A new Rapid On Site Evaluation (ROSE)* service at Forth Valley Royal Hospital is helping to speed up and improve lung cancer diagnosis.

The service, a collaboration between local respiratory and pathology teams, is already making a significant difference to local patients.

It enables specialists to assess samples taken during an Endobronchial Ultrasound** (EBUS) procedure in real time. This helps ensure samples are of the quality required to make a clear diagnosis and that enough material is collected for genetic testing. The result is faster diagnoses, quicker lab results and earlier discussion to agree the best treatment plans for local patients.

The NHS Forth Valley team behind the new service includes Drs Jonathan Gareze, Laura Maclean and Amanda Forbes, along with biomedical science staff Dawn Sutherland and Claire Mullen, who trained at St Thomas’ Hospital in London to bring ROSE to NHS Forth Valley. They work closely with respiratory consultants Drs Ronan Breen, Euan Cameron, Alison MacKenzie and Claribel Simmons who carry out the EBUS procedures. ROSE is also supported by a dedicated team of endoscopy nurses all of whom have quickly adapted to the new sample handling arrangements.

Between January and August 2025, 98 patients had ROSE performed alongside their EBUS. During this time, the team achieved a major improvement in service quality, reducing the repeat procedure rate by over 65% (from 14% to just 4%). Implementing ROSE has also enabled these test results to be turned around in 48 hours, allowing full pathology results to be discussed at the multidisciplinary team meetings within the same week to agree the best treatment plan.

Plans are underway to train additional laboratory staff and obtain funding to support the ongoing service. Feedback so far has been overwhelmingly positive, and the team hopes to make ROSE a permanent part of the lung cancer diagnostic pathway at Forth Valley Royal Hospital.

Additional Information

*Rapid On-Site Evaluation (ROSE) in bronchoscopy is a technique using immediate microscopic review of collected samples during the procedure, ensuring enough diagnostic material is obtained for accurate cancer diagnosis and molecular testing, reducing repeat procedures, and guiding treatment decisions faster. It significantly improves sampling adequacy for diagnosing lung tumours, leading to quicker treatment if cancer is confirmed or enabling additional tests to be carried out right away.

**Endobronchial Ultrasound (EBUS) is a minimally invasive procedure using a bronchoscope with an ultrasound probe to see inside airways and sample nearby lymph nodes or masses for diagnosing lung conditions like cancer, infections or inflammatory diseases. It allows staff to get precise tissue samples (biopsies) from hard-to-reach areas in the chest, providing crucial diagnostic information without major surgery.