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Mondoni M, Wahidi MM, Sotgiu G. Combination of cryobiopsy with EBUS-TBNA-Might rapid on-site evaluation successfully drive patient selection? Pulmonology 2024; 30:416-418. [PMID: 38538490 DOI: 10.1016/j.pulmoe.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 09/05/2024] Open
Affiliation(s)
- M Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
| | - M M Wahidi
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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2
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Rodriguez GR, Trachiotis GD, Mullenix PS, Antevil JL. Minimally Invasive with Maximal Yield: A Narrative Review of Current Practices in Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer. J Laparoendosc Adv Surg Tech A 2024; 34:773-785. [PMID: 38727568 DOI: 10.1089/lap.2024.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Background: Lung cancer remains the leading cause of cancer deaths in the United States despite declining incidence and improved outcomes because of advancements in early detection and development of novel therapies. Accurate mediastinal lymph node staging is crucial for determining prognosis and guiding treatment decisions, particularly for non-small cell lung cancer (NSCLC). Materials and Methods: A systematic search of PubMed was conducted to identify English language articles published between January 2010 and January 2024 focusing on preoperative lymph node staging in adults with NSCLC. Case series, observational studies, randomized trials, guidelines, narrative reviews, systematic reviews, and meta-analyses were included. Results: Various imaging modalities, surgical and nonsurgical procedures for mediastinal lymph node staging were reviewed, including positron emission tomography with computed tomography, cervical mediastinoscopy, video-assisted cervical mediastinoscopy, anterior mediastinotomy, video-assisted thoracoscopy, endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA), transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and computed tomography-guided percutaneous lymph node biopsy. EBUS-FNA emerged as the preferred initial staging procedure because of its high sensitivity and low complication rate. Combining it with other procedures or confirmatory testing may be helpful in determining appropriate treatment. Conclusions: Although cervical mediastinoscopy remains a valuable confirmatory procedure in select cases, its role as a first-line staging modality is diminishing with the widespread adoption of EBUS-FNA and EUS-FNA. The combination of EBUS-FNA and EUS-FNA allows access to nearly all mediastinal lymph node stations with high diagnostic accuracy. Future research may further refine the selection criteria for invasive mediastinal staging procedures, ultimately optimizing patient outcomes in the management of NSCLC.
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Affiliation(s)
- Gustavo R Rodriguez
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
| | - Gregory D Trachiotis
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Philip S Mullenix
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jared L Antevil
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
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Sana M, Mahmood Butt F, Amir A. The Diagnostic Value of Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in Diagnosing FDG-PET-Avid Lymph Nodes in Extrapulmonary Malignancies. Cureus 2024; 16:e68269. [PMID: 39350840 PMCID: PMC11440340 DOI: 10.7759/cureus.68269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2024] [Indexed: 10/04/2024] Open
Abstract
Background and objective The accurate diagnosis of extrapulmonary malignancies with mediastinal lymphadenopathy is crucial for effective patient management. Endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) has emerged as a valuable tool in assessing fluorodeoxyglucose (FDG)-positron emission tomography (PET)-avid lymph nodes (LNs). In this study, we aimed to evaluate the diagnostic value of EBUS-FNA in patients with mediastinal lymphadenopathy in extrapulmonary malignancies and compare its efficacy with PET-CT. Methodology This retrospective, cross-sectional study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, from February 2018 to February 2023. It included patients with extrapulmonary malignancies with mediastinal lymphadenopathy displaying abnormal PET-CT uptake, with LN diameters ≥5 mm, excluding lung cancer cases. Data on demographics, malignancy type, LN involvement, PET-CT findings, and EBUS-FNA histopathology were collected. EBUS-FNA procedures involved a 22-gauge needle, and samples were analyzed cytologically and histologically. SPSS Statistics version 20 (IBM Corp., Armonk, NY) was used to perform the statistical analysis. Results The study analyzed a total of 216 patients. Males comprised 56.3% of the cohort, and females 43.7%. The most common malignancy was lymphoma (33.0%), followed by breast cancer (12.6%). EBUS-FNA exhibited a sensitivity of 90.9% compared to PET-CT's sensitivity of 72.7%. Lymph node morphology on EBUS showed low echogenicity and irregular borders in malignant cases. Subcarinal and right hilar were the most frequently sampled lymph nodes. The study found significant differences in lymph node characteristics between non-malignant and malignant groups, with EBUS-FNA effectively identifying malignancies. Conclusions EBUS-FNA demonstrates high sensitivity and diagnostic utility in identifying malignant lymph nodes in patients with extrapulmonary malignancies. Its effectiveness in detecting true positive cases highlights its importance as a complementary diagnostic tool to PET-CT in oncological diagnostics.
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Affiliation(s)
- Mahreen Sana
- Pulmonology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem Mahmood Butt
- Pulmonology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Adnan Amir
- Pulmonology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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4
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Khoury LM, Sheehan KN, Mariencheck WI, Gershner KA, Maslonka M, Niehaus AG, Isom S, Bellinger CR. Endobronchial Ultrasound Guided Transbronchial Needle Aspiration and PD-L1 Yields. Lung 2024; 202:325-330. [PMID: 38637361 PMCID: PMC11143017 DOI: 10.1007/s00408-024-00692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Immunotherapy is a leading approach for treating advanced non-small cell lung cancer (NSCLC) by targeting the PD-1/PD-L1 checkpoint signaling pathway, particularly in tumors expressing high levels of PD-L1 (Jug et al. in J Am Soc Cytopathol 9:485-493, 2020; Perrotta et al. in Chest 158: 1230-1239, 2020). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method to obtain tissue for molecular studies, including PD-L1 analysis, in unresectable tumors (Genova et al. in Front Immunol 12: 799455, 2021; Wang et al. in Ann Oncol 29: 1417-1422, 2018). This study aimed to assess the adequacy of PD-L1 assessment in EBUS-TBNA cytology specimens. METHODS Data was collected retrospectively from patients who underwent EBUS-TBNA between 2017 and 2021 for suspected lung cancer biopsy. Samples positive for NSCLC were examined for PD-L1 expression. EBUS was performed by experienced practitioners, following institutional guidelines of a minimum of five aspirations from positively identified lesions. Sample adequacy for molecular testing was determined by the pathology department. RESULTS The analysis involved 387 NSCLC cases (149 squamous cell, 191 adenocarcinoma, 47 unspecified). Of the 263 EBUS-TBNA specimens tested for PD-L1, 237 (90.1%) were deemed adequate. While 84% adhered to the protocol, adherence did not yield better results. Significantly higher PD-L1 adequacy was observed in squamous cell carcinomas (93.2%) compared to adenocarcinoma (87.6%). The number of aspirations and sedation type did not correlate with PD-L1 adequacy in either cancer type, but lesion size and location had a significant impact in adenocarcinomas. Adenocarcinoma exhibited higher PD-L1 expression (68%) compared to squamous cell carcinoma (48%). CONCLUSION EBUS-TBNA offers high yields for assessing immunotherapy markers like PD-L1, with satisfactory adequacy regardless of NSCLC subtype, lesion size, or location.
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Affiliation(s)
- Lara M Khoury
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Kristin N Sheehan
- Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - William I Mariencheck
- Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Katherine A Gershner
- Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Matthew Maslonka
- Department of Pulmonary and Critical Care Medicine, Nebraska Pulmonary Specialties, Lincoln, NE, USA
| | - Angela G Niehaus
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christina R Bellinger
- Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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5
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Rodrigues LV, Viegas M, Cordovilla R, Taborda-Barata L, Sousa V. Feasibility of EBUS-TBNA for the molecular characterization of non-small cell lung cancer. J Bras Pneumol 2024; 50:e20230193. [PMID: 38808822 PMCID: PMC11185151 DOI: 10.36416/1806-3756/e20230193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Affiliation(s)
- Luis Vaz Rodrigues
- . Serviço de Pneumologia, Instituto Português de Oncologia, Francisco Gentil, Coimbra, Portugal
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Marta Viegas
- . Serviço de Anatomia Patológica, Laboratório de Patologia Molecular, Instituto Português de Oncologia, Francisco Gentil, Coimbra, Portugal
| | - Rosa Cordovilla
- . Serviço de Pneumologia, Hospital Universitário de Salamanca, Salamanca, Espanha
| | - Luis Taborda-Barata
- . Health Sciences Research Centre and UBIAir - CICS-UBI - Clinical & Experimental Lung Centre, Universidade da Beira Interior, Covilhã, Portugal
| | - Vitor Sousa
- . Instituto de Anatomia Patológica e Patologia Molecular, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
- . Research Center for Environment, Genetics and Oncobiology - CIMAGO -Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- . Centro de Pneumologia, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- . Serviço de Anatomia Patológica, Hospitais da Universidade de Coimbra, Coimbra, Portugal
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6
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Liao H, Zhu M, Li R, Wang D, Xiao D, Chen Y, Cheng Z. Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing thoracic lesions: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1383600. [PMID: 38799146 PMCID: PMC11116619 DOI: 10.3389/fmed.2024.1383600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for biopsy of lung, peri-pulmonary tissue and lymph nodes under real-time ultrasound-guided biopsy. It is used in the diagnosis and/or staging of benign and malignant pulmonary and non-pulmonary diseases. Our study is based on a large sample size, in a diversified population which provides a representative real-world cohort for analysis. Methods Patients who underwent EBUS-TBNA procedure between September 2019 and August 2022 were included in this retrospective study. For cases diagnosed as benign and unclassified lesions by EBUS-TBNA, the final diagnosis was determined by further invasive surgery or a combination of therapy and clinical follow-up for at least 6 months. Results A total of 618 patients were included in the study, including 182 females (29.4%) and 436 males (70.6%). The mean age of all patients was 61.9 ± 10.5 years. These patients were successfully punctured by EBUS-TBNA to obtain pathological results. The pathological diagnosis results of EBUS-TBNA were compared with the final clinical diagnosis results as follows: 133 cases (21.5%) of benign lesions and 485 cases (78.5%) of malignant lesions were finally diagnosed. Among them, the pathological diagnosis was obtained by EBUS-TBNA in 546 patients (88.3%) (464 malignant lesions and 82 benign conditions), while EBUS-TBNA was unable to define diagnosis in 72 patients (11.6%). 20/72 non-diagnostic EBUS-TBNA were true negative. The overall diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA were 91.3%, 100%, 100%, 27.8%, and 91.6% [95% confidence interval (CI): 89.1-93.6%], respectively. In this study, only one case had active bleeding without serious complications during the EBUS-TBNA procedure. Conclusion Given its low invasiveness, high diagnostic accuracy, and safety, EBUS-TBNA is worth promoting in thoracic lesions.
