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

Background 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 onsite evaluation (ROSE) for CT-guided lung biopsies at our institution. The diminished use of ROSE during the pandemic prompted us to re-evaluate the potential value of ROSE for CT-guided lung biopsies. Materials and Methods We retrospectively identified all CT-guided lung biopsies from 2017-2022. Associations between the use of ROSE, adequate diagnostic and ancillary testing (PD-L1 immunohistochemistry and next-generation sequencing) outcomes, and other factors such as the number of passes performed and lesion size, were evaluated. Results 912 CT-guided lung biopsies were performed from 2017-2022; 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 (OR=2.14, 95% CI: [1.24-3.70], p=0.006) and successful molecular testing (OR=2.16, 95% CI: [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.