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Feasibility and reliability of evaluate PD-L1 expression determination using small biopsy specimens in non-small cell lung cancer.

Thorac Cancer 2021 Jul 21. Epub 2021 Jul 21.

Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.

Background: Programmed cell death ligand-1 (PD-L1) is a useful biomarker in non-small cell lung cancer (NSCLC) patients who would probably benefit from immunotherapy. In most patients with advanced stage NSCLC, only small biopsy specimens were available for the evaluation of PD-L1 expression. In this study, we evaluated the feasibility and reliability of PD-L1 testing on small biopsy samples. Read More

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Transcutaneous Mediastinal Ultrasonography (TMUS) Vs Endosonography (EBUS-TBNA and EUS-B-FNA) for Evaluating Intrathoracic Lymphadenopathy in Children.

J Ultrasound Med 2021 Jul 19. Epub 2021 Jul 19.

Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

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Endobronchial ultrasound-guided transbronchial cryo-nodal biopsy: a novel approach for mediastinal lymph node sampling.

Respirol Case Rep 2021 Aug 8;9(8):e00808. Epub 2021 Jul 8.

Division of Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Division Spectrum Health Medical Group Grand Rapids MI USA.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is preferred for evaluating malignant lymph nodes and staging of lung cancer. Nevertheless, larger tissue samples are increasingly needed, particularly for molecular analysis. We describe the feasibility, technical details, and complications of EBUS-guided transbronchial cryo-node biopsy (TBCNB) in four patients with mediastinal adenopathy. Read More

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Prospective evaluation of EBUS-TBNA specimens for programmed death-ligand 1 expression in non-small cell lung cancer patients: a pilot study.

J Bras Pneumol 2021 12;47(4):e20200584. Epub 2021 Jul 12.

. Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia.

Objective: EBUS-TBNA cytological sampling is routinely performed for pathological diagnosis, mediastinal staging, and molecular testing in lung cancer patients. EBUS-TBNA samples are not formally accepted for testing programmed death-ligand 1 (PD-L1) expression. The objective of the study was to compare the feasibility, reproducibility, and accuracy of PD-L1 expression assessment in cytological specimens and histological samples. Read More

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A randomized comparison of sample adequacy and diagnostic yield of various suction pressures in EBUS-TBNA.

Adv Respir Med 2021 ;89(3):268-276

All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Introduction: The evidence for using vacuum suction during EBUS is sparse and the optimal suction pressure for obtaining adequate samples has not yet been determined. Our aim was to assess the influence of suction on the adequacy and diagnostic yield of EBUS-TBNA.

Material And Methods: This single-center, prospective, randomized, non-inferiority trial assessed whether no-suction and 10 mL suction are inferior to 20 mL suction for adequacy and diagnostic yield of EBUS-TBNA aspirates. Read More

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January 2021

Comparison of the diagnostic effectiveness between an expert and a student in the diagnosis of sarcoidosis by transbronchial biopsy of mediastinal lymph nodes under the control of endosonography.

Adv Respir Med 2021 ;89(3):241-246

Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes is currently considered to be the most effective minimally invasive diagnostic method in patients with suspected stage I and II sarcoidosis. However, diagnostic effectiveness depends on the experience and skills of the doctor which is dependent on the number of correctly performed procedures. The aim of the study is to compare the diagnostic effectiveness of the EBUS-TBNA test obtained by an expert in this field vs that of his student. Read More

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January 2021

Knowledge and Practice Patterns Among Pulmonologists for Molecular Biomarker Testing in Advanced Non-Small Cell Lung Cancer.

Chest 2021 Jun 25. Epub 2021 Jun 25.

Medical University of South Carolina, Division of Pulmonary and Critical Care Medicine; Charleston, SC. Electronic address:

Background: Targeted therapies for advanced non-small cell lung cancer (NSCLC) with oncogenic drivers have caused a paradigm shift in care. Biomarker testing is needed to assess eligibility for these therapies. Pulmonologists often perform bronchoscopy, providing tissue for both pathological diagnosis and biomarker analysis. Read More

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Performance monitoring of EBUS for the staging and diagnosis of lung cancer: auditing the Greater Manchester EBUS service against new national standards.

BMJ Open Respir Res 2021 Jun;8(1)

Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a pivotal test in lung cancer staging and diagnosis, mandating robust audit and performance monitoring of EBUS services. We present the first regional cancer alliance EBUS performance audit against the new National EBUS specification.

