Does ROSE matter? Evaluation of final diagnostic, PD-L1 immunohistochemistry, and molecular testing yields of CT-guided lung biopsies performed before and after the onset of the COVID-19 pandemic

Emma B Jennings; Robert B Percarpio; Laura J Tafe; Eugene Demidenko; Joshua Levy; Edward J Gutmann; Jonathan D Marotti

doi:10.1016/j.jasc.2024.03.004

Does ROSE matter? Evaluation of final diagnostic, PD-L1 immunohistochemistry, and molecular testing yields of CT-guided lung biopsies performed before and after the onset of the COVID-19 pandemic

J Am Soc Cytopathol. 2024 Mar 29:S2213-2945(24)00024-3. doi: 10.1016/j.jasc.2024.03.004. Online ahead of print.

Authors

Emma B Jennings¹, Robert B Percarpio², Laura J Tafe³, Eugene Demidenko⁴, Joshua Levy⁵, Edward J Gutmann³, Jonathan D Marotti⁶

Affiliations

¹ Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
² Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
³ Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
⁴ Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
⁵ Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
⁶ Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: Jonathan.d.marotti@hitchcock.org.

PMID: 38677893
DOI: 10.1016/j.jasc.2024.03.004

Abstract

Introduction: The onset of the COVID-19 pandemic, with urgent implementation of safety protocols limiting the number of on-site personnel, essentially terminated the use of rapid on-site evaluation (ROSE) for computed tomography (CT)--guided lung biopsies at our institution. The diminished use of ROSE during the pandemic prompted us to reevaluate the potential value of ROSE for CT-guided lung biopsies.

Materials and methods: We retrospectively identified all CT-guided lung biopsies from 2017 to 2022. Associations between the use of ROSE, adequate diagnostic and ancillary testing (programmed death-ligand 1 immunohistochemistry and next-generation sequencing) outcomes, and other factors such as the number of passes performed and lesion size, were evaluated.

Results: Nine hundred twelve CT-guided lung biopsies were performed from 2017 to 2022; 171 (19%) utilized ROSE. The use of ROSE had been steadily decreasing prior to the pandemic but was essentially eliminated with the onset of the pandemic. By univariable analysis, the employment of ROSE was more likely to be associated with an adequate final diagnosis (odds ratio = 2.14, 95% confidence interval: [1.24-3.70], P = 0.006) and successful molecular testing (odds ratio = 2.16, 95% confidence interval: [1.11-4.21], P = 0.024). However, those associations were not present in multivariable analyses that incorporated the number of passes performed or lesion size. There were no differences in diagnostic adequacy or ancillary testing yields when comparing the periods 2017-2019 and 2020-2022, despite declining use of ROSE.

Conclusions: If ROSE is not requested for CT-guided lung biopsies, proceduralists should err on the side of performing more, rather than fewer, passes, particularly for smaller lesions.

Keywords: COVID-19; CT-guided biopsy; Cytology; ROSE; Rapid on-site evaluation.