Protocol to Improve Genotyping of Non-Small-Cell Lung Cancer Diagnosed Using EBUS-TBNA

Area of Science:

• Oncology
• Pulmonology
• Pathology
• Molecular Diagnostics

Background:

• Targeted therapies for non-small-cell lung cancer (NSCLC) rely on identifying driver mutations like EGFR and ALK.
• Endobronchial ultrasound-guided-transbronchial needle aspiration (EBUS-TBNA) is a key diagnostic tool for NSCLC.
• Optimizing tissue acquisition for molecular analysis via EBUS-TBNA requires standardized protocols.

Purpose of the Study:

• To implement and evaluate a standardized quality improvement protocol for EBUS-TBNA sample acquisition and processing.
• To enhance the yield of tissue adequate for EGFR and ALK genetic analysis in NSCLC patients.
• To assess the impact of the protocol on diagnostic accuracy and patient safety.

Main Methods:

• A multidisciplinary team (pulmonology, oncology, pathology) developed a standardized protocol for EBUS-TBNA.
• The protocol included standardized sample acquisition and on-site processing procedures.
• Tissue adequacy for EGFR and ALK molecular testing was compared pre- and post-protocol implementation.

Main Results:

• The study included 50 NSCLCs pre-protocol and 109 NSCLCs post-protocol.
• Adequacy for EGFR molecular analysis increased from 36% to 80% (P < 0.01).
• Adequacy for ALK molecular analysis increased from 41% to 80% (P < 0.01), with no increase in complications.

Conclusions:

• Implementation of a standardized protocol for EBUS-TBNA significantly improves tissue adequacy for molecular genetic analysis in NSCLC.
• This quality improvement enhances the utility of EBUS-TBNA for guiding targeted therapy selection in NSCLC.