Methods: Across the five EBUS centres in the Greater Manchester Cancer Alliance, data are recorded at the point of procedure, when pathological results are available and at 6 months postprocedure to review any further pathological sampling (eg, at surgical resection) and the outcome of clinical-radiological follow-up. Read More

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Effect of chlorhexidine mouthrinse on prevention of microbial contamination during EBUS-TBNA: a study protocol for a randomized controlled trial.

Tuberc Respir Dis (Seoul) 2021 Jun 24. Epub 2021 Jun 24.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard diagnostic method for mediastinal and hilar lymphadenopathy. Although rare, fatal infectious complications can occur following EBUS-TBNA. However, to date, there is a lack of effective preventive strategies to reduce these complications. Read More

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Endosonography-Guided Biopsy as a First Test in the Diagnosis of Lymphoma.

Semin Thorac Cardiovasc Surg 2021 Jun 19. Epub 2021 Jun 19.

Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada. Electronic address:

To evaluate the diagnostic accuracy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) in the diagnosis of lymphoma. A retrospective analysis of patients with suspected mediastinal lymphoproliferative disorders who underwent EBUS-TBNA, EUS-FNA or combined procedures from 2009 to 2019 was conducted using a prospectively maintained interventional thoracic endoscopy database. Demographic data, imaging, needle size, surgical biopsy, complications rate and pathology reports were reviewed. Read More

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Suitability of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration versus Paired Transbronchial Biopsy Specimens for Evaluating Programmed Death Ligand-1 Expression in Stage III and IV Lung Cancer: A Comparative Retrospective Study.

J Cancer 2021 27;12(15):4478-4487. Epub 2021 May 27.

Department of Respiratory Medicine, Kanazawa University Hospital.

Cancer cells usually escape tumor-reactive T-cell responses using immune checkpoint proteins, such as programmed death protein-1 (PD-1) and its ligand, programmed death ligand-1 (PD-L1). These proteins can be blocked by immune checkpoint inhibitors (ICIs); the decision on ICI-based first-line treatment for advanced lung cancers depends on the PD-L1 levels in tumor specimens. Determining the PD-L1 expression conventionally requires histological specimens from resected tumors and core biopsy specimens. Read More

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Spontaneous regression following endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer patients.

Respir Investig 2021 Jun 16. Epub 2021 Jun 16.

Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan.

Spontaneous regression (SR) is defined as a complete or partial, temporary or permanent disappearance of a tumor without anticancer treatment, which potentially develops after surgery or biopsy for primary and metastatic tumors despite unknown incidence rate. Here, we report the incidence rate of SR after endobronchial ultrasound-guided transbronchial nodal needle aspiration (EBUS-TBNA) in lung cancer patients. Among 96 patients evaluable with chest CT before and after EBUS-TBNA, SR was found in three patients (3. Read More

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Utility of Elastography for Differentiating Malignant and Benign Lymph Nodes During EBUS-TBNA: A Systematic Review and Meta-analysis.

J Bronchology Interv Pulmonol 2021 Jun 16. Epub 2021 Jun 16.

Departments of Pulmonary, Critical Care, and Sleep Medicine Biostatistics, All India Institute of Medical Sciences (AIIMS) Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India.

Background: Ultrasound elastography noninvasively estimates tissue hardness. Studies have evaluated elastography for differentiating malignant from benign lymph nodes during endobronchial ultrasound-guided transbronchial needle aspiration. Several methods of performing elastography are described with variable diagnostic accuracy. Read More

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[Application of endobronchial ultrasound in children: an analysis of 4 cases].

Zhonghua Er Ke Za Zhi 2021 Jun;59(6):511-515

Department No. 2 of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.

To investigate the feasibility, clinical efficacy and safety of endobronchial ultasound (EBUS) in children. The radiological features, EBUS images, pathological results and intraoperative and postoperative complications of 3 cases who underwent EBUS examination and 1 case who underwent EBUS guided transbronchial needle aspiration (EBUS-TBNA) were retrospectively analyzed. Among the 4 cases, 2 were males and 2 were females, with the onset age of 7. Read More

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The role of endobronchial ultrasound-guided transbronchial needle aspiration in the differential diagnosis of isolated mediastinal and/or hilar lymphadenopathy.

Diagn Cytopathol 2021 Jun 2. Epub 2021 Jun 2.

Department of Pulmonary Medicine, Firat University, School of Medicine, Elazig, Turkey.

Introduction: Isolated mediastinal and/or hilar lymphadenopathy (IMHL) has become an increasingly common finding as a result of the increased use of thoracic imaging modalities. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is accepted as the first step diagnostic method in the differential diagnosis of IMHL.