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Affiliation(s)
- Huibin Liao
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Miaojuan Zhu
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ru Li
- Department of Respiratory and Critical Care Medicine, Macheng Second People's Hospital, Huanggang, China
| | - DeXin Wang
- Department of Respiratory and Critical Care Medicine, Qichun County People's Hospital, Huanggang, China
| | - Dan Xiao
- Department of Respiratory and Critical Care Medicine, Xishui Hospital Affiliated to Hubei University of Science and Technology, Huanggang, China
| | - Yifei Chen
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhenshun Cheng
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
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Vakil E, Dumoulin E, Stollery D, Gillson AM, MacEachern P, Dhaliwal I, Mitchell M, Li P, Schieman C, Romatowski N, Chee AC, Tyan CC, Fortin M, Hergott CA, Tremblay A. Molecular analysis of endobronchial ultrasound needle aspirates in patients with non-small cell lung cancer: Results from the SCOPE database. Cytopathology 2024; 35:378-382. [PMID: 38349229 DOI: 10.1111/cyt.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Molecular subtyping of non-small cell lung cancer (NSCLC) is critical in the diagnostic evaluation of patients with advanced disease. This study aimed to examine whether samples from endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of intrathoracic lymph nodes and/or lung lesions are adequate for molecular analysis across various institutions. METHODS We retrospectively reviewed all cases of linear EBUS-TBNA with a final bronchoscopic diagnosis of NSCLC entered in the Stather Canadian Outcomes registry for chest ProcEdures database. The primary outcome was specimen inadequacy rate for each molecular target, as defined by the local laboratory or pathologist. RESULTS A total of 866 EBUS-TBNA procedures for NSCLC were identified. Specimen inadequacy rates were 3.8% for EGFR, 2.5% for ALK-1 and 3.5% for PD-L1. Largest target size was not different between adequate and inadequate specimens, and rapid onsite evaluation did not increase specimen adequacy rates. One centre using next-generation sequencing for EGFR had lower adequacy rates than 2 others using matrix-assisted laser desorption/ionization time-of-flight mass spectrophotometry. CONCLUSION EBUS-TBNA specimens have a very low-specimen inadequacy rate for molecular subtyping of non-small cell lung cancer.
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Affiliation(s)
- Erik Vakil
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Dumoulin
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Stollery
- Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ashley-Mae Gillson
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Paul MacEachern
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | | | - Michael Mitchell
- Division of Respirology, Western University, London, Ontario, Canada
| | - Pen Li
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Alex C Chee
- Division of Respirology, Alberta Health Services, Calgary, Alberta, Canada
| | - Chung Chun Tyan
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marc Fortin
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | | | - Alain Tremblay
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
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Tajarernmuang P, Aliaga F, Alwakeel AJ, Tavaziva G, Turner K, Menzies D, Wang H, Ofiara L, Benedetti A, Gonzalez AV. Accuracy of Cytologic vs Histologic Specimens for Assessment of Programmed Cell Death Ligand-1 Expression in Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Chest 2024; 165:461-474. [PMID: 37739030 DOI: 10.1016/j.chest.2023.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Programmed cell death ligand-1 (PD-L1) expression on tumor cells, evaluated by immunohistochemistry, guides the use of immunotherapy in advanced non-small cell lung cancer (NSCLC). RESEARCH QUESTION What is the sensitivity and specificity of PD-L1 testing performed in cytologic vs paired histologic specimens in patients with NSCLC? STUDY DESIGN AND METHODS The MEDLINE, Embase, Web of Science, and Cochrane Library databases were searched through June 1, 2021. The primary outcome was pooled sensitivity and specificity of PD-L1 testing performed on cytologic specimens compared with the reference standard of histologic specimens, analyzed at the PD-L1 expression cutoffs (tumor proportion score) ≥ 1% and ≥ 50%. Pooled sensitivity and specificity, and associated 95% CIs, were estimated using bivariate generalized linear mixed models. RESULTS Twenty-six articles were included, encompassing a total of 1,064 pairs of histology specimens and cytology cell blocks, and 267 pairs of histology specimens and direct smears. Among these, 946 paired specimens were acquired without interval treatment between the collection of histology and cytology samples. The pooled sensitivity and specificity of cytology specimens compared with paired histology specimens at the PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.77-0.89) and 0.88 (95% CI, 0.82-0.93), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.78 (95% CI, 0.69-0.86) and 0.94 (95% CI, 0.91-0.96), respectively. When only paired specimens acquired without interval treatment were considered, the pooled sensitivity and specificity of cytology specimens at PD-L1 expression cutoff ≥ 1% were 0.84 (95% CI, 0.76-0.90) and 0.89 (95% CI, 0.82-0.94), respectively, whereas the pooled sensitivity and specificity at cutoff ≥ 50% were 0.80 (95% CI, 0.71-0.89) and 0.94 (95% CI, 0.91-0.96), respectively. INTERPRETATION Cytologic specimens provide an accurate assessment of PD-L1 expression in most patients with NSCLC, at both ≥ 1% and ≥ 50% cutoffs, when compared with histologic specimens. TRIAL REGISTRATION PROSPERO; No.: CRD42020153279; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Pattraporn Tajarernmuang
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Respiratory, Critical Care and Allergy Division, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Felipe Aliaga
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (CAS-UDD), Santiago, Chile
| | - Amr J Alwakeel
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Pulmonary Medicine Division, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Gamuchirai Tavaziva
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Kimberly Turner
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Respiratory Division, McGill University Health Centre, Montreal, QC, Canada
| | - Hangjun Wang
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Linda Ofiara
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics & Occupational Health, Medicine, McGill University, Montreal, QC, Canada
| | - Anne V Gonzalez
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada; Respiratory Division, McGill University Health Centre, Montreal, QC, Canada.
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9
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Yu Lee-Mateus A, Sawal N, Hartley C, Edell E, Vierkant RA, Reisenauer J. Efficacy of Robotic Bronchoscopy for Molecular Marker Analysis in Primary Lung Cancer. Clin Lung Cancer 2024; 25:e11-e17. [PMID: 37932179 DOI: 10.1016/j.cllc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Molecular testing has become a more frequent necessity in NSCLC management. Using next-generation sequencing, multiple targets for therapy can be identified with small amounts of nuclear material. The authors evaluated the performance of robotic-assisted bronchoscopy in acquiring tissue that meets pre-analytic criteria for PD-L1 immunohistochemistry and/or next-generation sequencing. MATERIALS AND METHODS Patients with a diagnosis of primary lung cancer identified through robotic bronchoscopy were retrospectively reviewed. Pathology reports were assessed for results of molecular testing and detection of programmed death-ligand 1 (PD-L1). An independent pathologist evaluated each specimen type (smears, cell block, tissue biopsy, and/or touch prep) to determine whether each tissue type would meet pre-analytic criteria for attempting next-generation sequencing and/or PD-L1 immunohistochemistry. RESULTS Seventy-eight patients with primary lung were reviewed. By independent pathologic assessment of cytological smears, cell block, biopsy, and/or touch preparations, 72% of samples were found to be adequate for molecular and PD-L1 testing. Preanalytic adequacy (%) for next-generation sequencing (NGS) and PD-L1 staining was determined based on specimen type: cytological smear 48.6% for NGS; cell block 14.3% for NGS and 32.9% for PD-L1; biopsy 29.2% for NGS and 62.5% for PD-L1; and touch prep 61.4% for NGS. CONCLUSION Robotic-assisted bronchoscopy yielded samples that met preanalytic criteria for molecular testing in 72% of cases. These results support the use of robotic-assisted bronchoscopy for both the diagnosis and molecular testing of early-stage lung cancer.
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Affiliation(s)
| | - Naina Sawal
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Eric Edell
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Janani Reisenauer
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN.
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10
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Hendry S, Mamotte L, Mesbah Ardakani N, Leslie C, Tesfai Y, Grieu-Iacopetta F, Izaac K, Singh S, Ardakani R, Thomas M, Giardina T, Robinson C, Frost F, Amanuel B. Adequacy of cytology and small biopsy samples obtained with rapid onsite evaluation (ROSE) for predictive biomarker testing in non-small cell lung cancer. Pathology 2023; 55:917-921. [PMID: 37805343 DOI: 10.1016/j.pathol.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 10/09/2023]
Abstract
Complete biomarker workup of non-small cell lung cancer (NSCLC) specimens is essential for appropriate and timely clinical management decisions. This can be challenging to achieve from small cytology and histology specimens, with increasing numbers of molecular and immunohistochemical biomarkers required. We conducted a 5 year retrospective audit of cases at our institution to assess the diagnostic and biomarker testing adequacy rates, particularly those specimens obtained with rapid onsite evaluation (ROSE), performed by a cytopathologist and a cytology scientist or pathology trainee, including all endobronchial ultrasound guided transbronchial needle aspirations (EBUS-TBNA), CT guided lung fine needle aspirations (FNA) and CT guided lung core biopsies. A total of 5,354 cases were identified, of which 92.2% had sufficient material for diagnosis. Of the 1506 cases identified with a recorded diagnosis of lung adenocarcinoma or NSCLC, not otherwise specified, 1001 (66.5%) had biomarker testing requested. Sufficient material was available in 89.5% of cases for a complete biomarker workup which included EGFR and KRAS mutational testing (all cases), ALK, ROS1 and PD-L1 immunohistochemistry (all cases), and ALK and ROS1 FISH (as required). For EGFR and KRAS mutational testing across both cytology and histology specimens, 99% of cases were sufficient. Of the samples in which a complete biomarker workup was unable to be performed, approximately half were only insufficient due to inadequate numbers of tumour cells for PD-L1 immunohistochemistry. Excluding PD-L1 IHC, 952 (95.1%) of samples obtained with ROSE were sufficient for the remainder of the testing requirements. Next generation sequencing using a 33 gene custom AmpliSeq panel was achieved in up to 72% of cases. In conclusion, small cytology and histology specimens obtained with ROSE are suitable for predictive biomarker testing in NSCLC, although attention needs to be paid to obtaining sufficient cells (>100) for PD-L1 immunohistochemistry.
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Affiliation(s)
- Shona Hendry
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia.
| | - Louis Mamotte
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Connull Leslie
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Yordanos Tesfai
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Fabienne Grieu-Iacopetta
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Katherine Izaac
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Shalinder Singh
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Rasha Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Marc Thomas
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Tindaro Giardina
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Cleo Robinson
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia; Discipline of Pathology and Laboratory Science, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Felicity Frost
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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11
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Velasco-Albendea FJ, Cruz-Rueda JJ, Gil-Belmonte MJ, Pérez-Rodríguez Á, López-Pardo A, Agredano-Ávila B, Lozano-Paniagua D, Nievas-Soriano BJ. The Contribution of Mediastinal Transbronchial Nodal Cryobiopsy to Morpho-Histological and Molecular Diagnosis. Diagnostics (Basel) 2023; 13:3476. [PMID: 37998611 PMCID: PMC10670691 DOI: 10.3390/diagnostics13223476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
(1) Background: endobronchial ultrasound-guided mediastinal transbronchial cryo-node biopsy, previously assisted by fine-needle aspiration, is a novel technique of particular interest in the field of lung cancer diagnosis and is of great utility for extrathoracic tumor metastases, lymphomas, and granulomatous diseases. An integrated histological and molecular diagnosis of small samples implies additional difficulty for the pathologist. Additionally, emerging tumor biomarkers create the need to search for new approaches to better manage the tissue sample; (2) Methods: An analytical observational study of 32 mediastinal node cryobiopsies is carried out in 27 patients (n = 27). Statistical analysis using the t-student and Wilcoxon signed-rank tests for paired data is performed with SPSS 26 and R Statistical software. The significance level is established at p < 0.05; (3) Results: cryobiopsies were valid for diagnosis in 25 of 27 patients, with a maximum average size of 3.5 ± 0.7 mm. A total of 18 samples (66.67%) were positive for malignancy and 9 (33.33%) were benign. The tumor percentage measured in all neoplastic samples was greater than 30%. The average DNA and RNA extracted in nine non-small cell lung cancer cases was 97.2 ± 22.4 ng/µL and 26.6 ± 4.9 ng/µL, respectively; (4) Conclusions: the sample size obtained from an endobronchial ultrasound-guided mediastinal transbronchial cryo-node biopsy facilitates the morphological and histo-architectural assessment of inflammatory and neoplastic pathology. It optimizes molecular tests in the latter due to more tumor cells, DNA, and RNA.
