The Limited Role of Rapid On-Site Evaluation in Lymphoid Lesions

Summary: Introduction: Rapid on-site evaluation (ROSE) offers crucial guidance to operators during biopsy procedures to ensure adequate sampling. Despite the frequency lymphoid lesions are subjected to ROSE, the impact of ROSE in these lesions has not been thoroughly explored in the literature. This study aims to assess the impact of ROSE on lymphoid lesions by summarizing biopsy cases with a clinical suspicion or history of lymphoma. Materials and Methods: A total of 173 cases with a clinical suspicion or history for lymphoma underwent biopsy with ROSE at the University of Colorado – Anschutz Medical Campus in 2023. These cases were evaluated for ROSE impressions, cytotechnologist diagnoses, and final diagnoses. Results: Out of 173 cases, 93 were diagnosed with lymphoma. Among these positive cases, the false negative rate of ROSE impressions was 53.8% (50 cases), while the false negative rate of cytotechnologists' diagnoses was 10.8% (10 cases). For the 69 cases diagnosed negative for lymphoma, both the false positive rates of ROSE impressions and cytotechnologists' diagnoses were 1.5% (1 case) respectively. In total, we observed a discordance rate of 29.5% in ROSE impressions and 6.4% in cytotechnologists' diagnoses. All cases that underwent ROSE were provided with definitive final diagnoses using the routine lymphoma protocol (with 2 cores in fixation and RPMI respectively). Conclusions: The main goal of ROSE is to secure an adequate sample for an accurate final diagnosis while minimizing time and costs. Our research reveals significant disparities between preliminary cytological diagnoses and final conclusions, regardless of ROSE implementation. The utility of ROSE in lymphoma cases appears limited. Therefore, we recommend implementing a standard lymphoma protocol to preserve materials for surgical diagnosis and other necessary tests, thereby eliminating the necessity for ROSE involvement in cases with suspected lymphoma.