Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Ln. 442, Sec. 1, Jingguo Road, North Dist, Hsinchu City, 30059, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No. 7 ChungShan South Road, Taipei, 10002, Taiwan.
Sci Rep. 2018 Apr 11;8(1):5837. doi: 10.1038/s41598-018-24300-7.
Radial endobronchial ultrasound (R-EBUS) is one important diagnostic approach in non-small cell lung cancers (NSCLC). However, the small samples obtained from R-EBUS-guided transbronchial biopsies are sometimes insufficient for pathological and molecular diagnosis. Herein, we investigated the suitability of R-EBUS-guided bronchial brushing specimens for NSCLC diagnosis and EGFR genotyping. We enrolled 941 consecutive patients with peripheral pulmonary lesions who underwent R-EBUS. Cytology-positive brushing specimens from non-squamous NSCLC patients were tested for EGFR mutations. Non-squamous NSCLC was diagnosed in 624 patients (66.3%). Positive cytology was documented in the brushing samples of 376 patients (60.3%). Higher diagnostic yields were obtained in patients exhibiting bronchus signs on chest tomography, and those with R-EBUS probe located within the lesion. EGFR genotyping was successfully performed in 363 samples (96.5% of cytology-positive brushing samples). EGFR genotyping concordance between brushing specimens and matched tissue samples was 88.7% (kappa = 0.745, P < 0.001). Furthermore, 144 non-squamous NSCLC patients (23.1%) with failed pathological diagnosis or EGER sequencing by R-EBUS-guided transbronchial biopsy required repeat biopsies. However, it was achieved successfully from the brushing specimens of 57 patients (39.6%). In conclusion, for patients with peripheral lung cancer, R-EBUS-guided bronchial brushing could provide an additional sampling method for diagnosis and EGFR genotyping.
经支气管径向超声（R-EBUS）是一种重要的非小细胞肺癌（NSCLC）诊断方法。然而，从 R-EBUS 引导的经支气管活检获得的小样本有时不足以进行病理和分子诊断。在此，我们研究了 R-EBUS 引导的支气管刷检标本在 NSCLC 诊断和 EGFR 基因分型中的适用性。我们纳入了 941 例连续的外周肺部病变患者，这些患者均接受了 R-EBUS 检查。对非鳞状 NSCLC 患者的细胞学阳性刷检标本进行 EGFR 突变检测。624 例患者（66.3%）诊断为非鳞状 NSCLC。376 例患者（60.3%）的刷检标本细胞学阳性。在胸部 CT 显示支气管征象的患者和 R-EBUS 探头位于病变内的患者中，获得了更高的诊断率。363 例标本（细胞学阳性刷检标本的 96.5%）成功进行了 EGFR 基因分型。刷检标本和匹配组织标本的 EGFR 基因分型一致性为 88.7%（kappa 值=0.745，P<0.001）。此外，144 例经 R-EBUS 引导的经支气管活检未能进行病理诊断或 EGFR 测序的非鳞状 NSCLC 患者（23.1%）需要重复活检。然而，从 57 例患者（39.6%）的刷检标本中成功完成了重复活检。总之，对于外周肺癌患者，R-EBUS 引导的支气管刷检可为诊断和 EGFR 基因分型提供一种额外的采样方法。
