Impact of the COVID-19 Pandemic on ROSE Utilization and Final Diagnostic, PD-L1 Immunohistochemistry, and Molecular Testing Yields of CT-guided Lung Biopsies

ABSTRACT

Introduction: The onset of the COVID-19 pandemic, with urgent implementation of safety protocols limiting the number of on-site personnel, curtailed the utilization of rapid on-site evaluation (ROSE) for CT-guided lung biopsies at our institution. The pandemic, therefore, created an opportunity to examine the role of ROSE in diagnostic adequacy and ancillary testing yield for CT-guided lung biopsies. Material(s) and Method(s) We retrospectively identified all CT-guided lung biopsies performed from 2017-2021. The utilization of ROSE, adequacy of final diagnoses, and ancillary testing yield (PD-L1 immunohistochemistry, next generation sequencing) were ed from pathology reports and compared between 2017-2019 and 2020-2021. Cases were considered nondiagnostic if a definitive neoplastic diagnosis could not be rendered (e.g., atypical or suspicious diagnoses) or the histologic features did not explain imaging findings. Chi-square tests of independence were performed to examine relations between variables. Result(s) 766 CT-guided lung biopsies were performed from 2017-2021;174 (23%) utilized ROSE. The use of ROSE had been steadily decreasing prior to the pandemic and essentially ceased at the onset of the pandemic and never returned to pre-pandemic volumes (Figure 1). Overall (2017-2021), ROSE was more likely to be associated with an adequate final diagnosis (p=.003) and successful molecular testing (p=.013). ROSE was not associated with adequacy of PD-L1 results (p=.797). Comparing the periods 2017-2019 and 2020-2021 (with decreased utilization of ROSE in the latter), there was a trend towards a higher percentage of inadequate final diagnoses (17 vs. 24%, p=.08). Conclusion(s) Overall, ROSE was associated with higher diagnostic and molecular testing yields for CT-guided lung biopsies. The COVID-19 pandemic markedly reduced ROSE use during these procedures;evaluation of the impact on clinical care is ongoing with further studies investigating lesion size, number of passes, and need for repeat procedures.