Rapid On Site Evaluation of Fine Needle Aspiration versus Core Biopsy Touch Preparations: Diagnostic Value and Impact of Biopsy Site

Summary: Introduction: Rapid onsite evaluation (ROSE) is highly beneficial for increasing diagnostic yield of fine needle aspiration biopsy (FNA). When FNA and core biopsy take place concurrently, ROSE can also be conducted for core biopsy in the form of a touch preparation (TP). However, whether TP ROSE adds value to diagnostic yield is unknown. Materials and Methods: The electronic pathology records at our institution were searched for all cases where both FNA and TP ROSE was conducted over the previous calendar year. Three reviewers recorded biopsy site, FNA ROSE, TP ROSE, and final diagnoses. Non-neoplastic cases, such as cyst contents and fibrofatty tissue, were excluded. Results: A total of 109 cases from various biopsy sites were reviewed. The majority of cases (97/109, 89%) showed concordance between FNA ROSE and TP ROSE diagnoses. In the discrepant cases (12/109, 11%), the most common biopsy site was lung (n=5), followed by soft tissue (n=3), liver (n=2), lymph node (n=1), and kidney (n=1) (Table 1). Two lung cases and the lymph node case had diagnostic material on FNA ROSE only (3/12). The remainder of the cases had diagnostic material on TP ROSE, but not on FNA ROSE (8/12). In one case, scant material on TP ROSE prompted sampling of a different area of the target, resulting in diagnostic core biopsies. Mucinous adenocarcinoma and spindle cell neoplasms were the most common diagnoses in discrepant cases (Figure 1). Conclusions: In the majority of cases with both FNA and TP ROSE, the on-site diagnosis was concordant (97/109, 89%). TP ROSE may add value when sampling challenging lesions in certain biopsy sites, such as lung and soft tissue.