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Before your biopsy

Asking for ROSE: — On-Site Adequacy Assessment at Your Biopsy

If your biopsy sample comes back inadequate, you face a repeat procedure and more waiting. Rapid On-Site Evaluation — ROSE — places a pathologist in the procedure room to check the sample before you leave the table. You can ask for it. This page explains how.

Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026

  • A pathologist in the room — ROSE checks sample quality in real time, not days later in the laboratory.
  • Reduces repeat procedures — If the sample is not adequate, the radiologist takes more passes immediately.
  • You can ask for it — ROSE is not automatic. Asking in advance is how you find out whether your centre offers it.
  • Not available everywhere — Availability depends on the procedure type and the centre's staffing.
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ROSE stands for Rapid On-Site Evaluation. A pathologist examines a smear from your biopsy sample in the procedure room, before you leave the table, to confirm the sample is adequate. It is available at some centres. You can ask for it before your biopsy is booked.

What changes when ROSE is part of your biopsy?

FeatureWithout ROSEWith ROSE
Sample adequacy checkDone in the laboratory, days after the procedureDone in minutes while you are still on the table
If sample is inadequateYou are called back for a repeat procedureThe radiologist takes more passes on the spot
Adequacy confirmedOnly when the laboratory processes the sampleBefore you leave the procedure room
Full pathology reportReady in daysStill takes days — ROSE checks adequacy, not diagnosis
Available everywhereYes — standard at all centresNo — depends on centre and procedure type

How to ask for ROSE before your procedure

  • Ask your oncologist whether ROSE is available for your specific procedure type before the date is fixed.
  • When booking, ask the coordinator whether a cytopathologist or cytotechnician will attend on the day.
  • Ask early — at the point the oncologist is writing the referral, not on the day of the procedure.
  • If ROSE is not available at the booked centre, ask whether another centre offering ROSE is an option.
  • If you have already had one inadequate biopsy, ask specifically what will be different this time.

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What if ROSE is not available at your centre?

ROSE requires a cytopathologist or trained cytotechnician to be present in the procedure room, and not every centre is staffed for it. If it is not available, ask your oncologist whether referral to a different centre is appropriate for your procedure.

For procedures such as bronchoscopy and EUS-guided biopsies, ROSE makes a meaningful difference to adequacy rates, according to ASCO and ESMO guidance. For core needle biopsies, where a visible tissue core is retrieved, adequacy is often easier to judge without it.

If you have already had one inadequate biopsy, the case for raising ROSE with your oncologist before agreeing to a repeat is strong.

Questions about what ROSE can and cannot do

Does ROSE mean I will have the result the same day?

No. ROSE checks only whether the sample contains enough cellular material to process. That takes minutes. The full pathology report — which gives the diagnosis, subtype, and biomarker results — still takes several days and is produced in the laboratory as normal. ROSE reduces the risk of having to repeat the procedure. It does not speed up the diagnosis.

Which types of biopsy benefit most from ROSE?

ROSE is most commonly offered for endobronchial ultrasound-guided biopsy (EBUS), endoscopic ultrasound-guided biopsy (EUS), and CT-guided fine needle aspiration. For core needle biopsies, where a visible tissue core is retrieved, adequacy is easier to judge visually without formal ROSE. Your radiologist or oncologist can confirm whether ROSE is standard practice for your specific procedure at their centre.

Does ROSE cost extra?

At some centres ROSE is included in the procedure cost; at others it carries a separate charge for the cytopathologist's attendance. Ask when the procedure is being booked. If you have already had one inadequate biopsy and are paying for a repeat, the cost of ROSE is worth raising directly — avoiding a third procedure is financially significant. Any figure you are given is indicative and subject to change.

Does ROSE guarantee the sample will be adequate?

No. ROSE reduces the chance of a repeat caused by an inadequate sample, but it does not eliminate it. Even a sample confirmed adequate by ROSE can come back inconclusive in the laboratory if it did not capture the most diagnostically useful part of the tumour, or if additional tests such as immunohistochemistry require more material than the initial smear contained. It improves the odds; it is not a guarantee.

