ORIGINAL ARTICLE Comparison of the Quality of Smears in Transbronchial Fine-Needle Aspirates Using Two Staining Methods for Rapid On-Site Evaluation Mercia Louw, M.D., 1 * Karen Brundyn, M.D., 1 Pawel T. Schubert, M.D., M.I.A.C., 1 Colleen A. Wright, M.D., F.I.A.C., 1 Chris T. Bolliger, M.D., 2 and Andreas H. Diacon, M.D. 3 Transbronchial needle aspiration (TBNA) via flexible bronchos- copy is a well-established sampling modality for lung masses. The procedure is useful in the diagnosis of neoplastic and non- neoplastic lesions as well as for staging of bronchogenic carci- noma. Rapid on-site evaluation (ROSE) adds value as it has the advantage of triaging material during the procedure so avoiding a battery of investigations. Frequently used rapid stains are the modified Wright-Giemsa water-based stain (WG-ROSE) and the alcohol-based modified Papanicolaou stain (Pap-ROSE). Final review of laboratory-based Giemsa and Pap stains supplemented by ancillary investigations is essential for quality assurance. To investigate whether and how ROSE influenced the quantity and quality of the material submitted to the laboratory we random- ized 126 patients to WG-ROSE, requiring only one pathologist on-site, or combined WG- and Pap-ROSE, requiring an addi- tional person on-site to assist with staining. In those patients with positive TBNA we graded the laboratory-based slides of the first pass containing diagnostic material into insufficient, suspi- cious, adequate and excellent. The first diagnostic pass was found after 3.06 6 1.94 (SD) passes and 3.13 6 2.16 passes with WG-ROSE and combined ROSE (P ¼ 0.87), respectively. Following WG-ROSE and combined ROSE 69% and 71.1% (P ¼ 0.509) of slides were diagnostic (adequate or excellent) on laboratory-based Giemsa stains, and 93.3% and 100% (P ¼ 0.134) were scored adequate or excellent on laboratory-based Pap stains. We concluded that the less costly and labour intensive WG-ROSE procedure is adequate for TBNA. This has cost implications especially in resource poor settings. Diagn. Cytopathol. 2011;00:000–000. ' 2011 Wiley-Liss, Inc. Key Words: transbronchial needle aspirate; rapid on-site evalu- ation; Wright-Giemsa based rapid stain; Papanicolaou based rapid stain Transbronchial needle aspiration (TBNA) via flexible bronchoscopy is well established as a sampling method for central lung masses, providing a diagnosis as well as assisting with staging of neoplastic lesions. 1–3 Rapid on-site evaluation (ROSE) performed in real time by a cytopathologist present in theatre has been shown to improve TBNA yield as it reduces the number of passes required and allows for termination of sampling when the diagnostic objective has been met. 3–8 The on-site evalua- tion of cellular aspirates usually shortens the procedure, largely eliminates the need for a tissue biopsy, and allows triaging of material for further investigations as determined by the pathologist. These investigations may include immunocytochemistry, core biopsy, micro- biological culture, flow cytometry or electron microscopy. TBNA and ROSE are cost-saving and facilitate emer- gency treatment, for example, in patients with severe symptoms from intrabronchial or superior vena cava obstruction that need urgent chemotherapy or radiotherapy following diagnosis of malignant disease. ROSE can be a challenging task because numerous sites are aspirated in fast succession and the cytopatholo- 1 Division of Anatomical Pathology, Department of Pathology, Stellen- bosch University and NHLS Tygerberg Hospital, Cape Town, South Africa 2 Department of Medicine, Stellenbosch University, Cape Town, South Africa 3 Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa *Correspondence to: M. Louw, M.D., Division of Anatomical Patho- logy, PO Box 19063, Tygerberg 7505, South Africa. E-mail: ml2@sun.ac.za Received 17 September 2010; Accepted 23 November 2010 DOI 10.1002/dc.21628 Published online in Wiley Online Library (wileyonlinelibrary.com). ' 2011 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 00, No 00 1