Andrei Gabriela Marina, Motaș Natalia, Rădulescu Virginia Maria, Ionovici Nina, Bunescu Marius, Zob Daniela Luminița, Biciușcă Viorel, Dumitrescu Florentina, Marcu Eugenia Andreea, Cioboată Ramona, Olteanu Mihai
Department of Internal Medicine-Pneumology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Thoracic Surgery II, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania.
J Clin Med. 2025 Sep 1;14(17):6179. doi: 10.3390/jcm14176179.
: Lung cancer remains the leading cause of cancer-related mortality worldwide, with a high proportion of cases diagnosed at advanced stages. Accurate mediastinal staging is essential to guide optimal therapeutic decisions. This study aimed to evaluate the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and to develop a composite clinical-molecular score (EXPoSURE) for risk stratification. : A retrospective study was performed that included 131 patients diagnosed with lung cancer between December 2023 and December 2024 at a regional oncology center in Oltenia, Romania. All patients underwent bronchoscopy and EBUS-TBNA using a standardized protocol. Clinical, pathological, and molecular data were collected to assess diagnostic yield, staging performance, and the association with molecular markers. The EXPoSURE score integrated PD-L1, p63, EGFR status, comorbidities, histological type, and TNM stage. : EBUS-TBNA provided a conclusive diagnosis in 91.6% of cases, with a low rebiopsy rate of 8.4% and no requirement for mediastinoscopy. Most patients (68%) were diagnosed at stage IV. PD-L1, p63, and EGFR expression showed no significant correlation with TNM stage, while the EXPoSURE score demonstrated promising stratification capability. Occupational exposure appeared to influence disease severity in some subgroups, although further validation is needed. : EBUS-TBNA is a valuable, safe, and effective approach for minimally invasive diagnosis and mediastinal staging of lung cancer. The proposed EXPoSURE composite score may contribute to a multidimensional risk assessment, supporting more tailored management strategies and warranting prospective validation.
肺癌仍然是全球癌症相关死亡的主要原因，很大比例的病例在晚期才被诊断出来。准确的纵隔分期对于指导最佳治疗决策至关重要。本研究旨在评估支气管内超声引导下经支气管针吸活检（EBUS-TBNA）的诊断性能，并开发一种用于风险分层的综合临床-分子评分（EXPoSURE）。：进行了一项回顾性研究，纳入了2023年12月至2024年12月期间在罗马尼亚奥尔特尼亚地区肿瘤中心被诊断为肺癌的131例患者。所有患者均按照标准化方案接受支气管镜检查和EBUS-TBNA。收集临床、病理和分子数据以评估诊断率、分期性能以及与分子标志物的关联。EXPoSURE评分综合了PD-L1、p63、EGFR状态、合并症、组织学类型和TNM分期。：EBUS-TBNA在91.6%的病例中提供了确定性诊断，再次活检率低至8.4%，且无需进行纵隔镜检查。大多数患者（68%）被诊断为IV期。PD-L1、p63和EGFR表达与TNM分期无显著相关性，而EXPoSURE评分显示出有前景的分层能力。职业暴露似乎在某些亚组中影响疾病严重程度，尽管需要进一步验证。：EBUS-TBNA是一种用于肺癌微创诊断和纵隔分期的有价值、安全且有效的方法。所提出的EXPoSURE综合评分可能有助于进行多维度风险评估，支持更具针对性的管理策略，并需要进行前瞻性验证。
