Benchmarking Cytology Support for ROSE during Endoscopic and Bronchoscopic Procedures

Introduction There has been an increase in endoscopic and bronchoscopic biopsies as minimally invasive ways to obtain specimens from gastrointestinal (GI) or pancreatobiliary lesions, and thoracic or mediastinal lesions, respectively. As hospitals undertake more of these procedures, it is important to consider the staffing implications that this has on cytopathology laboratories with respect to support for rapid on-site evaluation (ROSE). Materials and Methods Volume and time data from endoscopic ultrasound (EUS) and bronchoscopic procedures (including endobronchial ultrasound transbronchial needle aspirations (EBUS TBNA) and small biopsies with touch preparation) in the GI or bronchoscopy suite, or operating room (OR), were reviewed for 2 months at two different medical centers with ROSE services provided by cytologists or fellows physically present at the procedure and cytopathologists located remotely using telecytology. Statistical analysis was performed to investigate significant trends based on location of the biopsies and other factors. Results A total of 16 proceduralists performed 159 procedures and submitted 276 different specimens over 16 total weeks at two institutions. The total ROSE time for the on-site personnel to cover these procedures was 109.3 total hours (62.3 (57%) bronchoscopy), 29.8 (27%) GI, 17.2 (16%) OR), which represents an average of 0.69 hours (41.4 min) per procedure, or 0.40 hours (24.0 min) per part, with the shortest procedure times per sample recorded during bronchoscopy. When stratified by practice volume for individual proceduralists, the average time per specimen sample submitted was shorter for proceduralists with high volume practices and was most pronounced during bronchoscopy procedures. Conclusions Endoscopic and bronchoscopic procedures account for an increasing amount of the ROSE time for the cytology team. On average, each ROSE procedure takes 0.69 hours (41.4 min) or approximately 0.40 hours (24.0 min) per specimen, with shorter time requirements for specimens obtained in bronchoscopy procedures and for operators with high volume practices for EBUS TBNAs. This provides important benchmarking data to calculate staffing needs for cytology to provide ROSE support for different proceduralists.