Combining biopsy tools improves mutation detection rate in central lung cancer

Area of Science:

• Oncology
• Pulmonology
• Molecular Diagnostics

Background:

• Accurate molecular profiling is crucial for targeted therapy selection in lung cancer.
• Central exophytic lung cancers present unique diagnostic challenges.
• Endoscopic ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a key diagnostic tool.

Purpose of the Study:

• To evaluate the diagnostic yield of combined forceps biopsy and EBUS-TBNA for oncogenic mutations and PD-L1 expression in central exophytic lung cancer.
• To assess the added value of mediastinal lymph node sampling and circulating tumor DNA (ctDNA) analysis.

Main Methods:

• Retrospective analysis of patients with central exophytic lung cancer.
• Comparison of detection rates for mutations and PD-L1 using forceps biopsy alone, EBUS-TBNA alone, and combined techniques.
• Analysis of additional diagnostic information from mediastinal lymph node biopsies and ctDNA.

Main Results:

• Combined forceps and EBUS-TBNA significantly increased the detection rate of oncogenic mutations and PD-L1 positivity compared to either method alone.
• Sampling of mediastinal lymph nodes did not provide additional diagnostic benefit.
• ctDNA analysis did not yield supplementary diagnostic information in this cohort.

Conclusions:

• Combined forceps biopsy and EBUS-TBNA is an effective strategy for comprehensive molecular profiling of central exophytic lung cancers.
• Mediastinal lymph node sampling and ctDNA analysis are not recommended for routine additional benefit in this specific context.