Clinical guidelines promote the identification of several targetable biomarkers to drive treatment decisions in advanced non-small cell lung cancer (NSCLC), but half of all patients do not have a viable biopsy. Specimens from endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) are an alternative source of material for the initial diagnosis of NSCLC, however their usefulness for a complete molecular characterization remains controversial. EBUS-TBNA samples were prospectively tested for several biomarkers by next-generation sequencing (NGS), nCounter, and immunohistochemistry (PD-L1). The primary objectives were to assess the sensitivity of EBUS-TBNA samples for a comprehensive molecular characterization and to compare its performance to the reference standard of biopsy samples. Seventy-two EBUS-TBNA procedures were performed, and 42 NSCLC patients were diagnosed. Among all cytological samples, 92.9% were successfully genotyped by NGS, 95.2% by nCounter, and 100% by immunohistochemistry. There were 29 paired biopsy samples; 79.3% samples had enough tumor material for genomic genotyping, and 96.6% for PD-L1 immunohistochemistry. A good concordance was found between both sources of material: 88.9% for PD-L1, 100% for NGS and nCounter. EBUS-TBNA is a feasible alternative source of material for NSCLC genotyping and allows the identification of patient candidates for personalized therapies with high concordance when compared with biopsy.

BackgroundThe role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods: This observational multicenter study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June, 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression.ResultsA total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). One hundred forty-seven bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperemia (11.4%). The independent predictors of in-hospital mortality were: older age (Odds ratio [OR]=1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR=1.60; p=0.041), absence of mucosal hyperemia (OR=0.49; p=0.041) and the presence of haematic secretions (OR=1.79; p=0.032).ConclusionsBronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.

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05). The average scores for the functioning scales increased continuously, so that the QoL improved in the active arm despite the advanced stage of the disease(P<0.05). 3-month DCR after treatment was 42.9% in the active arm and 16.7% in the control arm (P<0.05). Both interleukin-6 and c-reactive protein were significantly decrease after treatments in active arm in comparison with control arm (P<0.05). However, there were no significant differences in 3 month DCR, PFS and OS between the three groups with different applied dosages of vitamin C. No significant differences were observed between parameters of adenocarcinoma and squamous cell carcinoma and between EGFR(+) and EGFR(e). Conclusion: IVC + mEHT treatment significantly improves QoL, prolongs PFS and OS, and moderates cancer-related inflammation, and so is a feasible treatment for patients with advanced NSCLC. This trial is registered in ClinicalTrials.gov (ID: NCT02655913).