Navigational bronchoscopy specimens and PD-L1 expression: a retrospective study

Area of Science:

• Pulmonology
• Oncology
• Diagnostic Pathology

Background:

• Navigational bronchoscopy (NB) is increasingly used for lung nodule biopsy.
• Data on NB's adequacy for programmed death-ligand 1 (PD-L1) testing in non-small cell lung cancer (NSCLC) is limited.
• Accurate PD-L1 expression is crucial for guiding immunotherapy in NSCLC.

Purpose of the Study:

• To evaluate the adequacy of samples obtained via NB for PD-L1 testing in NSCLC patients.
• To determine the performance of NB in providing sufficient material for PD-L1 analysis.
• To identify factors influencing PD-L1 sample adequacy from NB.

Main Methods:

• Retrospective review of 102 consecutive NB procedures for lung nodules/masses diagnosed with NSCLC.
• Analysis of procedural, demographic, and diagnostic data, focusing on PD-L1 sample adequacy.
• Statistical evaluation using modified Poisson regression to assess factors associated with adequacy.

Main Results:

• 73% of NB samples were adequate for PD-L1 testing.
• Radial endobronchial ultrasound (REBUS) was used in 99% of biopsies.
• Only 4% of cases required additional biopsies (CT-guided or surgical) due to insufficient tissue.
• No factors were found to predict PD-L1 adequacy.

Conclusions:

• Navigational bronchoscopy demonstrates good performance in obtaining adequate samples for PD-L1 testing in NSCLC.
• A low rate (4%) of additional procedures were needed for insufficient tissue.
• Further studies are recommended to validate these findings against surgical resection specimens.