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Lung Cancer |

Endobronchial Ultrasound With Transbronchial Needle Aspiration (EBUS-TBNA) for Concurrent Diagnosis and Molecular Analysis: A Single-Center Experience

John Sentz*, DO; Hans Lee, MD; Rajiv Malhotra, DO; Michael Idowu, MD; Adele Kraft, MD; Ray Shepherd, MD
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Virginia Commonwealth University, Richmond, VA


Chest. 2012;142(4_MeetingAbstracts):557A. doi:10.1378/chest.1364566
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Abstract

SESSION TYPE: Lung Cancer I

PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM

PURPOSE: Lung cancer remains the leading cause of cancer deaths worldwide. Recent advances in targeted therapy have produced promising treatment responses in patients with NSCLC who have been identified to have Epidermal Growth Factor Receptor (EGFR) and Kristen-Rous sarcoma virus (KRAS) mutations. Acquiring tissue for molecular analysis is essential for treatment planning with tyrosine kinase inhibitors and other similar agents. EBUS-TBNA allows for aspiration of mediastinal lymph nodes and lung masses in a less invasive manner compared to traditional mediastinoscopy. There is limited data evaluating concurrent diagnosis and molecular analysis from EBUS-TBNA. This is a report of the use of EBUS-TBNA to diagnose and acquire tissue for molecular analysis at a single, tertiary care center.

METHODS: From May 2011 to April 2012, EBUS-TBNA bronchoscopy for the initial diagnosis of adenocarcinoma with molecular analysis for EGFR and KRAS mutations were retrospectively reviewed. Tissue was collected by biopsy of either hilar/mediastinal lymph nodes or lung mass. Once the diagnosis of adenocarcinoma was confirmed, remaining biopsy samples were tested for mutation analysis. Diagnosis, molecular results, and number of TBNA biopsies at each site were reviewed.

RESULTS: Twenty-eight consecutive patients diagnosed with primary adenocarcinoma of the lung were reviewed. The diagnosis of adenocarcinoma was made with the initial EBUS-TBNA biopsy in 23 of the 28 cases (82%). Eighteen samples were sent for molecular analysis of the EGFR gene mutation and 15 (83%) of the samples provided sufficient material for analysis. Twelve of those tissue samples were concomitantly tested for KRAS. EGFR mutations were present in 6% and KRAS in 33% of specimens. The mean number of TBNA biopsy passes at a single site was 4.

CONCLUSIONS: EBUS-TBNA is an effective modality for diagnosing lung adenocarcinoma and providing sufficient tissue for one or more molecular assay in a single bronchoscopy.

CLINICAL IMPLICATIONS: EBUS-TBNA is an effective modality for diagnosing lung adenocarcinoma and providing sufficient tissue for one or more molecular assay in a single bronchoscopy.

DISCLOSURE: The following authors have nothing to disclose: John Sentz, Hans Lee, Rajiv Malhotra, Michael Idowu, Adele Kraft, Ray Shepherd

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Virginia Commonwealth University, Richmond, VA

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