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  • JNJ-42153605 We found a low NPV for EBUS TBNA

    2019-08-26

    We found a low NPV (56%) for EBUS-TBNA in centrally located lung lesions. These data are in line with other case series, which reported values ranging between 23% and 75% [[10], [11], [12], [13], [14], [15]]. This value, however, is likely to be influenced by the high prevalence of malignancy (92.4%) in the JNJ-42153605 we analyzed. Accordingly, Almeida et al attributed their high NPV (75%) to the lower prevalence of malignancy in their study population, as compared to other studies [14]. Only 3 minor adverse events were noticed in our study, all of which were sedation-related. This confirms the excellent safety profile of EBUS as a diagnostic tool for the diagnosis of lung cancer and is in line with data collected so far [23,24]. Safety data combined with the high visualization rate of central lesions by EBUS are important, as CT guided sampling in this setting as compared to peripheral lung lesions is more challenging, with a higher complication rate [25,26]. In recent years, new effective therapeutic options such as targeted therapy and immunotherapy have been introduced for the treatment of patients with advanced and locally advanced disease [3,27,28]. Previous studies demonstrated the suitability of EBUS specimens obtained from lymphadenopathy for the molecular profiling of lung cancer [[29], [30], [31], [32]]. Our series demonstrates that also EBUS-derived samples from intrapulmonary tumors can be successfully used to test all the clinically indicated molecular biomarkers in most patients (86%). To date, only Almeida et al. had provided preliminary evidence of the suitability of EBUS samples retrieved from intrapulmonary lesions for EGFR and ALK testing [14]. Among operated patients with possible T4 at CT scan, no false negatives at JNJ-42153605 EBUS were found, suggesting that in expert hands, EBUS can offer valuable information in confirming or excluding locally advanced disease. Of high importance, EBUS gave additional information in 2/30 cases we included in T4 evaluation, demonstrating its relevant contribution in cases in which chest CT interpretation is uncertain. Accurate evaluation of the primary tumor (T parameter) is important in the decision making process that leads to management of lung neoplasms as tumor invasion of mediastinal structures, as well as of the large vessels (T4/stage IIIB), limits therapeutic options for patients [33]. T4 evaluation through radiological techniques such as CT and PET/CT is challenging, with variable sensitivity reported [34]. MRI of the chest has been shown not to significantly improve evaluation of mediastinal invasion [35]. Esophageal ultrasound (EUS) is useful in detecting and diagnosing lung cancer which is adjacent to the esophagus [36,37]. A recent retrospective analysis on 426 patients with NSCLC found a good specificity for EUS in evaluating local invasion, with a higher accuracy when combined with chest CT [38]. Adding T4 evaluation to EBUS applications would allow clinicians to achieve information on diagnosis, mediastinal staging and local invasion in a single procedure and exploratory thoracotomies could be prevented. As EBUS is indicated by guidelines for nodal staging in centrally located lung tumors [39], sampling and T4 assessment should be considered when clinically indicated. Future prospective trials, with careful inclusion criteria are needed to further refine the role of EBUS in diagnosis and T staging of lung cancer.
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    Introduction Immune checkpoint inhibitors (ICIs) including programmed death-1 (PD-1) and programed death-ligand 1 (PD-L1) inhibitors have been one of the mainstream therapies in patients with non-small cell lung cancer (NSCLC) [[1], [2], [3], [4]]. Immunohistochemical staining of PD-L1 is currently used as a biomarker for selecting patients who are likely to benefit from treatment with ICIs; for example, pembrolizumab was approved as a first-line treatment for metastatic NSCLC in cases demonstrating equal to or more than 50% positivity of PD-L1 staining [3]. Therefore, the evaluation of PD-L1 status is critical to determine the most appropriate treatment strategy for patients with advanced NSCLC. Regrettably, most patients with NSCLC are diagnosed at advanced stages, and only tiny biopsy specimens are sometimes often available for histopathological diagnosis and further genetic/molecular analyses.