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Pulmonary Procedures |

Improving Quantity and Quality for Histological Differentiation and Molecular Analysis in Transbronchial Needle Aspirations

Christina Bellinger; Deepankar Sharma; Travis Dotson
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Wake Forest Baptist Health, Winston Salem, NC


Chest. 2014;146(4_MeetingAbstracts):750A. doi:10.1378/chest.1990099
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Abstract

SESSION TITLE: EBUS Insights

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM

PURPOSE: Personalized genomic medicine has become a center of focus for lung cancer treatment. Key biomarkers of main interest that directly impact first line therapy in adenocarcinoma are Epidermal growth factor receptor (EGFR) and the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) translocation. As the demand for more tissue is on the rise to perform these tests, so is the demand for less invasive testing modalities, especially endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). We instituted a TBNA standardized specimen acquisition protocol to improve yield for histological subtyping of NSCLC and molecular analysis for EGFR and ALK testing.

METHODS: During the procedure, two slides are made for each TBNA aspirate. One slide is stained for rapid on-site cytology (ROSE) and the other is placed in ethanol. Remaining material in the needle is rinsed into CytoLyt® Solution. Once ROSE confirms the presence of malignant cells, three dedicated passes are made and the full contents of the aspirate is rinsed into the CytoLyt® Solution. If NSCLC is suspected, a final pass is made and two unstained slides are reserved for ALK testing. If the final pathology read is “adenocarcinoma” or “NSCLC, favor adenocarcinoma” ALK gene rearrangement testing and EGFR mutation testing is performed. We compared prospectively collected data after instituting the protocol to yields before standardization.

RESULTS: We reviewed 219 cases sampling 315 nodes. Overall sensitivity was 94% and specificity 100%. Fifty-four cases (n=119) were malignancy, 71 of which were NSCLC. Sixty-four occurred before the new protocol and seven after. There were 19 cases of squamous cell and 40 cases of adenocarcinoma. Not otherwise specified and poorly differentiated reduced from 6% to 0% with the new protocol. Sufficient material for ALK and EGFR testing occurred in 46% of adenocarcinoma pre-protocol and 90% of adenocarcinoma post-protocol.

CONCLUSIONS: With the implementation of a standardized sampling protocol with TBNA, we have so far reduced our incidences of NOS and increased quality pathologic material available for molecular analysis. This was a newly instituted protocol and we anticipate generating additional statistically significant data over the next six months.

CLINICAL IMPLICATIONS: A standardized protocol for specimen acquisition during TBNA may maximize tissue for diagnosis, histological subtyping, and molecular analysis.

DISCLOSURE: The following authors have nothing to disclose: Christina Bellinger, Deepankar Sharma, Travis Dotson

No Product/Research Disclosure Information


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