Overview and update on molecular testing in non‐small cell lung carcinoma utilizing endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) samples

Abstract

Lung carcinoma remains one of the most frequent and aggressive human neoplasms. Fortunately, in the last decades, the increasing knowledge of the molecular mechanisms leading to cancer development has allowed the use of targeted therapies with improvement of prognosis in many patients. Clinical management has also changed after the introduction of endobronchialultrasonographic bronchoscopy that allows a conservative staging of lung tumors, avoiding the need of mediastinoscopy for lymph node staging. Lung pathologists and cytopathologists are facing the challenge of giving the more comprehensive prognostic and predictive information with ever smaller tissue or cytological samples. The aim of this review is to summarize the molecular testing for non‐small cell lung carcinoma and how pathologists can contribute to the patient's outcome with a conscious management of biological samples.

Patients with fibrosis from non-alcoholic steatohepatitis have heterogeneous intrahepatic macrophages and therapeutic targets

“…prior to treatment with chemo-and immunotherapies [49,50]. Even though liquid biopsy is being used successfully for cancers, there has been limited success with systemic biomarkers for inflammatory and infectious diseases [51,52].…”

“…Since other less invasive tools such as Fibroscan and tissue elastography are being more frequently utilized [48], biopsies are collected less frequently, which makes the development of precision medicine approaches even more challenging. Patients with cancer routinely provide tissue samples for molecular testing and to determine the expression of targets by immunohistochemical staining prior to treatment with chemo- and immunotherapies [49, 50]. Even though liquid biopsy is being used successfully for cancers, there has been limited success with systemic biomarkers for inflammatory and infectious diseases [51, 52].…”

Molecular testing in cytology

“…NGS‐based molecular testing has been applied in cytology samples obtained by endobronchial ultrasound‐guide transbronchial needle aspiration (EBUS‐TBNA) to molecular profile non‐small cell lung cancer (NSCLC) in select patients to detect potentially actionable mutations. In this special issue, two papers from Schmitt et al 8 and Aceñero et al 9 review and summarize the use of molecular techniques in cytological material obtained from EBUS‐TBNA, showing the value of NGS and the panels utilized as well as highlighting the role of the cytopathologist in this scenario. The same cytology samples can and should be used to perform PD‐L1 immunocytochemistry to select and predict immunotherapy response.…”