Diagnostic Yield of EBUS-TBNA for the Evaluation of Centrally Located Peribronchial Pulmonary Lesions

Abstract

Where available, EBUS-TBNA of centrally located peribronchial lung lesions should be given a strong consideration given its high diagnostic yield.

Adequacy of endosonography‐derived samples from peribronchial or periesophageal intrapulmonary lesions for the molecular profiling of lung cancer

“…Most studies that assessed the suitability of EBUS‐TBNA for the molecular profiling on intrathoracic lymph node metastases reported an average node size consistently smaller than 20 mm . On the contrary, an average size ranging from 25 to 53 mm was reported in all the literature studies that described the performance characteristics of EBUS‐TBNA for the diagnosis of centrally located intrapulmonary tumours . In particular, the possibility for the operator to move the needle back and forth through a long tract inside a large lesion usually allows blood and small tissue cores to clot inside the needle.…”

“…Second, the sample size of this study is small in absolute terms. However, lung lesions are sampled with endosonography much less frequently than lymphadenopathy, and our patient population (99 patients overall, 53 of them with advanced lung cancer) is indeed one of the largest reported in the literature so far …”

“…[12][13][14][15][16] On the contrary, an average size ranging from 25 to 53 mm was reported in all the literature studies that described the performance characteristics of EBUS-TBNA for the diagnosis of centrally located intrapulmonary tumours. [28][29][30][31][32][33][34][35] In particular, the possibility for the operator to move the needle back and forth through a long tract inside a large lesion usually allows blood and small tissue cores to clot inside the needle. This leads often to the formation of long fragments that reproduce the shape of the needle and that can be put directly into formalin to be processed as a biopsy (Figure 1A-D).…”

“…In the last 5 years, a few series have appeared in the literature suggesting that endosonography can also be used successfully to diagnose bronchoscopically invisible, centrally located intrapulmonary lesions . However, only one of them has recently provided information on adequacy of these samples for some ( EGFR, ALK ) of the molecular tests currently indicated in patients with advanced disease .…”

“…27 In the last 5 years, a few series have appeared in the literature suggesting that endosonography can also be used successfully to diagnose bronchoscopically invisible, centrally located intrapulmonary lesions. [28][29][30][31][32][33][34][35][36] However, only one of them has recently provided information on adequacy of these samples for some (EGFR, ALK) of the molecular tests currently indicated in patients with advanced disease. 28 The present study aimed to evaluate the yield of endosonographyderived samples from intrapulmonary lesions for genotyping and PD-L1 testing in patients with advanced non-small cell lung cancer (NSCLC).…”