ROSE inadequacy does not equal biopsy failure in CT-guided lung core biopsies

Rapid onsite evaluation (ROSE) inadequacy during CT-guided lung core biopsy isn't biopsy failure: 59.2% of ROSE-inadequate samples still yielded a diagnosis; negative predictive value 40.8%. First-pass adequacy 64.8%, rising to 82.4% after seven passes.

• Overall diagnostic yield was 89.7% (846/943); ROSE adequacy plateaued after three passes, with 17.9% (169/943) persistently inadequate.
• ROSE sensitivity 88.2%, specificity 71.1%, positive predictive value 96.4%, negative predictive value 40.8%.
• Larger lesion size and absence of perilesional hemorrhage independently predicted first-pass ROSE adequacy on multivariable analysis.

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