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Affiliation(s)
| | - Juan José Cruz-Rueda
- Clinical Management Unit of Pneumology, Torrecárdenas University Hospital, 04009 Almeria, Spain; (J.J.C.-R.); (A.L.-P.)
| | - María Jesús Gil-Belmonte
- Clinical Management Unit of Pathological Anatomy, Torrecárdenas University Hospital, 04009 Almeria, Spain; (F.J.V.-A.); (B.A.-Á.)
| | - Álvaro Pérez-Rodríguez
- Department of Pathological Anatomy, Hospital Clínico Universitario, 47003 Valladolid, Spain;
| | - Andrés López-Pardo
- Clinical Management Unit of Pneumology, Torrecárdenas University Hospital, 04009 Almeria, Spain; (J.J.C.-R.); (A.L.-P.)
| | - Beatriz Agredano-Ávila
- Clinical Management Unit of Pathological Anatomy, Torrecárdenas University Hospital, 04009 Almeria, Spain; (F.J.V.-A.); (B.A.-Á.)
| | - David Lozano-Paniagua
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain;
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12
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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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13
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Lalić N, Lovrenski A, Ilić M, Ivanov O, Bojović M, Lalić I, Popević S, Stjepanović M, Janjić N. Invasive Diagnostic Procedures from Bronchoscopy to Surgical Biopsy-Optimization of Non-Small Cell Lung Cancer Samples for Molecular Testing. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1723. [PMID: 37893442 PMCID: PMC10608158 DOI: 10.3390/medicina59101723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Treatment of advanced lung cancer (LC) has become increasingly personalized over the past decade due to an improved understanding of tumor molecular biology and antitumor immunity. The main task of a pulmonologist oncologist is to establish a tumor diagnosis and, ideally, to confirm the stage of the disease with the least invasive technique possible. Materials and Methods: The paper will summarize published reviews and original papers, as well as published clinical studies and case reports, which studied the role and compared the methods of invasive pulmonology diagnostics to obtain adequate tumor tissue samples for molecular analysis, thereby determining the most effective molecular treatments. Results: Bronchoscopy is often recommended as the initial diagnostic procedure for LC. If the tumor is endoscopically visible, the biopsy sample is susceptible to molecular testing, the same as tumor tissue samples obtained from surgical resection and mediastinoscopy. The use of new sampling methods, such as cryobiopsy for peripheral tumor lesions or cytoblock obtained by ultrasound-guided transbronchial needle aspiration (TBNA), enables obtaining adequate small biopsies and cytological samples for molecular testing, which have until recently been considered unsuitable for this type of analysis. During LC patients' treatment, resistance occurs due to changes in the mutational tumor status or pathohistological tumor type. Therefore, the repeated taking of liquid biopsies for molecular analysis or rebiopsy of tumor tissue for new pathohistological and molecular profiling has recently been mandated. Conclusions: In thoracic oncology, preference should be given to the least invasive diagnostic procedure providing a sample for histology rather than for cytology. However, there is increasing evidence that, when properly processed, cytology samples can be sufficient for both the cancer diagnosis and molecular analyses. A good knowledge of diagnostic procedures is essential for LC diagnosing and treatment in the personalized therapy era.
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Affiliation(s)
- Nensi Lalić
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandra Lovrenski
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Miroslav Ilić
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Olivera Ivanov
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Clinic of Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Marko Bojović
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Clinic of Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Ivica Lalić
- Faculty of Pharmacy, University Business Academy in Novi Sad, Trg Mladenaca 5, 21101 Novi Sad, Serbia;
| | - Spasoje Popević
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (M.S.)
- University Hospital of Pulmonology, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Mihailo Stjepanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (M.S.)
- University Hospital of Pulmonology, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nataša Janjić
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
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14
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Ortiz-Jaimes G, Reisenauer J. Real-World Impact of Robotic-Assisted Bronchoscopy on the Staging and Diagnosis of Lung Cancer: The Shape of Current and Potential Opportunities. Pragmat Obs Res 2023; 14:75-94. [PMID: 37694262 PMCID: PMC10492559 DOI: 10.2147/por.s395806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
The approach to peripheral pulmonary lesions (PPL) has been evolving continuously. Advanced bronchoscopic navigational techniques have improved the airway-based approaches to these lesions. Robotic Assisted Bronchoscopy (RAB) can be considered the current pinnacle of this evolution; allowing for a safer approach to sampling lesions previously considered outside of bronchoscopic reach. We present a comprehensive review of the changing epidemiology of lung cancer and the importance of early tissue sampling, the evolution of sampling and navigational bronchoscopic techniques, technical considerations and evidence pertaining to the use of RAB, and adjunct techniques in the diagnosis of lung cancer. Complications and future applications of RAB are also discussed.
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Affiliation(s)
- Gabriel Ortiz-Jaimes
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Janani Reisenauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
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15
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Biondini D, Tinè M, Semenzato U, Daverio M, Scalvenzi F, Bazzan E, Turato G, Damin M, Spagnolo P. Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities. Diagnostics (Basel) 2023; 13:2565. [PMID: 37568927 PMCID: PMC10417616 DOI: 10.3390/diagnostics13152565] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Endobronchial Ultrasound (EBUS) has been widely used to stage lung tumors and to diagnose mediastinal diseases. In the last decade, this procedure has evolved in several technical aspects, with new tools available to optimize tissue sampling and to increase its diagnostic yield, like elastography, different types of needles and, most recently, miniforceps and cryobiopsy. Accordingly, the indications for the use of the EBUS scope into the airways to perform the Endobronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) has also extended beyond the endobronchial and thoracic boundaries to sample lesions from the liver, left adrenal gland and retroperitoneal lymph nodes via the gastroesophageal tract, performing the Endoscopic UltraSound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA). In this review, we summarize and critically discuss the main indication for the use of the EBUS scope, even the more uncommon, to underline its utility and versatility in clinical practice.
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Affiliation(s)
- Davide Biondini
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Mariaenrica Tinè
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Umberto Semenzato
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Matteo Daverio
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Francesca Scalvenzi
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Erica Bazzan
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Graziella Turato
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Marco Damin
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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16
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Steinfort DP, Evison M, Witt A, Tsaknis G, Kheir F, Manners D, Madan K, Sidhu C, Fantin A, Korevaar DA, Van Der Heijden EHFM. Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement. Respirology 2023; 28:722-743. [PMID: 37463832 DOI: 10.1111/resp.14549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Since their introduction, both linear and radial endobronchial ultrasound (EBUS) have become an integral component of the practice of Pulmonology and Thoracic Oncology. The quality of health care can be measured by comparing the performance of an individual or a health service with an ideal threshold or benchmark. The taskforce sought to evaluate quality indicators in EBUS bronchoscopy based on clinical relevance/importance and on the basis that observed significant variation in outcomes indicates potential for improvement in health care outcomes. METHODS A comprehensive literature review informed the composition of a comprehensive list of candidate quality indicators in EBUS. A multiple-round modified Delphi consensus process was subsequently performed with the aim of reaching consensus over a final list of quality indicators and performance targets for these indicators. Standard reporting items were developed, with a strong preference for items where evidence demonstrates a relationship with quality indicator outcomes. RESULTS Twelve quality Indicators are proposed, with performance targets supported by evidence from the literature. Standardized reporting items for both radial and linear EBUS are recommended, with evidence supporting their utility in assessing procedural outcomes presented. CONCLUSION This statement is intended to provide a framework for individual proceduralists to assess the quality of EBUS they provide their patients through the identification of clinically relevant, feasible quality measures. Emphasis is placed on outcome measures, with a preference for consistent terminology to allow communication and benchmarking between centres.
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Affiliation(s)
- Daniel P Steinfort
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ashleigh Witt
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Georgios Tsaknis
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Medicine, Kettering General Hospital, UK
| | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Manners
- St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Calvin Sidhu
- School of Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Alberto Fantin
- Department of Pulmonology, University Hospital of Udine (ASUFC), Udine, Italy
| | - Daniel A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
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17
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Wahidi MM, Lee S, Cramer GR, Cangelosi MJ. Sampling of Thoracic Lymph Nodes and Lung Lesions: Trends in Procedural Utilization. Respiration 2023; 102:495-502. [PMID: 37290401 DOI: 10.1159/000530741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/05/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Advances in bronchoscopy have impacted the practice patterns in the sampling of thoracic lymph nodes and lung lesions. OBJECTIVES The aim of the study was to study the trends in utilization of mediastinoscopy, transthoracic needle aspiration (TTNA), and bronchoscopic transbronchial sampling. METHODS We conducted an analysis of patient claims for sampling of thoracic lymph nodes and lung lesions in the Medicare population and a sample of the commercial population between 2016 and 2020. We used Current Procedural Terminology codes to identify mediastinoscopy, TTNA, and bronchoscopic transbronchial sampling. Post-procedural pneumothorax rates were assessed by procedure type including subset analyses for patients with chronic obstructive pulmonary disease (COPD). RESULTS Between 2016 and 2020, utilization of mediastinoscopy has decreased in both the Medicare and commercial populations (-47.3% and -65.4%, respectively), while linear endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) has increased only in the Medicare population (+28.2%). Percutaneous lung biopsy claims dropped by -17.0% in the Medicare and -41.22% in the commercial population. The use of bronchoscopic TBNA and forceps biopsy declined in both populations, but the reliance on a combination of guided technology (radial EBUS-guided and navigation) grew in the Medicare and commercial populations (+76.3% and +25%). Rates of post-procedural pneumothorax were significantly higher following percutaneous biopsy compared to bronchoscopic transbronchial biopsy. CONCLUSIONS Linear EBUS-guided sampling has surpassed mediastinoscopy as the technique for sampling thoracic lymph nodes. Transbronchial lung sampling is increasingly being performed with guidance technology. This trend is aligned with favorable rates of post-procedure pneumothorax for transbronchial biopsy.
