Rapid On-Site Evaluation (ROSE): Real-Time Cytology and Pathology

Introduction

Rapid On-Site Evaluation (ROSE) is a powerful tool that allows for immediate microscopic assessment of cellular samples during fine-needle aspiration (FNA) and other minimally invasive procedures. By enabling real-time feedback, ROSE helps guide specimen adequacy, improves diagnostic accuracy, and reduces the need for repeat procedures.

This article explores the significance of ROSE in modern medical practice, its applications across different specialties, and the advantages it offers for both clinicians and patients.

Summary

• ROSE is a technique used in cytology and pathology for immediate on-site assessment of samples.
• It enhances diagnostic accuracy, reduces the need for repeat biopsies, and speeds up decision-making.
• ROSE is commonly used in pulmonology, gastroenterology, dermatology, and oncology.
• The integration of ROSE with advanced imaging techniques, such as confocal microscopy / confocal laser scanning microscopy (CLSM) / reflectance confocal microscopy (RCM) further enhances diagnostic precision.

What is Rapid On-Site Evaluation (ROSE)?

Rapid On-Site Evaluation (ROSE) is a cytopathological technique where a pathologist or trained cytotechnologist examines samples immediately after collection to assess their adequacy and preliminary findings. This method is particularly useful in procedures where real-time feedback can help optimize sample collection, ensuring sufficient material for definitive diagnosis.

The evaluation process typically involves:

1. Immediate preparation of slides
2. Staining of the sample using rapid staining methods.
3. Microscopic examination to determine cellular adequacy and potential diagnostic features.
4. Communication between the cytologist and the performing physician to adjust sample collection if needed.

Applications of ROSE in Medicine

ROSE is widely used across multiple medical specialties, particularly in minimally invasive diagnostic procedures where real-time cytological assessment is crucial.

1. Pulmonology: ROSE in Endobronchial Ultrasound-Guided Fine-Needle Aspiration (EBUS-FNA)

• Used to evaluate lung lesions, lymph nodes, and mediastinal masses.
• Improves diagnostic yield in lung cancer staging and infectious disease evaluation.

2. Gastroenterology: ROSE in Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA)

• Helps diagnose pancreatic, biliary, and gastrointestinal tract tumors.
• Reduces the need for repeat procedures, ensuring adequate sample collection in a single session.

3. Dermatology: ROSE in Skin Cytology and Confocal Microscopy

• Applied in real-time evaluation of skin lesions, particularly in melanoma and non-melanoma skin cancer assessment.
• Can be combined with Reflectance Confocal Microscopy (RCM) to enhance accuracy in non-invasive dermatological diagnosis.

4. Oncology: ROSE in Tumor Biopsies and Cancer Diagnosis

• Used during image-guided biopsies to ensure sample adequacy.
• Plays a key role in precision medicine by facilitating rapid molecular and histopathological analysis.

5. Head and Neck Pathology: ROSE in Thyroid and Lymph Node FNAs

• Enhances the accuracy of thyroid nodule evaluations.
• Improves lymphoma diagnosis by ensuring an adequate cell population for flow cytometry.

Benefits of ROSE in Clinical Practice

1. Increased Diagnostic Accuracy

By ensuring specimen adequacy at the time of collection, ROSE minimizes the chances of inconclusive results, leading to more accurate diagnoses.

2. Reduced Need for Repeat Biopsies

Inadequate samples can delay patient care and require additional procedures. ROSE helps avoid this by confirming sample quality in real time.

3. Faster Decision-Making and Treatment Planning

Immediate preliminary results allow clinicians to make faster treatment decisions, improving workflow efficiency.

4. Improved Patient Experience

Minimizing repeat procedures reduces patient discomfort, anxiety, and the overall time spent on diagnosis.

5. Cost-Effectiveness

By reducing repeat biopsies and unnecessary imaging studies, ROSE contributes to healthcare cost savings.

Challenges and Limitations of ROSE

While ROSE offers numerous advantages, there are some challenges associated with its implementation:

• Need for Trained Personnel: ROSE requires the presence of an experienced cytopathologist or cytotechnologist, which may not always be feasible.
• Time Constraints: In busy clinical settings, integrating ROSE into routine workflows may be challenging.
• Equipment Requirements: Proper staining and microscopy equipment are essential for effective on-site evaluation.

Despite these challenges, the benefits of ROSE often outweigh its limitations, making it a valuable tool in diagnostic medicine.

Future of ROSE and Emerging Technologies

As medical technology advances, ROSE is evolving through digital pathology and artificial intelligence (AI)-assisted diagnostics. AI-powered image analysis tools are being developed to assist cytologists in rapid sample evaluation, improving efficiency and reducing the dependency on human expertise.

Additionally, confocal imaging and fluorescence confocal microscopy  are being integrated with ROSE to provide even more detailed cellular analysis in real time. These advancements will further enhance the role of ROSE in precision medicine.

Trusted Resources & References

• American Society of Cytopathology (ASC)
• National Cancer Institute (NCI)
• International Academy of Cytology (IAC)

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Conclusion

Rapid On-Site Evaluation (ROSE) is transforming the field of diagnostic medicine by providing real-time, high-precision cytological assessments. Its applications across pulmonology, gastroenterology, dermatology, and oncology demonstrate its versatility and impact on patient care.

By integrating ROSE with advanced imaging technologies such as confocal microscopy, clinicians can achieve even greater diagnostic accuracy while reducing the need for invasive procedures. As AI and digital pathology continue to evolve, the future of ROSE looks even more promising, with potential for automation and enhanced diagnostic capabilities.

For healthcare providers looking to improve diagnostic efficiency and accuracy, ROSE is a valuable tool that enhances both clinical workflow and patient outcomes.