Pilot Study of the Performance of 19-G Needle in Endobronchial Ultrasound-guided Transbronchial Aspiration for the Diagnosis and Testing of Molecular Markers in Lung Cancer

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the standard for diagnosis and staging of lung cancer. Historically, 21-and 22-G needles have been paired with EBUS. We evaluated the performance of EBUS-TBNA using a larger 19-G needle in the assessment of tumor tissue obtained and success of testing for molecular markers.Methods: We prospectively enrolled adult patients with lymphadenopathy concerning for metastatic lung cancer. Patients underwent diagnostic EBUS-TBNA utilizing 19-G needles. Cases of non-small cell lung cancer (NSCLC) were evaluated for programmed cell death receptor ligand (PD-L1) expression. Cases of adenocarcinoma or undifferentiated NSCLC were further evaluated for 3 molecular markers for driver mutations: epidermal growth factor receptor (EGFR), c-ros oncogene 1 (ROS-1), and anaplastic lymphoma kinase (ALK).Results: Fifty patients were enrolled and underwent EBUS-TBNA using 19-G needles. PD-L1 assay was successfully performed in 90% of NSCLC cases. In adenocarcinoma or undifferentiated NSCLC cases, the success rate in testing was 90% for EGFR and 86% for ALK. ROS-1 testing had a success rate of 67%; 24% of these specimens had adequate tumor cells but there was technical difficulty with the assay. Block quality was judged by total number of tumor cells per hematoxylin and eosin-stained slide of each cell block (58% of specimens had > 500 cells and 22% had 200 to 500 cells). There were no adverse events.Conclusion: EBUS-TBNA using 19-G needles can obtain a high number of tumor cells and has a high rate of success in performing assays for PD-L1, EGFR, and ALK in NSCLC patients without an increase in adverse events. The success rate of ROS-1 testing was lower.

Program death ligand‐1 immunocytochemistry in lung cancer cytological samples: A systematic review

“…Studies analyzing PD‐L1 testing on lung carcinoma cytology specimens originated mostly from the USA, followed by publications arising from Italy, Canada, United Kingdom, China, Germany, Japan, India, Turkey and other countries. The Dako clone 22C3 was the most common clone analyzed on cytology specimens, followed by the Ventana SP263 clone 17–67 . The data collected included the clone type used in each study.…”

“…There is no published evidence that needle size significantly affects sample adequacy for PD-L1 testing. 31,62 Although, a recent study by Hardy et al 76 showed that needle size can still affect adequate sample procurement. In this study, PD-L1 testing failures occurred in 3/5 (60%) 22G needle biopsies, 1/5 (20%) in 21G needle biopsies, and 2/39 (5.1%) in 19G needle biopsies (with a p value of .016).…”

“…In this study, 42.9% of the samples demonstrated positive PD‐L1 expression. Similarly, Wahidi et al 31 concluded that the utility of utilizing a 19G needle for PD‐L1 testing and molecular testing without the risk of any increase in adverse events.…”

“…There is no published evidence that needle size significantly affects sample adequacy for PD‐L1 testing 31,62 . Although, a recent study by Hardy et al 76 showed that needle size can still affect adequate sample procurement.…”

Lymphadenopathy and Granulomas: Benignancy of Malignancy and Differential Diagnosis with Endobronchial Ultrasound-Transbronchial Needle Biopsy 19G Needle Fine-Needle Aspiration Biopsy

“…This means the sample size is larger and cell blocks have enough tissue sample to diagnose lymphoma, sarcoidosis and other types of cancer (metastatic) [ 16 ]. The sample size of the 19G needle means more tissue and less cytology [ 17 , 18 ]. The issue remains for cases with high suspicion of lymphoma (Hodgkin and less for non-Hodgkin) and false negative results; however, the same issue remains for other cases of false negative results when we have necrotic samples.…”