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Affiliation(s)
- Momen M Wahidi
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sonia Lee
- Boston Scientific, Marlborough, Massachusetts, USA
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18
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Rai H, Graham E, Ghoshal A, McDill H, Hassan M, Nicholson T, Taylor L, Corcoran J, Howell T, Daneshvar C. Endobronchial Ultrasound-guided Sampling of Centrally Located Intrapulmonary Tumors Provides Suitable Material for Diagnostic and Molecular Testing. J Bronchology Interv Pulmonol 2023; 30:163-168. [PMID: 36094327 DOI: 10.1097/lbr.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Curvilinear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a key diagnostic and staging procedure for patients with suspected lung cancer. However, sampling centrally located intrapulmonary tumors is feasible but less well established. METHODS We retrospectively evaluated the diagnostic utility of EBUS-TBNA in patients who underwent sampling of centrally located intrapulmonary tumors. Diagnostic accuracy, sample suitability for molecular testing, and complications were assessed. RESULTS Between January 2015 and April 2021, 102 EBUS-TBNA procedures sampled centrally located intrapulmonary tumors in 99 patients. The median age was 70 [interquartile range, 63 to 75] years and 51% (51/99) were male. The commonest site was the right upper lobe (n=42/99; 42%). The median tumor size was 29 [interquartile range, 21 to 35] mm. The diagnostic yield was 88/102 (86%) with a false negative rate of 14% (14/102). In addition to intrapulmonary tumor sampling, lymph nodes were sampled in 65/102 procedures and 30/65(46%) were positive for lung cancer. Cancer was diagnosed in 87/99 (88%) cases. When requested, molecular testing was adequate in ≥94% of samples. Complications included minor bleeding in 6/102 (6%) with 2 requiring cold saline instillation, desaturation in 1/102 (1%), and tachycardia in 1/102(1%). One procedure was abandoned due to patient tachycardia. Delayed complications occurred in 1 patient who was hospitalized ≤7 days with pneumonia. CONCLUSION EBUS-TBNA sampling of centrally located intrapulmonary tumors provides similar diagnostic accuracy to lymph node sampling, provides suitable material for molecular testing, and has a low complication rate.
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Affiliation(s)
- Hem Rai
- Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter
| | - Emma Graham
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Avik Ghoshal
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen McDill
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Maged Hassan
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Thomas Nicholson
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Lindsey Taylor
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - John Corcoran
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Timothy Howell
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
| | - Cyrus Daneshvar
- Interventional Pulmonology Service University Hospitals Plymouth NHS Trust, Plymouth
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NSCLC in the Era of Targeted and Immunotherapy: What Every Pulmonologist Must Know. Diagnostics (Basel) 2023; 13:diagnostics13061117. [PMID: 36980426 PMCID: PMC10047174 DOI: 10.3390/diagnostics13061117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
The treatment of non-small cell lung cancer has dramatically changed over the last decade through the use of targeted therapies and immunotherapies. Implementation of these treatment regimens relies on detailed knowledge regarding each tumor’s specific genomic profile, underscoring the necessity of obtaining superior diagnostic tissue specimens. While these treatment approaches are commonly utilized in the metastatic setting, approval among earlier-stage disease will continue to rise, highlighting the importance of early and comprehensive biomarker testing at the time of diagnosis for all patients. Pulmonologists play an integral role in the diagnosis and staging of non-small cell lung cancer via sophisticated tissue sampling techniques. This multifaceted review will highlight current indications for the use of targeted therapies and immunotherapies in non-small cell lung cancer and will outline the quality of various diagnostic approaches and subsequent success of tissue biomarker testing. Pulmonologist-specific methods, including endobronchial ultrasound and guided bronchoscopy, will be examined as well as other modalities such as CT-guided transthoracic biopsy and more.
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20
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McLoughlin KC, Bott MJ. Robotic Bronchoscopy for the Diagnosis of Pulmonary Lesions. Thorac Surg Clin 2023; 33:109-116. [PMID: 36372527 PMCID: PMC10566151 DOI: 10.1016/j.thorsurg.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pulmonary nodules (lesions <3 cm in size) are commonly identified on computed tomographic scans, but radiographic features alone are inadequate to reliably differentiate between benign and malignant etiologies. Therefore, tissue biopsy remains the standard approach to determine the appropriate treatment course for many patients with pulmonary nodules. Although percutaneous biopsy is highly accurate, it poses substantial risks of procedural complications, including pneumothorax and bleeding. Robotic bronchoscopy has recently been developed to overcome many of the limitations of previous navigational platforms. Here, we explore the currently available systems for robotic bronchoscopy-in particular, electromagnetic-navigation robotic-assisted bronchoscopy and shape-sensing robotic-assisted bronchoscopy.
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Affiliation(s)
- Kaitlin C McLoughlin
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Matthew J Bott
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
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21
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Assessment of Tissue Adequacy by EBUS in Conjunction with PET Scan and Operator's Experience. Clin Pract 2022; 12:942-949. [PMID: 36412678 PMCID: PMC9680420 DOI: 10.3390/clinpract12060099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Mediastinal lymph node assessment is a crucial step in non-small cell lung cancer staging. Positron emission tomography (PET) has been the gold standard for the assessment of mediastinal lymphadenopathy, though it has limited specificity. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is quick, accurate, and a less invasive method for obtaining a diagnostic sample in contrast to mediastinoscopy. We performed a retrospective chart analysis of 171 patients to assess the adequacy of tissue obtained by EBUS for diagnosis and molecular profiling as well as the assessment of staging and lymph node (LN) stations diagnostic yield, in correlation to PET scan and the operator’s level of experience. A significantly increased tissue adequacy was observed based on the operators’ experience, with the highest adequacy noted in trained Interventional Pulmonologist (IP) (100%), followed by >5 years of experience (93.33%), and 88.89% adequacy with <5 years of experience (p = 0.0019). PET-CT scan 18F-fluorodeoxyglucose (FDG) uptake in levels 1, 2, and 3 LN had a tissue adequacy of 76.67%, 54.64%, and 35.56%, respectively (p = 0.0009). EBUS bronchoscopy method could be used to achieve an accurate diagnosis, with IP-trained operators yielding the best results. There is no correlation with PET scan positivity, indicating that both PET and EBUS are complementary methods needed for staging.
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22
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Quinn ZL, Barta JA, Johnson JM. Molecular lung cancer: How targeted therapies and personalized medicine are re-defining cancer care. Am J Med Sci 2022; 364:371-378. [PMID: 35469765 DOI: 10.1016/j.amjms.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/25/2022] [Accepted: 04/15/2022] [Indexed: 01/25/2023]
Abstract
Lung cancer remains the leading cause of cancer death in the United States and is unfortunately still frequently diagnosed in the metastatic setting, where the disease is considered incurable. Nearly 30% of these cancers may be driven by specific mutations that promote tumor growth and proliferation. These mutations are observed more frequently in young patients without significant smoking history and in certain racial and ethnic backgrounds. The past 15 years have marked a revolution for patients with molecularly driven lung cancer as novel, oral, targeted therapies have been developed that demonstrate superior activity with substantially better toxicity profiles in comparison to chemotherapy. Consideration of molecular testing for a driver mutation is imperative for all providers caring for patients with a new suspected lung cancer diagnosis, as discovery of an actionable mutation will have dramatic implications in regards to patient survival and quality of life.
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Affiliation(s)
- Zachary L Quinn
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Julie A Barta
- Department of Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer M Johnson
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Philadelphia, PA, USA.
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23
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Mondoni M, Sotgiu G. Optimizing the endoscopic diagnosis of mediastinal lymphadenopathy: a glimpse on cryobiopsy. BMC Pulm Med 2022; 22:355. [PMID: 36123592 PMCID: PMC9487110 DOI: 10.1186/s12890-022-02160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
Etiological diagnosis of mediastinal lymphadenopathy represents a daily challenge. Endosonography (transesophageal and transbronchial ultrasound-guided needle aspiration) is the recommended technique in the first diagnostic work-up and in the mediastinal staging of lung cancer. Despite a good sensitivity, limited amount of collected tissue may hamper molecular assessment in advanced lung cancer and in the diagnosis of lymphoproliferative disorders, fibrotic sarcoidosis, and mycobacterial lymphadenitis. Cryobiopsy, a bronchoscopic technique based on cooling, crystallization, and subsequent collection of tissue, has been successfully employed in the diagnosis of interstitial lung diseases. Cryoprobes provide larger amount of tissue than conventional bronchoscopic sampling tools and might potentially prevent the need for invasive surgical procedures. New applications of the technique (e.g., bronchoscopic diagnosis of peripheral pulmonary lesions and mediastinal lymph nodes) have been recently described in few reports. In a recent issue of the Journal, Genova et al. described five patients who underwent endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) followed by ultrasound-guided transbronchial cryobiopsy of mediastinal lymphadenopathy for a suspected malignancy. The authors discussed about the potential added value of mediastinal cryobiopsy on a correct histopathological and molecular assessment in patients with malignancies. EBUS-cryobiopsy could be a promising technique in the diagnostic pathway of mediastinal lymphadenitis. However, cryobiopsy is now available only in few selected centres. The learning curve of the technique adapted to mediastinal ultrasound-guided sampling, the optimal sampling strategy, its true diagnostic accuracy in patients with malignant and benign diseases, as well as its safety, are still largely unclear. Mediastinal cryobiopsy could be complementary rather than alternative to conventional endosonography. Rapid on-site evaluation of EBUS-TBNA could guide subsequent sampling with cryoprobes in case of poor collection of biological material or in case of suspected lymphoproliferative disorders. Further studies should investigate its diagnostic yield, in comparison or in combination with conventional endosonography, in large cohorts of patients with malignant or benign mediastinal lymphadenopthies.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo E Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudinì n.8, 20142, Milan, Italy.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
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24
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Tsaknis G, Naeem M, Rathinam S, Caswell A, Haycock J, McKenna J, Reddy RV. Utilization of High-pressure Suction for EBUS-TBNA Sampling in Suspected Lung Cancer. J Bronchology Interv Pulmonol 2022; 29:115-124. [PMID: 34369403 PMCID: PMC8942712 DOI: 10.1097/lbr.0000000000000798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sample adequacy for immediate molecular testing is paramount in lung cancer. To date, several endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) sampling setups have been evaluated, however, the utilization of high-pressure suction (HPS) has not yet been reported.The aim of this study was to evaluate the utilization of HPS onto the needle and its effect on sample volume and adequacy for molecular testing in patients with suspected lung cancer. METHODS We retrospectively analyzed 128 consecutive EBUS-TBNA performed for suspected lung cancer. This was confirmed in 109 patients. Other diagnoses confirmed in 12, and 7 referred for surgery. Sixty-three patients (89 targets) had HPS (May to September 2020), and compared with 46 (72 targets) who had standard vacuum syringe suction (October 2019 to March 2020). Several parameters and outcomes evaluated, such as number of needle passes, needle strokes, needle size, target size, positron emission tomography avidity, procedure time, blood content score, sample volume, adequacy for molecular testing, as well as baseline patient characteristics and complication rate. RESULTS There was no difference between the 2 groups in all baseline parameters and characteristics. In multivariable analysis, HPS was associated with significantly higher sample volume (11.2 vs. 9.1 mm3, P=0.036) and less additional procedures to achieve full molecular profiling (2/52 vs. 7/40, P=0.042), in necrotic targets of non-small cell lung cancer. Diagnostic yields were comparable. CONCLUSION HPS appears to be simple, no-cost, and safe, promising higher sample volume compared with vacuum syringe suction, and also appears to be associated with higher success of full molecular testing with less additional procedures, in non-small cell lung cancer necrotic targets.
