA-ROSE) at a tertiary care center with endobronchial ultrasound (EBUS) facility. J Cytol 2016; 33:22–26.

    Article  Google Scholar 

  31. Rokadia H, Mehta A, Culver DA, Patel J, Machuzak M, Almeida F, et al. Rapid on-site cytological examination (ROSE) in detection of granulomas in the mediastinal lymph nodes. Ann Am Thorac Soc 2016; 13:850–855.

    Article  Google Scholar 

  32. Kini SR. Color atlas of pulmonary cytopathology. New York, NY: Springer; 2002. Available at: [Accessed 4 March 2016].

    Book  Google Scholar 

  33. Bonifazi M, Zuccatosta L, Trisolini R, Moja L, Gasparini S. Transbronchial needle aspiration: a systematic review on predictors of a successful aspirate. Respiration 2013; 86:123–134.

    Article  Google Scholar 

  34. Casadio C, Guarize J, Donghi S, di Tonno C, Fumagalli C, Vacirca D, et al. Molecular testing for targeted therapy in advanced non-small cell lung cancer: suitability of endobronchial ultrasound transbronchial needle aspiration. Am J Clin Pathol 2015; 144:629–634.

    Article  CAS  Google Scholar 

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Correspondence to Maged Hassan.

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Hassan, M. Rapid on-site evaluation: what a microscope will add to the bronchoscopy unit? a concise review. Egypt J Bronchol 10, 206–211 (2016).

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  • bronchoscopy
  • endobronchial ultrasound
  • on-site cytology
  • rapid on-site evaluation
  • transbronchial needle aspiration