Suitability of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Specimens for Subtyping and Genotyping of Non–Small Cell Lung Cancer

Navani, Neal; Brown, James M.; Nankivell, Matthew; Woolhouse, Ian; Harrison, Richard; Jeebun, Vandana; Munavvar, Mohammed; Ng, Benjamin; Rassl, Doris M.; Falzon, Mary; Kocjan, Gabrijela; Rintoul, Robert C.; Nicholson, Andrew G.; Janes, Sam M.

doi:10.1164/rccm.201202-0294oc

Cited by 218 publications

(191 citation statements)

References 34 publications

(34 reference statements)

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“…EBUS-TBNA can provide adequate material for mutation analysis in cancer patients who are potential candidates for biological agents therapy in roughly 90% of the patients vs. close to 100 % with mediastinoscopy (12).…”

Section: Ideal Environment: Endoscopy Room Vs Operating Room (Or)mentioning

confidence: 99%

Ideal conditions to perform EBUS-TBNA

et al. 2017

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EBUS-TBNA is gaining widespread acceptance as a minimally invasive procedure for mediastinal staging and re-staging of lung cancer, diagnosis of lung tumors adjacent to large airways and characterization of both malignant and benign lymphadenopathy. The aim of this article is to describe the appropriate setting and practical aspects of the procedure that may help at the start of a new EBUS-TBNA program to improve patient safety, comfort and procedural yield according to operator experience, procedure aim, and institutional needs.

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Section: Ideal Environment: Endoscopy Room Vs Operating Room (Or)mentioning

confidence: 99%

Ideal conditions to perform EBUS-TBNA

et al. 2017

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“…Biopsies with small (18-to 20-gauge) core needles can yield sufficient and reliable samples for genomic testing (48). Similarly, groups have been optimizing techniques for nonsurgical sampling, such as endobronchial ultrasound-guided transbronchial needle aspiration, and mutation assays have been shown to be able to detect somatic mutations from cytology specimens, particularly if cell blocks are available (49,50). Ultimately, close communication between the clinical care team, testing laboratory, and pathologist is needed to ensure that specimens for molecular testing meet the laboratory's requirements for tumor content and quality.…”

Section: Clinical Application For Diagnostic Specimensmentioning

confidence: 99%

The Impact of Genomic Changes on Treatment of Lung Cancer

Cardarella

Johnson

2013

Am J Respir Crit Care Med

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The remarkable success of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors in patients with EGFR mutations and ALK rearrangements, respectively, introduced the era of targeted therapy in advanced non-small cell lung cancer (NSCLC), shifting treatment from platinum-based combination chemotherapy to molecularly tailored therapy. Recent genomic studies in lung adenocarcinoma identified other potential therapeutic targets, including ROS1 rearrangements, RET fusions, MET amplification, and activating mutations in BRAF, HER2, and KRAS in frequencies exceeding 1%. Lung cancers that harbor these genomic changes can potentially be targeted with agents approved for other indications or under clinical development. The need to generate increasing amounts of genomic information should prompt health-care providers to be mindful of the amounts of tissue needed for these assays when planning diagnostic procedures. In this review, we summarize oncogenic drivers in NSCLC that can be currently detected, highlight their potential therapeutic implications, and discuss practical considerations for successful application of tumor genotyping in clinical decision making.Keywords: lung cancer; cancer genomics; molecular targeted therapy Lung cancer remains the leading cause of cancer-related mortality in the United States and worldwide. Approximately 85% of patients are diagnosed with non-small cell lung cancer (NSCLC), and most present with advanced disease that is not amenable to curative therapy. For these patients, cytotoxic chemotherapy offers modest prolongation in survival. Over the past 2 decades, modifications of chemotherapy combinations, the addition of monoclonal antibodies, including bevacizumab and cetuximab, and the incorporation of histologic subtype into treatment decisions have added incrementally to the survival of patients with advanced NSCLC. However, therapeutic outcomes appear to have reached a plateau, with response rates of 20 to 35% and median survival of 8 to 12 months (1-3). Recently, clinical and laboratory research have led to a better understanding of the molecular pathogenesis that causes lung cancer. The ongoing research of patients with NSCLC and their tumors has demonstrated that NSCLC can be further defined at the molecular level by the identification and characterization of oncogenic drivers that occur in genes critical to cellular proliferation and survival, leading to aberrant activation of signaling proteins that induce sustained growth of the lung cancer cells. These advances in the molecular pathogenesis of NSCLC have prompted investigators to systematically characterize lung cancers for these oncogenic drivers and treat with appropriate targeted therapies. A cohort of patients can now be prospectively identified who have significantly improved outcomes with such therapies, with median survival in excess of 2 years, necessitating the routine identification of these genomically defined patient subsets. In this perspective, we review oncogenic ...

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“…EGFR mutation analysis using EBUS-TBNA samples was first reported in 2007 [Nakajima et al 2007] followed by multi-gene mutation analysis of metastatic lymph nodes . Owing to the spread of the technology, an increasing number of centers are now capable of reproducing the data [Navani et al 2012]. However, this requires expertise and the way that the samples are handled becomes crucial.…”

Section: Molecular Stagingmentioning

confidence: 99%

Bronchoscopic staging of lung cancer

Hanna

Yasufuku

2012

Ther Adv Respir Dis

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Advances in bronchoscopy have contributed valuable tools to the diagnosis and staging of lung cancer. Detection of lesions at the premalignant microscopic stage has become possible with autofluorescence bronchoscopy and narrow band imaging. Bronchoscopy also allows for sampling of visible intra-bronchial lesions and for transbronchial needle aspiration of lesions in pulmonary parenchyma. With endobronchial ultrasound guidance, real-time evaluation and biopsy of mediastinal and pulmonary lesions can be achieved, enabling accurate clinical and pathological T-staging and N-staging without the need for surgery. In combination with advanced imaging techniques, Navigational bronchoscopy allows for the targeting and biopsy of the most peripheral lesions that are located in the smallest airways. For patients in whom tumor genetics are important, bronchoscopic-guided transbronchial biopsy can provide sufficient material for molecular analysis. As minimally invasive technology continues to evolve and improve, bronchoscopic techniques are poised to continue to be essential for the diagnosis and staging of lung cancer.

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Suitability of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Specimens for Subtyping and Genotyping of Non–Small Cell Lung Cancer

Abstract: This large, multicenter, pragmatic study demonstrates that cytology samples obtained from EBUS-TBNA in routine practice are suitable for subtyping of NSCLC and EGFR mutation analysis and that the use of immunohistochemistry reduces the rate of NSCLC-NOS.

Cited by 218 publications

References 34 publications

Ideal conditions to perform EBUS-TBNA

Ideal conditions to perform EBUS-TBNA

The Impact of Genomic Changes on Treatment of Lung Cancer

Bronchoscopic staging of lung cancer

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