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Affiliation(s)
- George Tsaknis
- Department of Respiratory Medicine, Lung Cancer Service
- Department of Endoscopy, Kettering General Hospital NHS Foundation Trust, Kettering
| | - Muhammad Naeem
- Department of Respiratory Medicine, Lung Cancer Service
- Department of Endoscopy, Kettering General Hospital NHS Foundation Trust, Kettering
| | - Sridhar Rathinam
- Department of Respiratory Medicine, Lung Cancer Service
- Department of Thoracic Surgery, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK
| | - Alison Caswell
- Department of Endoscopy, Kettering General Hospital NHS Foundation Trust, Kettering
| | - Jayne Haycock
- Department of Endoscopy, Kettering General Hospital NHS Foundation Trust, Kettering
| | - Jane McKenna
- Department of Endoscopy, Kettering General Hospital NHS Foundation Trust, Kettering
| | - Raja V. Reddy
- Department of Respiratory Medicine, Lung Cancer Service
- Department of Endoscopy, Kettering General Hospital NHS Foundation Trust, Kettering
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25
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Is endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) reliable and safe procedure in geriatric patients? Aging Clin Exp Res 2022; 34:913-925. [PMID: 34731449 DOI: 10.1007/s40520-021-02012-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Even though studies have indicated the usefulness and safety of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA), elderly patient data are limited due to the small sample sizes. AIM We aimed to evaluate usage and safety of EBUS-TBNA in elderly population. METHODS This single-center retrospective study was conducted with patients who underwent an EBUS-TBNA procedure between September 2011 and December 2019. The patients were categorized into two groups: those aged 65 years or older (elderly group) and those younger than 65 years (younger group). RESULTS 2444 patient data, 1069 of which were in the elderly group, were analyzed. The cytological examination of EBUS-TBNA identified specimen adequacy in 96.8% of patients. One hundred and thirty patients (5.3%) experienced complications, with similar complication rates recorded in both the elderly and younger groups (5.4% vs 5.2%, p: 0.836). Logistic regression analyses revealed that age, and presence of hypertension, diabetes mellitus, coronary artery disease and malignancy are associated significantly with complication-related EBUS-TBNA. For the lymph nodes with a final diagnosis of malignancy, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EBUS-TBNA revealed a diagnostic performance in excess of 90% except for metastasis and lymphoma. CONCLUSION EBUS-TBNA can be considered a safe and effective technique in patients aged 65 years and over.
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26
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Gürün Kaya A, Çiledağ A, Erol S, Öz M, Doğan Mülazımoğlu D, Işık Ö, Özakıncı H, Çiftçi F, Şen E, Ceyhan K, Kaya A, Karnak D, Çelik G, İsmail S. Evaluation of lung cancer biomarkers profile for the decision of targeted therapy in EBUS-TBNA cytological samples. Scott Med J 2022; 67:18-27. [PMID: 35147461 DOI: 10.1177/00369330221078995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Guidelines recommend performing biomarker tests for epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), BRAF and ROS proto-oncogene-1(ROS1) genes and protein expression of programmed death ligand-1(PD-L1) in patients with non-small lung cell carcinoma (NSCLC). Studies reported that endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) can provide sufficient material for cancer biomarker analyses, but there are still concerns about the subject. AIM The purpose of the study was to assess the adequacy of EBUS-TBNA for testing lung cancer biomarkers. METHODS We retrospectively reviewed patients with NSCLC whose EBUS-TBNA was analysed for EGFR, ALK, ROS-1, BRAF and PD-L1 expression between December 2011 and December 2020. RESULTS A total of 394 patients were enrolled in the study. EGFR mutation and ALK fusion were the most common studied biomarkers. EBUS-TBNA adequacy rate for biomarker tests was found 99.0% for EGFR, 99.1 for ALK, 97.2% for ROS1, 100% for BRAF and 99.3% for PD-L1 testing. Multivariate analysis revealed the histological type, history of treatment for NSCL, size, or 18-fluorodeoxyglucose uptake of sampled lesion did not show any association with TBNA adequacy for biomarker testing. CONCLUSION EBUS-TBNA can provide adequate material for biomarker testing for EGFR, ALK, ROS-1, BRAF and PD-L1 expression.
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Affiliation(s)
- Aslıhan Gürün Kaya
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydın Çiledağ
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serhat Erol
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Miraç Öz
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Özlem Işık
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hilal Özakıncı
- Department of Pathology, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Çiftçi
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif Şen
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Koray Ceyhan
- Department of Pathology, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Akın Kaya
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Demet Karnak
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gökhan Çelik
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
| | - Savaş İsmail
- Department of Chest Diseases, 63990Ankara University Faculty of Medicine, Ankara, Turkey
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Karadzovska-Kotevska M, Brunnström H, Kosieradzki J, Ek L, Estberg C, Staaf J, Barath S, Planck M. Feasibility of EBUS-TBNA for histopathological and molecular diagnostics of NSCLC-A retrospective single-center experience. PLoS One 2022; 17:e0263342. [PMID: 35108331 PMCID: PMC8809531 DOI: 10.1371/journal.pone.0263342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive bronchoscopic procedure, well established as a diagnostic modality of first choice for diagnosis and staging of non-small cell lung cancer (NSCLC). The therapeutic decisions for advanced NSCLC require comprehensive profiling of actionable mutations, which is currently considered to be an essential part of the diagnostic process. The purpose of this study was to evaluate the utility of EBUS-TBNA cytology specimen for histological subtyping, molecular profiling of NSCLC by massive parallel sequencing (MPS), as well as for PD-L1 analysis. A retrospective review of 806 EBUS bronchoscopies was performed, resulting in a cohort of 132 consecutive patients with EBUS-TBNA specimens showing NSCLC cells in lymph nodes. Data on patient demographics, radiology features of the suspected tumor and mediastinal engagement, lymph nodes sampled, the histopathological subtype of NSCLC, and performed molecular analysis were collected. The EBUS-TBNA specimen proved sufficient for subtyping NSCLC in 83% and analysis of treatment predictive biomarkers in 77% (MPS in 53%). The adequacy of the EBUS-TBNA specimen was 69% for EGFR gene mutation analysis, 49% for analysis of ALK rearrangement, 36% for ROS1 rearrangement, and 33% for analysis of PD-L1. The findings of our study confirm that EBUS-TBNA cytology aspirate is appropriate for diagnosis and subtyping of NSCLC and largely also for treatment predictive molecular testing, although more data is needed on the utility of EBUS cytology specimen for MPS and PD-L1 analysis.
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Affiliation(s)
- Marija Karadzovska-Kotevska
- Department of Respiratory Diseases and Allergology, Skåne University Hospital Lund, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
- * E-mail:
| | - Hans Brunnström
- Division of Laboratory Medicine, Department of Genetics and Pathology, Region Skåne, Lund, Sweden
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jaroslaw Kosieradzki
- Department of Respiratory Diseases and Allergology, Skåne University Hospital Lund, Lund, Sweden
| | - Lars Ek
- Department of Respiratory Diseases and Allergology, Skåne University Hospital Lund, Lund, Sweden
| | - Christel Estberg
- Department of Respiratory Diseases and Allergology, Skåne University Hospital Lund, Lund, Sweden
| | - Johan Staaf
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Stefan Barath
- Department of Respiratory Diseases and Allergology, Skåne University Hospital Lund, Lund, Sweden
| | - Maria Planck
- Department of Respiratory Diseases and Allergology, Skåne University Hospital Lund, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
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Zhao JJ, Ping Chan H, Yang Soon Y, Huang Y, Soo RA, Kee AC. A systematic review and meta-analysis of the adequacy of endobronchial ultrasound transbronchial needle aspiration for next-generation sequencing in patients with non-small cell lung cancer. Lung Cancer 2022; 166:17-26. [DOI: 10.1016/j.lungcan.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 12/17/2022]
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Folch E, Mittal A, Oberg C. Robotic bronchoscopy and future directions of interventional pulmonology. Curr Opin Pulm Med 2022; 28:37-44. [PMID: 34789649 DOI: 10.1097/mcp.0000000000000849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To describe the emerging field of robotic bronchoscopy within advanced diagnostic bronchoscopy. We review the literature available for these two novel platforms to highlight their differences and discuss the impact on future directions. RECENT FINDINGS There are two distinct technologies both known as robotic bronchoscopy. The Monarch robotic-assisted bronchoscopy is based on electromagnetic guidance whereas the Ion robotic-assisted bronchoscopy is founded on shape sensing technology. Although there is ongoing work to explore the capabilities of these systems, studies have shown that both are safe modalities. Furthermore, both hold promise to improve diagnostic yield and may eventually pave the way for therapeutic bronchoscopic ablation in the future. SUMMARY Although both platforms fall under the umbrella term of robotic-assisted bronchoscopy, the Monarch and Ion systems are quite unique in their technology. Thus far, both have demonstrated safety, and early data shows promising results for improved diagnostic yield compared to previously advanced bronchoscopy modalities, especially when combined with advanced confirmatory imaging. Future directions may include bronchoscopic ablation of peripheral lesions given the stability and reach of these platforms.
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Affiliation(s)
- Erik Folch
- Department of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abhinav Mittal
- Department of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Catherine Oberg
- Division of Pulmonary, Critical Care, Allergy and Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Marshall T, Kalanjeri S, Almeida FA. Lung cancer staging, the established role of bronchoscopy. Curr Opin Pulm Med 2022; 28:17-30. [PMID: 34720099 DOI: 10.1097/mcp.0000000000000843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Lung cancer is the leading cause of cancer-related deaths worldwide. In the absence of distant metastases, accurate mediastinal nodal staging determines treatment approaches to achieve most favourable outcomes for patients. Mediastinal staging differentiates N0/N1 disease from N2/N3 in surgical candidates. Likewise, presence of nodal involvement in nonsurgical candidates who are being considered for stereotactic body radiation therapy is also critical. This review article seeks to discuss the current options available for mediastinal staging in nonsmall cell lung cancer (NSCLC), particularly the role of bronchoscopy. RECENT FINDINGS Although several techniques are available to stage the mediastinum, bronchoscopy with EBUS-TBNA with or without EUS-FNA appears to be superior in most clinical situations based on its ability to concomitantly diagnose and stage at once, safety, accessibility to the widest array of lymph node stations, cost and low risk of complications. However, training and experience are required to achieve consistent diagnostic accuracy with EBUS-TBNA. SUMMARY EBUS-TBNA with or without EUS-FNA is considered the modality of choice in the diagnosis and staging of NSCLC in both surgical and nonsurgical candidates.
