Role of rapid onsite evaluation in enhancing diagnostic yield of CT-guided core needle lung biopsies.

Authors

Anita Karimi, Elena N Petre, Hooman Yarmohammadi, Erica S Alexander, Ruben Geevarghese, Etay Ziv, Joseph Erinjeri, Oscar Lin, Or Kalchiem-Dekel, Stephen B Solomon

Published in

Journal of vascular and interventional radiology : JVIR. Pages 109029. Aug 17, 2026. Epub Aug 17, 2026.

Abstract

To evaluate the adequacy of Rapid Onsite Evaluation (ROSE) in relation to diagnostic yield of CT-guided percutaneous lung core needle biopsies (CNB) at a tertiary care cancer center.
A total of 943 CT-guided percutaneous CNB performed in the year 2022 were retrospectively reviewed. ROSE of specimens provided immediate feedback regarding the sample adequacy. The biopsies were divided into 3 groups based on ROSE results: 1) adequate on first pass; 2) adequate after repeat sampling and 3) inadequate. Patient, lesion, and procedure characteristics were analyzed in relation to ROSE adequacy using a multinomial logistic regression model.
Median lesion size was 1.8 cm (IQR: 1.2-2.8). The first-pass adequacy rate was 64.8% (611/943), increasing to 82.4% (777/943) after seven passes, with a clear plateau after three passes; 17.9% (169/943) samplings were persistently inadequate. Complete histopathologic processing resulted in an overall diagnostic yield of 89.7% (846/943). Critically, 59.2% of biopsies deemed inadequate by ROSE ultimately yielded a diagnostic result after complete pathologic processing. ROSE demonstrated a sensitivity of 88.2%, specificity of 71.1%, positive predictive value of 96.4%, and negative predictive value of 40.8%. Larger lesion size and absence of perilesional hemorrhage were associated with higher odds of first-pass adequacy on multivariable analysis.
Lesion size and perilesional hemorrhage are independent predictors of ROSE- adequacy for lung CNB. The low negative predictive value (40.8%) and the finding that 59.2% of ROSE-inadequate biopsies ultimately yielded a diagnostic result highlight that ROSE inadequacy should not be interpreted as synonymous with biopsy failure.

PMID:
42607883
Bibliographic data and abstract were imported from PubMed on 18 Aug 2026.

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