Asad Hussein, Saettele Timothy, Tawfik Ossama, Jones Philip, Aboudara Matthew
Department of Pulmonary and Critical Care, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Division of Pulmonary and Critical Care, Saint Luke's Health System, Frank and Evangeline Thompson Thoracic Center, Kansas City, MO, USA.
J Thorac Dis. 2022 Feb;14(2):295-305. doi: 10.21037/jtd-21-1454.
Additional data regarding the ability of navigational bronchoscopy (NB) to provide sufficient material for programmed death-ligand 1 (PD-L1) expression is needed. We performed a retrospective study of NB cases at our institution to determine performance of NB in providing adequate samples for PD-L1.
We conducted a retrospective review of all consecutive NB procedures performed at our institution from January 1, 2018 to August 4, 2020 that involved biopsies of a lung nodule/mass with a diagnosis of non-small cell lung cancer (NSCLC). The primary outcome was adequacy of material for PD-L1 testing. All procedural, demographic, and diagnostic data were collected. The association of factors with PD-L1 adequacy was evaluated with rate ratios (RR) using modified Poisson regression models with robust standard errors.
A total of 102 NB procedures with a diagnosis of NSCLC were performed over a 2-year period. The mean [standard deviation (SD)] nodule size was 25.0 [interquartile range (IQR), 18.0-32.0] mm and 57.8% (59/102) had a bronchus sign; 73% (68/93, 9 missing data) of samples were adequate for PD-L1 testing. Radial endobronchial ultrasound (REBUS) was utilized in 99% (101/102) of biopsies; a concentric or eccentric view was observed in 78.2% (79/101) and 16.8% (17/101), respectively. Transbronchial biopsy (TBBX) was performed in 92.2% (94/102). Only 4% (4/102) of cases required additional biopsies with either computed tomography (CT) guided transthoracic or surgical biopsies due to insufficient bronchoscopy tissue. No factors were predictive of PD-L1 adequacy in regression models.
NB demonstrated good performance in obtaining adequate samples for PD-L1 testing. Only 4% of patients required additional procedures for more tissue when clinically indicated. However, additional study is needed to validate these results against surgical resection specimens.
需要更多关于导航支气管镜检查（NB）为程序性死亡配体1（PD-L1）表达提供足够材料能力的数据。我们对本机构的NB病例进行了一项回顾性研究，以确定NB在为PD-L1提供充足样本方面的表现。
我们对2018年1月1日至2020年8月4日在本机构进行的所有连续性NB手术进行了回顾性分析，这些手术涉及对诊断为非小细胞肺癌（NSCLC）的肺结节/肿块进行活检。主要结果是用于PD-L1检测的材料是否充足。收集了所有手术、人口统计学和诊断数据。使用具有稳健标准误的修正泊松回归模型，通过率比（RR）评估各因素与PD-L1充足性的关联。
在两年期间共进行了102例诊断为NSCLC的NB手术。结节的平均[标准差（SD）]大小为25.0[四分位间距（IQR），18.0 - 32.0]mm，57.8%（59/102）有支气管征；73%（68/93，9例数据缺失）的样本足以进行PD-L1检测。99%（101/102）的活检使用了径向支气管内超声（REBUS）；分别有78.2%（79/101）和16.8%（17/101）观察到同心或偏心视图。92.2%（94/102）进行了经支气管活检（TBBX）。由于支气管镜检查组织不足，仅4%（4/102）的病例需要通过计算机断层扫描（CT）引导的经胸活检或手术活检进行额外活检。回归模型中没有因素可预测PD-L1充足性。
NB在获取足够的样本用于PD-L1检测方面表现良好。临床上仅4%的患者在需要更多组织时需要额外的手术。然而，需要进一步研究以对照手术切除标本验证这些结果。