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Affiliation(s)
- Tanya Marshall
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Satish Kalanjeri
- Pulmonary and Critical Care Medicine, Harry S. Truman Memorial Veterans Hospital
- Pulmonary and Critical Care Medicine, University of Missouri School of Medicine, Columbia, Missouri
| | - Francisco Aecio Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Fox AH, Jett JR, Roy UB, Johnson BE, King JC, Martin N, Osarogiagbon RU, Rivera MP, Rosenthal LS, Smith RA, Silvestri GA. Knowledge and Practice Patterns Among Pulmonologists for Molecular Biomarker Testing in Advanced Non-small Cell Lung Cancer. Chest 2021; 160:2293-2303. [PMID: 34181954 PMCID: PMC8727850 DOI: 10.1016/j.chest.2021.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Targeted therapies for advanced non-small cell lung cancer (NSCLC) with oncogenic drivers have caused a paradigm shift in care. Biomarker testing is needed to assess eligibility for these therapies. Pulmonologists often perform bronchoscopy, providing tissue for both pathologic diagnosis and biomarker analysis. We performed this survey to define the existing knowledge and practices regarding the pulmonologists' role in biomarker testing for advanced NSCLC. RESEARCH QUESTION What is the current knowledge and practice of pulmonologists regarding biomarker testing and targeted therapies in advanced NSCLC? STUDY DESIGN AND METHODS This cross-sectional study was performed using an electronic survey of a random sample of 7,238 pulmonologists. Questions focused on diagnostic steps and biomarker analyses for NSCLC. RESULTS A total of 453 pulmonologists responded. Respondents vary by reported lung cancer patient volume, ranging from 51% evaluating one to four new cases per month to 19% evaluating > 10 cases per month. Interventional training, academic practice setting, and higher volume of endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) were associated with increased knowledge of practice guidelines for the number of recommended passes during EBUS-TBNA (P < .05). Academic pulmonologists more commonly performed or referred for EBUS-TBNA than community pulmonologists (96% and 83%, respectively; P < .0005). Higher testing rates were associated with interventional training, academic setting, and the presence of an institutional policy, whereas lower testing rates were associated with general pulmonologists, practice in community settings, and lack of a guiding institutional policy (P < .05). INTERPRETATION Substantial differences among pulmonologists' evaluation of advanced NSCLC, variation in knowledge of available biomarkers and the importance of targeted therapies, and differences in institutional coordination likely lead to underutilization of biomarker testing. Interventional training appears to drive improved knowledge and practice for biomarker testing more than practice setting. Improvements are needed in tissue acquisition and interdisciplinary coordination to ensure universal and comprehensive testing for eligible patients.
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Affiliation(s)
- Adam H Fox
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC
| | | | | | | | | | | | | | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lauren S Rosenthal
- Prevention and Early Detection Department, American Cancer Society, Atlanta, GA
| | - Robert A Smith
- Prevention and Early Detection Department, American Cancer Society, Atlanta, GA
| | - Gerard A Silvestri
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
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Poudel B, Desman J, Aihara G, Weidman DI, Tsang A, Kovrizhkin K, Pereira T, Arun S, Pradeep T, Matin S, Liddell RP. Adequacy of samples obtained via percutaneous core-needle rebiopsy for EGFR T790M molecular analysis in patients with non-small cell lung cancer following acquired resistance to first-line therapy: A systematic review and meta-analysis. Cancer Treat Res Commun 2021; 29:100470. [PMID: 34628209 DOI: 10.1016/j.ctarc.2021.100470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 12/23/2022]
Abstract
MICRO ABSTRACT Rebiopsies characterizing resistance mutations in patients with non-small cell lung cancer (NSCLC) can guide personalized medicine and improve overall survival rates. In this systematic review, we examine the suitability of percutaneous core-needle biopsy (PT-CNB) to obtain adequate samples for molecular characterization of the acquired resistance mutation T790M. This review provides evidence that PT-CNB can obtain samples with high adequacy, with a mutation detection rate that is in accordance with prior literature. BACKGROUND Non-small cell lung cancer (NSCLC) comprises 85% of all lung cancers and has seen improved survival rates with the rise of personalized medicine. Resistance mutations to first-line therapies, such as T790M, however, render first-line therapies ineffective. Rebiopsies characterizing resistance mutations inform therapeutic decisions, which result in prolonged survival. Given the high efficacy of percutaneous core-needle biopsy (PT-CNB), we conducted the first systematic review to analyze the ability of PT-CNB to obtain samples of high adequacy in order to characterize the acquired resistance mutation T790M in patients with NSCLC. METHODS We performed a comprehensive literature search across PubMed, Embase, and CENTRAL. Search terms related to "NSCLC," "rebiopsy," and "PT-CNB" were used to obtain results. We included all prospective and retrospective studies that satisfied our inclusion and exclusion criteria. A random effects model was utilized to pool adequacy and detection rates of the chosen articles. We performed a systematic review, meta-analysis, and meta-regression to investigate the adequacy and T790M detection rates of samples obtained via PT-CNB. RESULTS Out of the 173 studies initially identified, 5 studies met the inclusion and exclusion criteria and were chosen for our final cohort of 436 patients for meta-analysis. The pooled adequacy rate of samples obtained via PT-CNB was 86.92% (95% CI: [79.31%, 92.0%]) and the pooled T790M detection rate was 46.0% (95% CI: [26.6%, 66.7%]). There was considerable heterogeneity among studies (I2 > 50%) in both adequacy and T790M detection rates. CONCLUSION PT-CNB can obtain adequate samples for T790M molecular characterization in NSCLC lung cancer patients. Additional prospective studies are needed to corroborate the results in this review.
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Affiliation(s)
- Bibhav Poudel
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Jacob Desman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Gohta Aihara
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Deborah I Weidman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Ashley Tsang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Katherine Kovrizhkin
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Tatiana Pereira
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Siddharth Arun
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Tejus Pradeep
- Department of Ophthalmology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Shababa Matin
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Robert P Liddell
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, United States of America.
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Yu Lee-Mateus A, Garcia-Saucedo JC, Abia-Trujillo D, Labarca G, Patel NM, Pascual JM, Fernandez-Bussy S. Comparing diagnostic sensitivity of different needle sizes for lymph nodes suspected of lung cancer in endobronchial ultrasound transbronchial needle aspiration: Systematic review and meta-analysis. CLINICAL RESPIRATORY JOURNAL 2021; 15:1328-1336. [PMID: 34402194 DOI: 10.1111/crj.13436] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/12/2021] [Accepted: 08/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure for evaluating hilar and mediastinal lymph nodes. The reported sensitivity and specificity of EBUS-TBNA are 95% and 97%, respectively. A comparison of diagnostic sensitivity for lymph nodes suspected of lung cancer according to needle size in EBUS-TBNA is needed. OBJECTIVES To compare the diagnostic sensitivity of the 19-G, 21-G, 22-G and 25-G needles for lymph nodes suspected of non-small cell lung cancer (NSCLC) using EBUS-TBNA. METHODS A literature search from PubMed, EMBASE, LILACS, DOAJ and CENTRAL through October 2020 was performed by two reviewers. The extracted data were evaluated using STATA® and Open Meta Analyst software for meta-analysis with a binary method model to compare sensitivity, specificity and summary receiver operating characteristic curve for each needle size. RESULTS Fourteen studies including 1296 participants were considered for the analysis. The overall sensitivity of EBUS-TBNA was 88.2% (95% CI 84%, 91%) and 93% (95% CI 88%, 95%) for the 19-G needle, 87.6% (95% CI 79.6%, 92.8%) for the 21-G needle and 85% (95% CI 80%, 88%) for the 22-G needle. The overall sensitivity of EBUS-TBNA for diagnosing NSCLC was 88.3% (95% CI, 81%, 93%) and 92.9% (95% CI, 85%, 97%) for the 19-G needle, 89.4% (95% CI 79.4%, 94.8%) for the 21-G needle and 82.1% (95% CI 66%, 91%) for the 22-G needle. CONCLUSION The 19-G, 21-G and 22-G needles present a similarly high diagnostic sensitivity in EBUS-TBNA. The 19-G needle provided better sample adequacy for molecular and immunohistochemical testing, improving diagnostic yield in this subgroup.
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Affiliation(s)
- Alejandra Yu Lee-Mateus
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Juan C Garcia-Saucedo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - David Abia-Trujillo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Gonzalo Labarca
- Department of Internal Medicine, Faculty of Medicine, University of Concepcion, Concepcion, Chile
| | - Neal M Patel
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Jorge M Pascual
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
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Wahidi MM, Davidson K, Shofer S, Mahmood K, Cheng G, Giovacchini C, Jones C, Jug R, Pavlisko EN, Wang X, Gu L, Weimholt C, Zhou Z, Chen A. Pilot Study of the Performance of 19-G Needle in Endobronchial Ultrasound-guided Transbronchial Aspiration for the Diagnosis and Testing of Molecular Markers in Lung Cancer. J Bronchology Interv Pulmonol 2021; 28:209-214. [PMID: 33273249 DOI: 10.1097/lbr.0000000000000736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the standard for diagnosis and staging of lung cancer. Historically, 21- and 22-G needles have been paired with EBUS. We evaluated the performance of EBUS-TBNA using a larger 19-G needle in the assessment of tumor tissue obtained and success of testing for molecular markers. METHODS We prospectively enrolled adult patients with lymphadenopathy concerning for metastatic lung cancer. Patients underwent diagnostic EBUS-TBNA utilizing 19-G needles. Cases of non-small cell lung cancer (NSCLC) were evaluated for programmed cell death receptor ligand (PD-L1) expression. Cases of adenocarcinoma or undifferentiated NSCLC were further evaluated for 3 molecular markers for driver mutations: epidermal growth factor receptor (EGFR), c-ros oncogene 1 (ROS-1), and anaplastic lymphoma kinase (ALK). RESULTS Fifty patients were enrolled and underwent EBUS-TBNA using 19-G needles. PD-L1 assay was successfully performed in 90% of NSCLC cases. In adenocarcinoma or undifferentiated NSCLC cases, the success rate in testing was 90% for EGFR and 86% for ALK. ROS-1 testing had a success rate of 67%; 24% of these specimens had adequate tumor cells but there was technical difficulty with the assay. Block quality was judged by total number of tumor cells per hematoxylin and eosin-stained slide of each cell block (58% of specimens had >500 cells and 22% had 200 to 500 cells). There were no adverse events. CONCLUSION EBUS-TBNA using 19-G needles can obtain a high number of tumor cells and has a high rate of success in performing assays for PD-L1, EGFR, and ALK in NSCLC patients without an increase in adverse events. The success rate of ROS-1 testing was lower.
