The Association of "GOOP" on Gross Examination of Fine Needle Aspiration Samples and On-Site Adequacy.

BACKGROUND: Rapid on-site cytologic evaluation (ROSE) is not always available for fine needle aspiration (FNA) specimens. We have examined the relationships between the presence of "GOOP" (defined as gooey white material) on FNA aspirates, on-site adequacy (OSA), and diagnosis. METHODS: Consecutive FNA samples obtained over the study interval were included. Samples were assessed macroscopically for the presence or absence of GOOP (GOOP+ or GOOP-). GOOP+ samples were further characterized as shiny (G+S) or cheesy (G+C). Gross descriptors were correlated with OSA and final diagnoses. RESULTS: Of the 204 sites biopsied, 102 were malignant, 94 benign, and 8 nondiagnostic. The presence of GOOP was highly predictive for adequacy (positive predictive value 98%). While these correlations for GOOP positivity were significant, the absence of GOOP did not rule out adequacy or malignancy. The presence of GOOP was also significantly correlated with a malignant diagnosis. CONCLUSIONS: We have prospectively demonstrated that the presence of GOOP correlates strongly with adequacy. This may be of value for those for whom ROSE is not available and, when available, may help prioritize specimens for on-site review.

Rapid On-Site Cytologic Evaluation: A Feasibility Study Using Ancillary Interventional Pulmonary Personnel.

BACKGROUND: Ancillary health professionals helping in a procedural service is a common practice everywhere. OBJECTIVES: This was a proof-of-concept study to assess feasibility of using ancillary personnel for rapid on-site cytologic evaluation (ROSE) at interventional pulmonary procedures. METHODS: After a training interval, a respiratory therapist (RT) performed ROSE on consecutive interventional pulmonary specimens. Sample sites included lymph nodes, lung, liver, and the left adrenal gland. RT findings were subsequently correlated with blinded cytopathology-performed ROSE and with final histopathology results, with primary foci of adequacy and the presence or absence of malignancy. RESULTS: Seventy consecutive cases involved 163 separate sites for ROSE analysis. Adequacy: There was a high level of concordance between RT-performed ROSE (RT-ROSE) and cytopathology ROSE (CYTO-ROSE). They agreed upon the adequacy of 159 specimens. The Cohen's κ coefficient ± asymptotic standard error (ASE) was 0.74 ± 0.175, with p < 0.0001. Malignancy: RT-ROSE concurred highly with CYTO-ROSE, with agreement on 150 (92%) of the 163 specimens. Cohen's κ coefficient ± ASE was 0.83 ± 0.045, with p < 0.0001. When the comparison was for malignancy by case rather than individual site, Cohen's κ coefficient ± ASE was 0.68 ± 0.08, with p < 0.0001. CONCLUSION: This study demonstrates that ancillary personnel supporting an interventional pulmonary service can be trained to perform initial ROSE. Cytopathology can be called after sampling and staining have produced adequate samples. This setup streamlines ROSE evaluation with regard to time and cost.

Tracheobronchial stent sizing and deployment practices airway stenting practices around the world: a survey study.

BACKGROUND: Tracheobronchial stents types, uses, techniques for deployment and extraction have practice variations around the world. METHODS: We collected responses by sending an online survey of 8 questions to world interventional bronchology member societies and social media groups. RESULTS: There were 269 respondents from 47 countries. Europe had 97 respondents from 22 countries. There were 8 respondents from Australia, 7 from Africa (3 countries) and 7 from 4 countries in South America (SA). North America (NA) had 72 respondents from 3 countries. Asia had 78 respondents from 14 countries. For stent placements 15% [41] used fiberoptic bronchoscope (FB) only. Rigid bronchoscopy (RB) was solely utilized by 38% [102]. Forty-six percent [123] used a combination of RB and FB (P value <0.00001). For stent extraction 13% [19] used FB alone, 57% [85] used RB, and 36% [54] used a combination of RB and FB (P value <0.00001). Placement of stents were 50.5% [135] only by direct visualization. Twenty-three percent [61] always used fluoroscopic guidance. Twenty-six-point-five percent [71] used fluoroscopy in certain cases (P value <0.00001). Sixty percent [162] decided stent sizing by measurements of stenotic and non-stenotic areas on radiology. Twelve percent [32] respondents used sizing devices. Sixty-five percent [177] used a ruler and bronchoscope to measure stenotic areas. Thirty-eight percent [104] used visual estimation and experience. Seven percent [19] used serial balloon dilatation size. To prevent clogging of stents, 22% [59] prescribed mucolytics. Seventy-three percent [195] nebulized saline, 26% [70] had Mucomyst Nebulization, 24% [65] Nebulized bronchodilators and other methods 11% [30] were advised. Covered self-expandable metal stents (SEMS) 44% was the commonest type of stent used around the world. Silicone stents 37%, Y stents 15%, uncovered SEMS 12%, Montgomery T tube 5% followed. Polyflex stents 3% and custom-made stents 3% were least used. Biodegradable stents were used by 7.5%, and not used by 92.5%. CONCLUSIONS: Tracheobronchial stent practice norms have slowly evolved, but its practice variations lack uniformity, and have sparse evidence-based studies for its direction.