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Updated: May 15, 2025
Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
Published on: November 10, 2014
High-Quality Samples for Next-Generation Sequencing and PD-L1 Assessment in Non-Small Cell Lung Cancer: The Role of
Marta Rodríguez González1, Juan Carlos Montero González1,2, José María Sayagués Manzano1,2
1Department of Pathology, Biomedical Research Institute of Salamanca (IBSAL), University Hospital of Salamanca, 37007 Salamanca, Spain.
Abstract:
Background/Objectives: Recent advances in the treatment of non-small cell lung cancer (NSCLC) have shifted from conventional chemotherapy to targeted therapies aimed at specific genetic mutations, particularly in the adenocarcinoma subtype. These therapies have improved overall survival and quality of life. However, some patients still face barriers to accessing these treatments due to challenges in diagnosing advanced-stage NSCLC. Limited tumor cellularity in small biopsies and cytological samples hinders the ability to perform further molecular analyses. Additionally, the increasing number of genetic alterations requiring testing complicates the diagnostic process. To overcome this challenge, we propose combining endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with next-generation sequencing (NGS) and immunohistochemistry for PD-L1. Methods: A total of 120 EBUS-TBNA samples were consecutively collected during the first year of integrating NGS at a reference hospital in Castilla y León, Spain. Depending on the histology and patient characteristics, a total of 67 NGS analyses and 116 PD-L1 determinations were performed. Results: The cytological sample obtained in these cases successfully achieved the triple objective proposed by the NCCN for lung cancer (diagnosis, staging, and molecular analysis in a single procedure) in 97% of instances. Conclusions: Our study highlights the effectiveness of EBUS-TBNA as a comprehensive, cost-effective, and safe diagnostic tool for NSCLC, successfully achieving the triple objective of diagnosis, staging, and molecular analysis in 97% of cases. The procedure consistently provided high-quality samples for NGS and PD-L1 testing, with minimal complications, reinforcing its value as a reliable approach for optimizing personalized treatment strategies.
Insights
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) effectively diagnoses non-small cell lung cancer (NSCLC), enabling staging and molecular analysis. This approach optimizes personalized treatment strategies for NSCLC patients.
Area of Science:
- Pulmonology
- Oncology
- Molecular Diagnostics
Background:
- Advances in non-small cell lung cancer (NSCLC) treatment favor targeted therapies over conventional chemotherapy.
- Access to targeted therapies is limited by diagnostic challenges in advanced NSCLC, including low cellularity in small biopsies.
- The growing number of genetic alterations necessitates complex molecular testing.
Purpose of the Study:
- To evaluate the combined utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with next-generation sequencing (NGS) and PD-L1 immunohistochemistry.
- To assess the feasibility of achieving diagnosis, staging, and molecular analysis in a single EBUS-TBNA procedure for NSCLC.
Main Methods:
- A prospective study involving 120 EBUS-TBNA samples collected over one year.
- NGS analysis was performed on 67 samples, and PD-L1 determination on 116 samples.
- Integration of EBUS-TBNA with NGS and PD-L1 testing at a reference hospital.
Main Results:
- The EBUS-TBNA procedure successfully met the National Comprehensive Cancer Network (NCCN) triple objective (diagnosis, staging, molecular analysis) in 97% of cases.
- High-quality samples suitable for NGS and PD-L1 testing were consistently obtained.
- The diagnostic approach demonstrated high effectiveness with minimal complications.
Conclusions:
- EBUS-TBNA is a comprehensive, cost-effective, and safe diagnostic tool for NSCLC.
- The procedure reliably facilitates diagnosis, staging, and molecular profiling in a single intervention.
- This integrated approach optimizes personalized treatment strategies for NSCLC patients.