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Affiliation(s)
- Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | | | - Scott Shofer
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Kamran Mahmood
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - George Cheng
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Coral Giovacchini
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Claudia Jones
- Department of Pathology, Duke University Medical Center
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center
| | | | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University, Durham
| | - Lin Gu
- Department of Biostatistics and Bioinformatics, Duke University, Durham
| | | | | | - Alexander Chen
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
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Tournoy TK, Tournoy KG. Digging mediastinal holes with vigour: a word of caution. Eur Respir J 2021; 59:13993003.01381-2021. [PMID: 34140295 DOI: 10.1183/13993003.01381-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 11/05/2022]
Affiliation(s)
| | - Kurt G Tournoy
- Gent University, Faculty of Medicine, Gent, Belgium.,Dept of Respiratory Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
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Zhang J, Huang ZS, Herth FJF, Fan Y. Reply to: "Digging mediastinal holes in vigor: a word of caution". Eur Respir J 2021; 59:13993003.01528-2021. [PMID: 34140300 DOI: 10.1183/13993003.01528-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/06/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Jing Zhang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zan-Sheng Huang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ye Fan
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Guarize J, Rocco EG, de Marinis F, Sedda G, Bertolaccini L, Donghi SM, Casiraghi M, Tonno CD, Barberis M, Spaggiari L. Prospective evaluation of EBUS-TBNA specimens for programmed death-ligand 1 expression in non-small cell lung cancer patients: a pilot study. J Bras Pneumol 2021; 47:e20200584. [PMID: 34259745 PMCID: PMC8332653 DOI: 10.36416/1806-3756/e20200584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE EBUS-TBNA cytological sampling is routinely performed for pathological diagnosis, mediastinal staging, and molecular testing in lung cancer patients. EBUS-TBNA samples are not formally accepted for testing programmed death-ligand 1 (PD-L1) expression. The objective of the study was to compare the feasibility, reproducibility, and accuracy of PD-L1 expression assessment in cytological specimens and histological samples. METHODS We prospectively collected histological (transbronchial forceps biopsy) and cytological (EBUS-TBNA) samples from peribronchial neoplastic lesions during an endoscopic procedure at the same target lesion for the pathological diagnosis and molecular assessment of stage IV non-small cell lung cancer (NSCLC). RESULTS Fifteen patients underwent the procedure. Adequate cytological samples (at least 100 neoplastic cells) were obtained in 12 cases (92.3%). Assessment of PD-L1 expression was similar between histological and cytological samples (agreement rate = 92%). Sensitivity and diagnostic accuracy of EBUS-TBNA cytological specimens were 88.9% and 100%, respectively. CONCLUSIONS The evaluation of PD-L1 expression in EBUS-TBNA cytological specimens is feasible and presents good reproducibility when compared with routine histological samples. EBUS-TBNA cytological samples could be used for the assessment of PD-L1 expression in patients with NSCLC as a minimally invasive approach in stage IV NSCLC cancer patients.
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Affiliation(s)
- Juliana Guarize
- . Pneumologia Interventistica, Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Elena Guerini Rocco
- . Divisione di Anatomia Patologica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Filippo de Marinis
- . Divisione di Oncologia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Giulia Sedda
- . Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Luca Bertolaccini
- . Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Stefano Maria Donghi
- . Pneumologia Interventistica, Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Monica Casiraghi
- . Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Clementina Di Tonno
- . Divisione di Anatomia Patologica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Massimo Barberis
- . Divisione di Anatomia Patologica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Lorenzo Spaggiari
- . Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
- . Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italia
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Su W, Tian XD, Liu P, Zhou DJ, Cao FL. Accuracy of endoscopic ultrasound-guided needle aspiration specimens for molecular diagnosis of non-small-cell lung carcinoma. World J Clin Cases 2020; 8:5139-5148. [PMID: 33269250 PMCID: PMC7674716 DOI: 10.12998/wjcc.v8.i21.5139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/04/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are highly sensitive for diagnosing and staging lung cancer. In recent years, targeted therapy has shown great significance in the treatment of non-small cell lung carcinoma (NSCLC). Using these minimally invasive techniques to obtain specimens for molecular testing will provide patients with a more convenient diagnostic approach.
AIM To evaluate the feasibility and accuracy of tissue samples obtained using EUS-FNA and EBUS-TBNA for molecular diagnosis of NSCLC.
METHODS A total of 83 patients with NSCLC underwent molecular testing using tissues obtained from EUS-FNA or EBUS-TBNA at the Tianjin Medical University Cancer Hospital from January 2017 to June 2019. All enrolled patients underwent chest computed tomography or positron emission tomography/computed tomography prior to puncture. We detected abnormal expression of EGFR, KRAS, MET, HER2, ROS1 and anaplastic lymphoma kinase protein. Two patients failed to complete molecular testing due to insufficient tumor tissue. The clinical features, puncture records, molecular testing results and targeted treatment in the remaining 81 patients were summarized.
RESULTS In a total of 99 tissue samples obtained from 83 patients, molecular testing was successfully completed in 93 samples with a sample adequacy ratio of 93.9% (93/99). Biopsy samples from two patients failed to provide test results due to insufficient tumor tissue. In the remaining 81 patients, 62 cases (76.5%) were found to have adenocarcinoma, 11 cases (13.6%) had squamous cell carcinoma, 3 cases (3.7%) had adenosquamous carcinoma and 5 cases (6.2%) had NSCLC-not otherwise specified. The results of molecular testing showed EGFR mutations in 21 cases (25.9%), KRAS mutations in 9 cases (11.1%), ROS-1 rearrangement in 1 case (1.2%) and anaplastic lymphoma kinase-positive in 5 cases (6.2%). Twenty-four patients with positive results received targeted therapy. The total effectiveness rate of targeted therapy was 66.7% (16/24), and the disease control rate was 83.3% (20/24).
CONCLUSION Tissue samples obtained by EUS-FNA or EBUS-TBNA are feasible for the molecular diagnosis of NSCLC and can provide reliable evidence for clinical diagnosis and treatment.
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Affiliation(s)
- Wei Su
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiang-Dong Tian
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Peng Liu
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - De-Jun Zhou
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Fu-Liang Cao
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
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Abstract
In the diagnosis of lung cancer, pulmonologists have several tools at their disposal. From the tried and true convex probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration to robotic bronchoscopy for peripheral lesions and new technology to unblind the biopsy tools, this article elucidates and expounds on the tools currently available and being developed for lung cancer diagnosis.
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Criner GJ, Eberhardt R, Fernandez-Bussy S, Gompelmann D, Maldonado F, Patel N, Shah PL, Slebos DJ, Valipour A, Wahidi MM, Weir M, Herth FJ. Interventional Bronchoscopy. Am J Respir Crit Care Med 2020; 202:29-50. [PMID: 32023078 DOI: 10.1164/rccm.201907-1292so] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions, and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies, and the ability to biopsy a lesion under direct visualization. The last 10-15 years have seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions, and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available or are currently being investigated to treat a broad range of airway and lung parenchymal diseases, such as asthma, emphysema, and chronic bronchitis, or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat, malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This State-of-the-Art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.
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Affiliation(s)
- Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ralf Eberhardt
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | - Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Fabien Maldonado
- Department of Medicine and Department of Thoracic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Neal Patel
- Division of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Pallav L Shah
- Respiratory Medicine at the Royal Brompton Hospital and National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Krankenhaus Nord, Vienna, Austria; and
| | - Momen M Wahidi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mark Weir
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Felix J Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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Mondoni M, Rinaldo RF, Carlucci P, Terraneo S, Saderi L, Centanni S, Sotgiu G. Bronchoscopic sampling techniques in the era of technological bronchoscopy. Pulmonology 2020; 28:461-471. [PMID: 32624385 DOI: 10.1016/j.pulmoe.2020.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
Flexible bronchoscopy is a key diagnostic and therapeutic tool. New endoscopes and technologically advanced navigational modalities have been recently introduced on the market and in clinical practice, mainly for the diagnosis of mediastinal lymph adenopathies and peripheral lung nodules. Bronchoscopic sampling tools have not changed significantly in the last three decades, with the sole exception of cryobiopsy. We carried out a non-systematic, narrative literature review aimed at summarizing the scientific evidence on the main indications/contraindications, diagnostic yield, and safety of the available bronchoscopic sampling techniques. Performance of bronchoalveolar lavage, bronchial washing, brushing, forceps biopsy, cryobiopsy and needle aspiration techniques are described, focusing on indications and diagnostic accuracy in the work-up of endobronchial lesions, peripheral pulmonary abnormalities, interstitial lung diseases, and/or hilar-mediastinal lymph adenopathies. Main factors affecting the diagnostic yield and the navigational methods are evaluated. Preliminary data on the utility of the newest sampling techniques (i.e., new needles, triple cytology needle brush, core biopsy system, and cautery-assisted transbronchial forceps biopsy) are shown. TAKE HOME MESSAGE: A deep knowledge of bronchoscopic sampling techniques is crucial in the era of technological bronchoscopy for an optimal management of respiratory diseases.
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Affiliation(s)
- M Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - R F Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - P Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - S Terraneo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - L Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - S Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy.
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Gonzalez AV. Stating the Obvious… Or Leading the Way Toward More Judicious Use of Diagnostic Bronchoscopy. Chest 2020; 157:1409-1410. [PMID: 32505303 DOI: 10.1016/j.chest.2020.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/12/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Anne V Gonzalez
- Respiratory Division, McGill University, Montreal, QC, Canada.
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Tajarernmuang P, Ofiara L, Beaudoin S, Gonzalez AV. Bronchoscopic tissue yield for advanced molecular testing: are we getting enough? J Thorac Dis 2020; 12:3287-3295. [PMID: 32642252 PMCID: PMC7330770 DOI: 10.21037/jtd-19-4119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/15/2020] [Indexed: 01/07/2023]
Abstract
The treatment of advanced lung cancer has become increasingly personalized over the past decade as a result of the improved understanding of tumor molecular biology and anti-tumor immunity. An adequate tumor sample is central to targetable mutation analysis, and immunologic profiling. The majority of lung cancer patients currently present at an advanced disease stage, so that diagnosis and staging are largely based on small biopsy and cytology specimens. Flexible bronchoscopy techniques play a prominent role in the acquisition of these diagnostic specimens. This narrative review summarizes the available evidence with regards to the role of various conventional and advanced flexible bronchoscopy techniques in acquiring sufficient tissue for mutation analysis and programmed death-ligand 1 (PD-L1) testing.
