EBUS-TBNA with ROSE-Tinted Spectacles?

We also note that Oki et al. [1] reported that the negative predictive value was 40% in the ROSE group and 63% in the nonROSE group. One may expect ROSE to improve negative predictive value and make a negative diagnosis more reliable; however, this seems not to be the case and merits further discussion. The number of passes before a node is classified as negative by ROSE requires clarification. The authors state that ROSE was performed by a cytotechnologist present in the endoscopy suite. We would like to draw attention to that as the routine presence of a cytotechnologist or pathologist in the endoscopy room would significantly increase the cost of an EBUS-TBNA procedure, while there is lack of available efficacy data in meaningful endpoints such as the sensitivity, safety or utility of samples for advanced diagnostics.