Research Papers:

Easily detectable cytomorphological features to evaluate during ROSE for rapid lung cancer diagnosis: from cytology to histology

Sara Ravaioli _, Sara Bravaccini, Maria Maddalena Tumedei, Flavio Pironi, Piero Candoli and Maurizio Puccetti

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Oncotarget. 2017; 8:11199-11205. https://doi.org/10.18632/oncotarget.13204

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Sara Ravaioli1,*, Sara Bravaccini1,*, Maria Maddalena Tumedei1, Flavio Pironi2, Piero Candoli3, Maurizio Puccetti2

1Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

2Pathology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy

3Pneumology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy

*These authors have contributed equally to this work

Correspondence to:

Sara Bravaccini, email: [email protected]

Keywords: lung cancer, ROSE, histotype, cytomorphological features

Received: July 20, 2016    Accepted: September 07, 2016    Published: November 08, 2016


In lung cancer patients, the only available diagnostic material often comes from biopsy or from cytological samples obtained by fine needle aspiration (FNA). There is a lack of easily detectable cytomorphological features for rapid on-site evaluation (ROSE) to orient lung cancer diagnosis towards a specific tumor histotype. We studied the cytological features evaluated on site to define tumor histotype and to establish the number of specimens to be taken. Cytological specimens from 273 consecutive patients were analyzed with ROSE: bronchoscopy with transbronchial needle aspiration (TBNA) had been performed in 72 patients and with endobronchial ultrasound (EBUS)-TBNA in 201. Cytomorphological features were correlated with the final diagnosis and diagnostic accuracy was measured. Analysis of the different cytomorphological parameters showed that the best sensitivity and specificity were obtained for adenocarcinoma by combining the presence of nucleoli and small/medium cell clusters, and for squamous cell carcinoma by considering the presence of necrosis ≥50% and large cell clusters. For small cell carcinoma, the best diagnostic accuracy was obtained by combining moderate necrosis (<50%) and the presence of single cells. Overall accuracy ranged from 90% to 97%. We showed that it was possible to establish the histotype of the most frequent lung cancers during ROSE using only a few easily identifiable cytomorphological parameters. An accurate diagnosis during ROSE could help endoscopists to decide how many tumor samples must be taken, e.g.a higher number of samples is needed for the biomolecular characterization of adenocarcinoma, whereas one sample may be sufficient for squamous cell carcinoma.

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