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Affiliation(s)
- Pattraporn Tajarernmuang
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Respiratory, Critical Care and Allergy Division, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Linda Ofiara
- Respiratory Division, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stéphane Beaudoin
- Respiratory Division, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anne V. Gonzalez
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Respiratory Division, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
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Folch EE, Labarca G, Ospina-Delgado D, Kheir F, Majid A, Khandhar SJ, Mehta HJ, Jantz MA, Fernandez-Bussy S. Sensitivity and Safety of Electromagnetic Navigation Bronchoscopy for Lung Cancer Diagnosis: Systematic Review and Meta-analysis. Chest 2020; 158:1753-1769. [PMID: 32450240 DOI: 10.1016/j.chest.2020.05.534] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bronchoscopy is a useful tool for the diagnosis of lesions near central airways; however, the diagnostic accuracy of these procedures for peripheral pulmonary lesions (PPLs) is a matter of ongoing debate. In this setting, electromagnetic navigation bronchoscopy (ENB) is a technique used to navigate and obtain samples from these lesions. This systematic review and meta-analysis aims to explore the sensitivity of ENB in patients with PPLs suspected of lung cancer. RESEARCH QUESTION In patients with peripheral pulmonary lesion suspected of lung cancer, what is the sensitivity and safety of electromagnetic navigation bronchoscopy compared to surgery or longitudinal follow up? STUDY DESIGN AND METHODS A comprehensive search of several databases was performed. Extracted data included sensitivity of ENB for malignancy, adequacy of the tissue sample, and complications. The study quality was assessed using the QUADAS-2 tool, and the combined data were meta-analyzed using a bivariate method model. A summary receiver operatic characteristic curve (sROC) was created. Finally, the quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Forty studies with a total of 3,342 participants were included in our analysis. ENB reported a pooled sensitivity of 77% (95% CI, 72%-82%; I2 = 80.6%) and a specificity of 100% (95% CI, 99%-100%; I2 = 0%) for malignancy. The sROC showed an area under the curve of 0.955 (P = .03). ENB achieved a sufficient sample for ancillary tests in 90.9% (95% CI, 84.8%-96.9%; I2 = 80.7%). Risk of pneumothorax was 2.0% (95% CI, 1.0-3.0; I2 = 45.2%). We found subgroup differences according to the risk of bias and the number of sampling techniques. Meta-regression showed an association between sensitivity and the mean distance of the sensor tip to the center of the nodule, the number of tissue sampling techniques, and the cancer prevalence in the study. INTERPRETATION ENB is very safe with good sensitivity for diagnosing malignancy in patients with PPLs. The applicability of our findings is limited because most studies were done with the superDimension navigation system and heterogeneity was high. TRIAL REGISTRY PROSPERO; No.: CRD42019109449; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Erik E Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Gonzalo Labarca
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile
| | - Daniel Ospina-Delgado
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Hiren J Mehta
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, FL
| | - Michael A Jantz
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, FL
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Roy-Chowdhuri S, Dacic S, Ghofrani M, Illei PB, Layfield LJ, Lee C, Michael CW, Miller RA, Mitchell JW, Nikolic B, Nowak JA, Pastis NJ, Rauch CA, Sharma A, Souter L, Billman BL, Thomas NE, VanderLaan PA, Voss JS, Wahidi MM, Yarmus LB, Gilbert CR. Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology. Arch Pathol Lab Med 2020; 144:933-958. [PMID: 32401054 DOI: 10.5858/arpa.2020-0119-cp] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The need for appropriate specimen use for ancillary testing has become more commonplace in the practice of pathology. This, coupled with improvements in technology, often provides less invasive methods of testing, but presents new challenges to appropriate specimen collection and handling of these small specimens, including thoracic small biopsy and cytology samples. OBJECTIVE.— To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies. METHODS.— The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Core needle biopsy, touch preparation, fine-needle aspiration, and effusion specimens with thoracic diseases including malignancy, granulomatous process/sarcoidosis, and infection (eg, tuberculosis) were deemed within scope. Ancillary studies included immunohistochemistry and immunocytochemistry, fluorescence in situ hybridization, mutational analysis, flow cytometry, cytogenetics, and microbiologic studies routinely performed in the clinical pathology laboratory. The use of rapid on-site evaluation was also covered. RESULTS.— Sixteen guideline statements were developed to assist clinicians and pathologists in collecting and processing thoracic small biopsy and cytology tissue samples. CONCLUSIONS.— Based on the systematic review and expert panel consensus, thoracic small specimens can be handled and processed to perform downstream testing (eg, molecular markers, immunohistochemical biomarkers), core needle and fine-needle techniques can provide appropriate cytologic and histologic specimens for ancillary studies, and rapid on-site cytologic evaluation remains helpful in appropriate triage, handling, and processing of specimens.
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Affiliation(s)
- Sinchita Roy-Chowdhuri
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Sanja Dacic
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Mohiedean Ghofrani
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Peter B Illei
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lester J Layfield
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Christopher Lee
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Claire W Michael
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Ross A Miller
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jason W Mitchell
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Boris Nikolic
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jan A Nowak
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Nicholas J Pastis
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Carol Ann Rauch
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Amita Sharma
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lesley Souter
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Brooke L Billman
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Nicole E Thomas
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Paul A VanderLaan
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jesse S Voss
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Momen M Wahidi
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lonny B Yarmus
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Christopher R Gilbert
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
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Balwan A, Bixby B, Grotepas C, Witt BL, Iravani A, Ansari S, Reddy CB. Core needle biopsy with endobronchial ultrasonography: single center experience with 100 cases. J Am Soc Cytopathol 2020; 9:249-253. [PMID: 32451285 DOI: 10.1016/j.jasc.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Adequate sampling by endobronchial ultrasound (EBUS)-transbronchial needle aspiration to meet the demands of precision medicine or histologic evaluation is challenging. There is increasing demand for core biopsy specimens with advances in therapy. Franseen enodoscopic ultrasound needles have shown promising results in gastroenterology application for obtaining core biopsies and same design has recently been extended for pulmonary use. We evaluated Franseen needles with EBUS to assess its utility, safety and ability to provide core biopsy specimens. MATERIALS AND METHODS Retrospective analysis of our database at the University of Utah of patients undergoing EBUS with a Franseen needle was performed to ascertain the performance characteristics of this needle in the first 100 patients after its implementation. Medical records were also reviewed to identify any immediate procedure-related complications. RESULTS One hundred seventy locations were sampled in 100 patients. A total of 152 lymph nodes and 18 masses were sampled. Core biopsies, as per pathology report, were seen in 87% of patients. A clinically concordant pathological diagnosis was established in 97% of patients. Diagnostic yield for granulomatous lymphadenopathy was 95.6% (22 of 23). No patient-related adverse events were noted. CONCLUSION The Franseen needle evaluated in this study can safely procure core tissue samples during EBUS bronchoscopy that are adequate for histopathological diagnosis in benign and malignant lesions. Its ability to provide adequate tissue in patients with granulomatous inflammation is encouraging.
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Affiliation(s)
- Akshu Balwan
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah.
| | - Billie Bixby
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Cassi Grotepas
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Benjamin L Witt
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Aidin Iravani
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Sikandar Ansari
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Chakravarthy B Reddy
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
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Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration to assess tumor-programmed cell death ligand-1 expression in mediastinal lymph nodes metastasized from non-small cell lung cancer. Surg Today 2020; 50:1049-1055. [PMID: 32166496 DOI: 10.1007/s00595-020-01989-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/11/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE We investigated the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to evaluate programmed cell death ligand-1 (PD-L1) expression in patients with advanced non-small cell lung cancer (NSCLC). METHODS A retrospective chart review of patients who underwent EBUS-TBNA between April 2017 and April 2019 was conducted. Among patients diagnosed with NSCLC, we investigated the rate of successful evaluation of tumor PD-L1 expression, compared the relevant factors between patients with evaluable and those with unevaluable PD-L1 expression, and examined the response to immune checkpoint inhibitors (ICIs) after EBUS-TBNA. RESULTS Of the 40 patients assessed, 32 (80%) had evaluable PD-L1 expression. Patients with evaluable PD-L1 expression were older than those with unevaluable PD-L1 expression (p = 0.017), and we noted a tendency for a larger diameter of the biopsied lymph node (p = 0.12). The response rate to ICIs was 100% in patients with a tumor proportion score (TPS) ≥ 50%, 33% in those with a TPS 1-49%, and 0% in those with a TPS < 1%. CONCLUSION The diagnostic yield of EBUS-TBNA to evaluate PD-L1 expression in advanced NSCLC appeared acceptable in association with relevant clinical outcomes after treatment with ICIs. A further prospective study with a larger sample size is required to confirm our findings.
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Ray AS, Li C, Murphy TE, Cai G, Araujo KL, Bramley K, DeBiasi EM, Pisani MA, Cortopassi IO, Puchalski JT. Improved Diagnostic Yield and Specimen Quality With Endobronchial Ultrasound-Guided Forceps Biopsies: A Retrospective Analysis. Ann Thorac Surg 2020; 109:894-901. [DOI: 10.1016/j.athoracsur.2019.08.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/22/2019] [Accepted: 08/30/2019] [Indexed: 12/25/2022]
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Sapalidis K, Romanidis K, Oikonomou P, Zarogoulidis P, Katsaounis A, Amaniti A, Michalopoulos N, Koulouris C, Tsakiridis K, Giannakidis D, Kesisoglou I, Ioannidis A, Nikolaos-Katsios I, Vagionas A, Hohenforst-Schmidt W, Huang H, Bai C, Goganau AM, Kosmidis C. Convex endobronchial ultrasound: same coin, two faces. Challenging biopsy and staging for non-small-cell lung cancer. Lung Cancer Manag 2020; 8:LMT20. [PMID: 31983928 PMCID: PMC6978727 DOI: 10.2217/lmt-2019-0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Lung cancer is still diagnosed at a late stage due to lack of early disease symptoms. Despite the development of new diagnostic endoscopic tools, such as radial/convex endobronchial ultrasounds (EBUS) and electromagnetic navigation, most patients are still diagnosed at advanced stage disease. Most of the patients refer to their doctor only if they cough blood or their cough changes character. There are challenging cases in the diagnosis and staging of a patient, such as the one that we will present. We present a case of lung cancer that was diagnosed through a biopsy from the main lesion, with access from the esophagus, through transbronchial needle aspiration with EBUS, under general anesthesia and intubation. Staging with transbronchial needle aspiration with EBUS was also performed at the same session.
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Affiliation(s)
- Konstantinos Sapalidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Romanidis
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagoula Oikonomou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paul Zarogoulidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Pulmonary Department, Creta InterClinic Private Hospital, Iraklio, Crete, Greece
| | - Athanasios Katsaounis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Amaniti
- Anesthesiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Michalopoulos
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charilaos Koulouris
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- Thoracic Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Dimitrios Giannakidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aris Ioannidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iason Nikolaos-Katsios
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, 'Hof' Clinics, University of Erlangen, Hof, Germany
| | - Haidong Huang
- The Diagnostic & Therapeutic Center of Respiratory Diseases, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Chong Bai
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandru Marian Goganau
- General Surgery Clinic 1, University of Medicine andPharmacy of Craiova, Craiova County Emergency Hospital, Craiova, Romania
| | - Christoforos Kosmidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Comparison of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration With Stylet Retracted Partially Versus Completely for Molecular Testing. J Bronchology Interv Pulmonol 2020; 26:222-224. [PMID: 31107296 DOI: 10.1097/lbr.0000000000000596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered to be the initial diagnostic modality for most patients with lung cancer. However, the optimal technique for maximizing yield continues to vary in the real-world setting. OBJECTIVES To evaluate the diagnostic yield of EBUS-TBNA with capillary sampling compared with complete stylet removal for molecular testing. METHODS Retrospective study, data from patients between January to May 2017 with indication of EBUS-TBNA whom ancillary testing, that is, next-generation sequencing, anaplastic lymphoma kinase (ALK), and programed death ligand-1 (PD-L1) expression was reviewed. The yield of 2 techniques, stylet retracted halfway (group 1) versus complete retraction (group 2), was compared. RESULTS A total of 24/27 (88.88%) samples were adequate for next-generation sequencing analysis in group 1 and 21/23 (91.30%) in group 2. For other molecular analyses, 24/27 (88.88%) samples in group 1 and 20/23 (86.95%) samples in group 2 were adequate for ALK analysis. 23/27 (85.18%) samples for group 1 and 20/23 (86.95%) samples for group 2 were adequate for PD-L1 analysis. Positive expression of PD-L1>50% was achieved in 9/23 (39.13%) of group 1 and 5/20 (25%) of group 2. There was no statistical difference in the yield between the 2 groups. CONCLUSION EBUS-TBNA using either capillary sampling or complete stylet removal are effective and has a high proportion of satisfactory results for ancillary testing.
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