Objective: To determine the diagnostic yield of the procedure and to analyze clinical and sonographic findings that can be used to differentiate the etiology of lymph node pathologies. Read More

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Usefulness and problems of cytological examination by endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy: A retrospective single-centre study.

Mol Clin Oncol 2021 Jul 19;15(1):138. Epub 2021 May 19.

Department of Pathology and Clinical Laboratory, Kansai Medical University, Hirakata, Osaka 573-1010, Japan.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive and useful technique for sampling mediastinal lymph nodes. High sensitivity and specificity of EBUS-TBNA in staging lung cancer have been reported. However, few studies have addressed the results of EBUS-TBNA in the diagnosis of mediastinal lymphadenopathy with or without lung cancer, since various neoplastic and non-neoplastic conditions can involve the mediastinal lymph nodes. Read More

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EBUS in optimizing non-small cell lung cancer diagnosis and treatment.

Med Pharm Rep 2021 Apr 29;94(2):176-184. Epub 2021 Apr 29.

Leon Daniello Pulmonology Hospital, Cluj-Napoca, Romania.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly used minimally invasive method for the diagnosis and staging of lung cancer. In order to improve its diagnostic accuracy, rapid on-site cytologic evaluation (ROSE) is being utilized in some institutions. ROSE, performed by a cytopathologist in the examination room, allows the assessment of the adequacy of the collected samples, identifies malignant cells and sometimes establishes diagnosis on the spot, thus improving diagnostic sensitivity. Read More

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Pneumonia, pleurisy, mediastinitis, and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration: A case report.

Medicine (Baltimore) 2021 May;100(20):e25973

Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0. Read More

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Rapid On-site Evaluation (ROSE) in Capillary Pull Versus Suction Biopsy Technique With Endobronchial Ultrasound-transbronchial Needle Aspiration (EBUS-TBNA).

J Bronchology Interv Pulmonol 2021 May 19. Epub 2021 May 19.

Departments of Medicine Pathology and Laboratory Medicine Division of Respirology, Schulich Faculty of Medicine and Dentistry, Western University, London, ON, Canada.

Background: Suction and capillary pull are 2 biopsy techniques used in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Although these techniques have been shown to perform comparably in terms of overall diagnostic yield, we hypothesized that the capillary pull technique would be associated with improved rapid on-site evaluation (ROSE) adequacy rates thus allowing for a shorter procedure time.

Methods: One hundred eighteen patients undergoing EBUS-TBNA for any indication were randomized to suction or capillary pull techniques for the first biopsy pass; the technique used for all subsequent passes was based on operator preference and was not recorded. Read More

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Simultaneous Onset of Mycobacterium kansasii Pulmonary Infection and Systemic Lupus Erythematosus: A Case Report.

Am J Case Rep 2021 May 19;22:e929866. Epub 2021 May 19.

Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.

BACKGROUND Systemic lupus erythematosus (SLE) is a systemic autoimmune disease resulting from dysregulation of the immune response. In genetically predisposed subjects, infections reputedly trigger an immune activation leading to autoimmunity and overt autoimmune diseases such as SLE. CASE REPORT We report the case of a 19-year-old woman who presented to our hospital reporting high-grade fever, dry cough, and polyarthralgia despite a course of empiric antibiotic and steroid therapy administered by her general practitioner (GP). Read More

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FDG-PET/CT for pretherapeutic lymph node staging in non-small cell lung cancer: A tailored approach to the ESTS/ESMO guideline workflow.

Lung Cancer 2021 07 7;157:66-74. Epub 2021 May 7.

Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address:

Objectives: In patients with NSCLC, current ESTS and ESMO guidelines recommend invasive lymph node (LN) staging with EBUS-TBNA even if FDG-PET/CT is negative for mediastinal LNs if at least one of three risk factors is present (cN1, non-peripheral primary or primary >3 cm). Modified workflows to avoid unnecessary invasive procedures were evaluated.

Materials And Methods: Monocentric retrospective analysis of pretherapeutic FDG-PET/CT in 247 patients with NSCLC (62 % male; age, 68 [43-88] years) using an analog or digital PET/CT scanner. Read More

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Examination of endobronchial ultrasound-guided transbronchial needle aspiration using a puncture needle with a side trap.

Sci Rep 2021 May 7;11(1):9789. Epub 2021 May 7.

Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing hilar and mediastinal lymph node enlargement; however, specimens obtained are often small and inadequate for pathologic diagnosis. In June 2017, EchoTip ProCore, a puncture needle with a side trap, was launched in Japan. In this single-center prospective interventional study, 57 patients with lymph nodes, intrapulmonary tumor or pleural mass were diagnosed using EBUS-TBNA with EchoTip ProCore between June 2017 and February 2020. Read More

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Alectinib for Miliary Lung Metastasis in -Positive Lung Adenocarcinoma.

Onco Targets Ther 2021 30;14:2911-2915. Epub 2021 Apr 30.

Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.

Background: Miliary pulmonary metastasis characterized by tiny nodules is a rare metastatic pattern in advanced non-small cell lung cancer (NSCLC) and is usually seen in patients harboring an mutation, and amylase-producing lung cancer is highly uncommon and rarely reported in NSCLC patients who have an mutation.

Case: A 32-year-old Japanese female was found to have miliary pulmonary nodules throughout both lung fields on a chest x-ray examination during an annual health check-up. Further examination by computed tomography (CT) revealed diffuse, bilateral, miliary nodules. Read More

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Transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: a randomised trial.

Eur Respir J 2021 May 6. Epub 2021 May 6.

Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China.

Background: Guidelines recommend endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as an initial investigation technique for mediastinal nodal staging in lung cancer. However, EBUS-TBNA can be limited by the inadequacy of intact tissues, which might restrict its diagnostic yield in mediastinal lesions of certain etiologies. We have previously shown that EBUS-guided transbronchial mediastinal cryobiopsy can provide intact samples with greater volume. Read More

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Adequacy of small biopsy and cytology specimens for comprehensive genomic profiling of patients with non-small-cell lung cancer to determine eligibility for immune checkpoint inhibitor and targeted therapy.

J Clin Pathol 2021 May 5. Epub 2021 May 5.

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Aims: In advanced-stage non-small-cell lung cancer (NSCLC), incomplete genotyping for guideline-recommended genomic biomarkers poses a significant challenge to making informed and timely clinical decisions. We report our institution's experience in assessing the adequacy of small specimens for comprehensive genomic profiling for guideline-recommended lung cancer biomarker testing.

Methods: We performed a retrospective evaluation of all image-guided procedures for NSCLC performed in our institution between October 2016 and July 2018, including core needle biopsy (CNB) and fine-needle aspiration (FNA) in patients who had undergone genomic profiling for lung cancer. Read More

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The cricothyroid versus Spray-As-You-Go method for topical anesthesia during Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA): The CRISPEN randomized clinical trial.

Lung India 2021 May-Jun;38(3):223-228

Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.

Background: Guidelines for flexible bronchoscopy in adults recommend both Cricothyroid and Spray-as-you-go method as the acceptable techniques for lignocaine administration. No studies have compared these two methods for topical anesthesia during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Objectives: Co-primary outcomes were the comparison of cough count and operator-rated overall procedure satisfaction on a Visual Analog Scale (VAS) between the groups. Read More

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Thrombolysis of Pulmonary Emboli via Endobronchial Ultrasound-Guided Transbronchial Needle Injection.

Ann Thorac Surg 2021 Aug 24;112(2):395-404. Epub 2020 Oct 24.

Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Ontario, Canada. Electronic address:

Background: Endobronchial ultrasound-guided transbronchial needle injection (EBUS-TBNI) is a novel technique for treating peribronchial targets. The aim of this study was to evaluate preliminary feasibility of thrombolysis of pulmonary emboli via EBUS-TBNI.

Methods: Yorkshire pigs (30-48 kg) were anesthetized and mechanically ventilated. Read More

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Predicting Lymph Node Metastasis in Non-Small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models.

Chest 2021 Apr 28. Epub 2021 Apr 28.

Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.

Background: Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in patients with non-small cell lung cancer (NSCLC) as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers.

Research Question: Are the HAL and HOMER models valid across multiple centers?

Study Design And Methods: This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stages T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. Read More

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EBUS-TBNA Cytological Samples for Comprehensive Molecular Testing in Non-Small Cell Lung Cancer.

Cancers (Basel) 2021 Apr 25;13(9). Epub 2021 Apr 25.

Translational Genomic and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain.

Clinical guidelines promote the identification of several targetable biomarkers to drive treatment decisions in advanced non-small cell lung cancer (NSCLC), but half of all patients do not have a viable biopsy. Specimens from endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) are an alternative source of material for the initial diagnosis of NSCLC, however their usefulness for a complete molecular characterization remains controversial. EBUS-TBNA samples were prospectively tested for several biomarkers by next-generation sequencing (NGS), nCounter, and immunohistochemistry (PD-L1). Read More

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