What if ROSE is not available anywhere near me?

Discuss the alternatives with your oncologist. For some biopsy types, an experienced radiologist using careful technique achieves reliable adequacy without formal ROSE. Ask what the adequacy rate is at the centre where your procedure is planned, and whether the approach will differ from the first attempt if you have already had an inadequate sample. If you are not satisfied with the answers, asking for a second opinion from another oncologist is a reasonable step.

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Common questions

Frequently asked questions

What exactly is ROSE?

ROSE stands for Rapid On-Site Evaluation. A cytopathologist or trained cytotechnician prepares a quick smear from the biopsy sample in the procedure room and examines it under a microscope within minutes. The purpose is to tell the radiologist whether the sample contains enough cellular material before the procedure ends. If it does not, the radiologist can take additional passes immediately. ROSE does not provide the diagnosis — that comes from the full laboratory report, which takes several days.

How do I find out if my centre offers ROSE?

Ask your oncologist before the referral is written. The question is whether ROSE — on-site adequacy evaluation — is available for your specific procedure type at the centre being considered. Some centres offer it for bronchoscopy or EUS-guided biopsies but not for CT-guided procedures. Your oncologist can confirm this with the radiology or endoscopy team. Ask for written confirmation rather than assuming it has been passed on from the booking team.

I already had one inadequate biopsy. Should I ask about ROSE for the repeat?

Yes. An inadequate first biopsy is one of the clearest reasons to raise ROSE before agreeing to a repeat. It is also reasonable to ask what else will be different this time — a more experienced radiologist, a different number of passes, a different approach to the tumour. These are straightforward questions and your oncologist should be able to answer them directly before you agree to the repeat procedure.

Does my oncologist have to refer me somewhere that offers ROSE?

The referral decision rests with your oncologist and weighs factors beyond ROSE alone — the radiologist's experience with your tumour type, travel distance, wait time, and overall centre capability. Ask the question clearly and ask for the reasoning if the recommended centre does not offer ROSE. If you are not satisfied with the answer, seeking a second opinion from another oncologist is a legitimate step.

Will the procedure take longer if ROSE is being done?

Usually by a small amount. The cytopathologist prepares and reviews the smear while you remain on the table, adding a few minutes between passes. For most patients this is not significant. The extra time on the table may prevent considerably more time lost to a repeat biopsy, recovery, and a delayed start to treatment. Ask the proceduralist how ROSE is handled at their centre so you know what to expect on the day.

Is ROSE available at CION centres?

CION coordinates biopsy procedures across its network and through partner facilities. Whether ROSE is available depends on the specific procedure you need and the centre carrying it out. Ask your CION oncologist directly — they can confirm availability at the point of referral and request it on your behalf if it is offered at the planned centre.

Full index

Browse all 701 biopsy topics

Every page in this section, grouped by the part of the journey it belongs to. Pick a group to see what is in it.

What Is a Biopsy?

What Is a Biopsy? Everything You Need to Know →

Types of Biopsy Compared

Which Biopsy Will You Have? Techniques Compared →

Preparing for a Biopsy

What to Expect on the Day of Your Biopsy →

Recovery and Aftercare

After a Biopsy: Recovery, Aftercare and Warning Signs →

Biopsy by Body Part

Biopsy by Body Part: What to Expect at Each Site →

Understanding Your Report

How to Read a Biopsy Report: Terms Explained →

IHC and Molecular Markers

IHC and Molecular Markers on a Biopsy: What They Mean →

Grading and Scoring Systems

Cytology & Prostate Scoring Systems Explained →

How Accurate Is a Biopsy?

How Accurate Is a Biopsy? Errors and Second Opinions →

If Your Result Is Benign

Your Biopsy Is Benign: What It Means and What Comes Next →

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