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Pulmonary Procedures |

Molecular Analysis of EBUS-TBNA vs Conventional TBNA in the Diagnosis of Non-small Cell Lung Cancer

Jonathan Hovda, MBA; Travis Dotson; Christina Bellinger
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Pulmonary and Critical Care, Wake Forest Baptist Medical Center, Winston-Salem, NC


Chest. 2014;146(4_MeetingAbstracts):744A. doi:10.1378/chest.1992383
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Abstract

SESSION TITLE: EBUS and Advanced Bronchoscopy Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Lung cancer diagnosis and staging requires sufficient material for identifying the type of cancer, the subtype of cancer, and pertinent molecular markers. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been shown to achieve all of these goals but few head-to-head comparisons exists for EBUS-TBNA versus conventional TBNA (cTBNA). Many lymph nodes are potentially amenable to either cTBNA or EBUS-TBNA sampling but little published data exists directly comparing yield, sample adequacy, and nodule characteristics at a single institution.

METHODS: 219 total TBNAs (145 EBUS & 74 cTBNA) were retrospectively reviewed to compare size of target lymph nodes, sensitivity and specificity, sample adequacy, NSCLC differentiation, and yield for determination of ALK and EGFR, when appropriate.

RESULTS: Composite sensitivity was 94% and specificity 100%. EBUS-TBNA targeted smaller nodules 16±8mm vs 25±15mm (p<0.001), as at our institution larger nodes and masses are usually sampled via cTBNA and EBUS-TBNA is performed on smaller nodes and for staging. Overall yield was comparable (91% vs 94%, p value>0.05) for both sampling modalities as was not otherwise specified (NOS) material. NSCLC was differentiated in a comparable manner using both modalities and there was no statistically significant difference in sufficiency of material for driver mutation analysis of echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) (54% vs 60%) or Epidermal growth factor receptor (EGFR) (54% vs 45%).

CONCLUSIONS: EBUS-TBNA and cTBNA are complimentary procedures with a similar diagnostic yield and similar yield for specimen adequacy of driver mutations.

CLINICAL IMPLICATIONS: When large lesions are sampled and full mediastinal staging is not needed, cTBNA can provide similarly sufficient material for cytology and molecular analysis compared to EBUS-TBNA.

DISCLOSURE: The following authors have nothing to disclose: Jonathan Hovda, Travis Dotson, Christina Bellinger

No Product/Research Disclosure Information


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