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Rapid on-site evaluation achieves 88.1% sensitivity and 91.7% specificity for lung cancer detectionRapid on-site testing improves lung cancer detection during bronchoscopy

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Key Takeaway
Note that ROSE demonstrates high sensitivity (88.1%) and specificity (91.7%) for lung cancer detection during EBUS-TBNA.

This meta-analysis evaluates the diagnostic accuracy of rapid on-site evaluation (ROSE) during endobronchial ultrasound-guided bronchoscopy (EBUS-TBNA) for patients with peripheral pulmonary lesions (PPLs). The analysis synthesized data from 1841 PPLs to determine how ROSE impacts the detection of lung cancer.

The meta-analysis reported a pooled sensitivity of 88.1% and a pooled specificity of 91.7% for lung cancer detection using ROSE. In a specific subset of patients who underwent CT, the pooled sensitivity increased to 94.2% and the pooled specificity reached 96.9%. Additionally, when ROSE was sampled by EBUS using a guide sheath, the reported sensitivity was 88.5%.

The authors note that while ROSE demonstrates high diagnostic accuracy for lung cancer detection in these cases, the results represent an association between the procedure and diagnostic performance rather than a causal link. The findings suggest that ROSE may be particularly useful in clinical workflows where CT imaging is available to support diagnosis.

How this fits prior evidence

This meta-analysis addresses a gap in intraprocedural diagnostic accuracy for lung cancer detection during EBUS-TBNA. While previous evidence highlighted that deep learning AI models show 88% sensitivity and 75% specificity for lung nodule malignancy classification, this study provides specific data on the utility of ROSE as a real-time clinical tool. The findings confirm high diagnostic performance for identifying malignancies in peripheral pulmonary lesions.

When doctors perform a bronchoscopy to look for lung cancer, they need to be as accurate as possible. A new approach called rapid on-site evaluation (ROSE) allows them to check tissue samples immediately during the procedure rather than waiting for lab results later.

This analysis looked at 1,841 cases of peripheral pulmonary lesions. The data showed that ROSE had a high sensitivity of 88.1% and a specificity of 91.7% for detecting lung cancer. For patients who also had a CT scan, the accuracy was even higher, with sensitivity reaching 94.2% and specificity at 96.9%.

While these results show that ROSE is a reliable tool for doctors to use during bronchoscopy, it is important to remember that this data shows how well the test performs rather than proving a direct cause of better outcomes. It provides clinicians with a more reliable way to confirm cancer in real-time.

What this means for you:
Rapid on-site testing (ROSE) helps doctors accurately identify lung cancer during bronchoscopy procedures.

Common questions

What is rapid on-site evaluation (ROSE)?

Rapid on-site evaluation, or ROSE, is a method where medical professionals check tissue samples immediately during a bronchoscopy procedure. Instead of waiting for laboratory results later, this allows doctors to confirm the presence of lung cancer more quickly while they are still performing the procedure.

How accurate is this test for lung cancer?

The study found that ROSE has a high sensitivity of 88.1% and a specificity of 91.7% for detecting lung cancer in patients with peripheral pulmonary lesions. For those who also had a CT scan, the accuracy was even higher, with sensitivity at 94.2% and specificity at 96.9%.

Is this test used during bronchoscopy?

Yes, this method is specifically used during endobronchial ultrasound-guided bronchoscopy (EBUS-TBNA). It helps doctors confirm cancer detection in real-time. When a guide sheath was used with the equipment, the sensitivity for the test was 88.5%.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
OBJECTIVE: Screening high-risk populations for lung cancer with low-dose computed tomography (LDCT) reduced lung cancer mortality. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established technique for the diagnosis of peripheral pulmonary lesions (PPLs) during bronchoscopy. Moreover, rapid on-site evaluation (ROSE) improves the diagnostic yield and accuracy of EBUS-TBNA. Nevertheless, it remains unclear whether ROSE is an efficacious diagnostic tool for PPLs. Therefore, this meta-analysis aimed to assess the diagnostic accuracy of ROSE for PPLs during EBUS bronchoscopy. METHODS: A comprehensive search of the PubMed, Embase, and Cochrane Library databases was conducted to identify studies that evaluated the diagnostic accuracy of ROSE for PPLs during EBUS bronchoscopy. Our study included articles that evaluated the performance of ROSE against a reference standard. Additionally, we examined journal articles that provided sufficient data to construct a 2 × 2 table on a per-lesion basis. To estimate the overall sensitivity and specificity, a meta-analysis was conducted using a bivariate random-effects model. RESULTS: Thirteen studies with 1841 PPLs were included. The meta-analysis yielded a pooled sensitivity of 88.1% and a pooled specificity of 91.7%. A subgroup analysis for studies that enrolled patients who underwent CT produced a pooled sensitivity of 94.2% and a pooled specificity of 96.9%. Furthermore, accuracy of ROSE sampled by EBUS using a guide sheath showed a pooled sensitivity of 88.5%. CONCLUSION: The ROSE technique demonstrated high sensitivity and specificity for lung cancer detection during EBUS bronchoscopy for PPLs. Furthermore, ROSE might have higher sensitivity among patients who underwent CT.
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