Flexible bronchoscopy for lung cancer diagnosis in patients aged ≥85 years

Mineshita, Masamichi; Morikawa, Kei; Furuya, Naoki; Kida, Hirotaka; Nishine, Hiroki; Handa, Hiroshi; Inoue, Tatsuya

doi:10.1111/ggi.14313

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…It goes without saying that the least invasive gene search is liquid biopsy [ 9 ]. However, since bronchoscopy is often used for the definitive diagnosis of lung cancer [ 28 , 29 ], we can often experience adverse events such as bleeding when collecting samples. The ability to perform gene panel tests on cytological specimens can greatly contribute to ensuring patient safety [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

A Prospective Validation Study of Lung Cancer Gene Panel Testing Using Cytological Specimens

Morikawa

Kida

Handa

et al. 2022

Cancers

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The gold standard for genetic panel test samples is considered to be tissue specimens. However, in clinical practice, tissue specimens are often unavailable. Therefore, using an amplicon-based high-sensitivity next-generation sequencing panel test capable of measuring eight druggable genes, we enrolled patients who underwent diagnostic procedures to evaluate analysis accuracy, nucleic acid yield, and quality using cytological specimens. Cytological specimens were suitable for both nucleic acid yield and specimen quality due to the ease of collection and processing. Cytological sample analysis detected gene mutations in 68.7% of lung adenocarcinomas, and these samples were consistent with companion diagnostic tests 99.5% of the time. Moreover, the allele frequency of gene mutations in cytological specimens showed a high correlation with tissue specimens. This is the first study to prospectively evaluate the feasibility of a lung cancer gene panel test using cytological specimens.Abstract: Background:Genetic panel tests require sufficient tissue samples, and therefore, cannot always be performed. Although collecting cytological specimens is easier than tissue collection, there are no validation studies on the diagnostic accuracy of lung cancer gene panel tests using cytology samples. Methods: Using an amplicon-based high-sensitivity next-generation sequencing panel test capable of measuring eight druggable genes, we prospectively enrolled consecutive patients who underwent diagnostic procedures. We evaluated the analysis accuracy rate, nucleic acid yield, and the quality of cytological specimens under brushing, needle aspiration, and pleural effusion. We then compared these specimens with collected tissue samples. Results: In 163 prospectively enrolled cases, nucleic acid extraction and analysis accuracy was 100% in cases diagnosed with adenocarcinoma. Gene mutations were found in 68.7% of cases with 99.5% (95% CI:98.2–99.9) concordance to companion diagnostics. The median DNA/RNA yield and DNA/RNA integrity number were 475/321 ng and 7.9/5.7, respectively. The correlation coefficient of the gene allele ratio in 64 cases compared with tissue samples was 0.711. Conclusion: The success of gene analysis using cytological specimens was high, and the yield and quality of the extracted nucleic acid were sufficient for panel analysis. Moreover, the allele frequency of gene mutations in cytological specimens showed high correlations with tissue specimens.

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Section: Discussionmentioning

confidence: 99%

A Prospective Validation Study of Lung Cancer Gene Panel Testing Using Cytological Specimens

Morikawa

Kida

Handa

et al. 2022

Cancers

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“…We previously reported that flexible bronchoscopy was safe for patients over 85 years of age [ 3 ]. Bronchoscopic interventions, such as high radiofrequency snare and APC, are less invasive treatments than surgical resection for advanced age patients.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Successful Treatment with Radiation Therapy in an Older Patient with Endobronchial Schwannoma

et al. 2022

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Bronchial schwannoma is extremely rare, accounting for a small percentage of benign bronchial tumors, with no determined standardized treatment. An 89-year-old woman with a persistent cough underwent CT scan which revealed a tracheal tumor. A diagnosis of endobronchial schwannoma was confirmed based on tissue obtained by high-frequency snare polypectomy. A hybrid stent was implanted in the trachea due to tumor regrowth; however, stent migration occurred, and it was removed after 1 month. Subsequently, radiation therapy was performed, and airway patency was well maintained for over 3 years. In general, surgical resection is recommended for endobronchial schwannoma; however, due to the age of this patient, resection was deemed invasive. Therefore, radiation therapy was administered as an alternative treatment.

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“…Elderly patients with cancer often have comorbidities such as pulmonary and cardiac disease and may be more susceptible to comorbidity‐related adverse events. There have been several reports on flexible bronchoscopy (FB) in elderly patients; 4 , 5 however, few reports have focused specifically on lung cancer, 6 although bronchoscopy methods vary by disease. In lung cancer practice, wide molecular profiling as a biomarker test is recommended to evaluate potential genetic variants, and tissue sampling is crucial.…”

Section: Introductionmentioning

confidence: 99%

Safety of flexible bronchoscopy and clinical course for elderly patients with suspected primary lung cancer

Saito,

Oi,

Ito

et al. 2024

Thoracic Cancer

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BackgroundThere have been several reports demonstrating the safety of flexible bronchoscopy (FB) in the elderly, but none have focused specifically on lung cancer, which is a frequent biopsy procedure.MethodsIn this study, we retrospectively evaluated the safety of FB and subsequent treatment in elderly patients with suspected primary lung cancer. Elderly patients were defined as 75 years of age or older.ResultsA total of 141 patients, 77 in the elderly group and 64 in the nonelderly group, were reviewed. The median age of the elderly group was 80 years. Transbronchial lung biopsy was performed in more than 80% of all patients. Primary lung cancer was diagnosed in 42 (54.4%) of the elderly group and 35 (54.7%) of the nonelderly group (p = 0.38). Approximately 70% of the elderly patients with a confirmed diagnosis were treated, while more than half of the undiagnosed elderly patients had best supportive care. Complications such as bleeding, pneumothorax, fever, and pneumonia were similar in the elderly and nonelderly groups.ConclusionsThis study suggests that flexible bronchoscopy can be performed as safely in the elderly as in the nonelderly. Furthermore, even elderly patients may have a greater chance of receiving treatment when a definitive diagnosis is achieved.

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Flexible bronchoscopy for lung cancer diagnosis in patients aged ≥85 years

Abstract: Flexible bronchoscopy (FB) is a common modality for the diagnosis of lung cancer. Recently, the number of older patients with lung cancer is increasing, and FB is being utilized more for these patients.

Cited by 4 publications

References 20 publications

A Prospective Validation Study of Lung Cancer Gene Panel Testing Using Cytological Specimens

A Prospective Validation Study of Lung Cancer Gene Panel Testing Using Cytological Specimens

Successful Treatment with Radiation Therapy in an Older Patient with Endobronchial Schwannoma

Safety of flexible bronchoscopy and clinical course for elderly patients with suspected primary lung cancer

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