Cancer Res Treat.  2019 Oct;51(4):1488-1499. 10.4143/crt.2019.031.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Re-biopsy in Previously Treated Lung Cancer

• Kim J
• Kang HJ
• Moon SH
• Lee JM
• Kim HY
• Lee GK
• Lee JS
• Hwangbo B

• KMID: 2460597
• DOI: http://doi.org/10.4143/crt.2019.031

Abstract

PURPOSE
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for the diagnosis and staging of lung cancer. However, evidence of its usefulness for re-biopsy in treated lung cancer, especially according to the previous treatment, is limited. We evaluated the role of EBUS-TBNA for re-biopsy and its diagnostic values in patients with different treatment histories.
MATERIALS AND METHODS
We reviewed the medical records of patients who underwent EBUS-TBNA for re-biopsy of suspicious recurrent or progressive lesions between January 2006 and December 2016 at the National Cancer Center in South Korea. Patients were categorized into three groups based on the previous treatment modalities: surgery, radiation, and palliation.
RESULTS
Among the 367 patients (surgery, n=192; radiation, n=40; palliation, n=135) who underwent EBUS-TBNA for re-biopsy, the overall sensitivity, negative predictive value (NPV), and diagnostic accuracy of EBUS-TBNA in detecting malignancy were 95.6%, 82.7%, and 96.3%, respectively. The sensitivity was lower in the radiation group (83.3%) when compared with the surgery (95.7%, p=0.042) and palliation (97.7%, p=0.012) groups. The NPV was lower in the palliation group (50.0%) than in the surgery group (88.5%, p=0.042). The sample adequacy of EBUS-TBNA specimens was lower in the radiation group (80.3%) than in the surgery (95.4%, p < 0.001) or palliation (97.8%, p < 0.001) groups. EGFR mutation analysis was feasible in 94.6% of the 92 cases, in which mutation analysis was requested. There were no major complications. Minor complications were reported in 12 patients (3.3%).
CONCLUSION
EBUS-TBNA showed high diagnostic values and high suitability for EGFR mutation analysis with regard to re-biopsy in patients with previously treated lung cancer. The sensitivity was lower in the radiation group and NPV was lower in the palliation group. The complication rate was low.

Keyword

Lung neoplasms; Endobronchial ultrasound; Biopsy

MeSH Terms

Biopsy
Diagnosis
Humans
Korea
Lung Neoplasms*
Lung*
Medical Records
Needles*

Figure

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  Fig. 1. (A) A 75-year-old man with adenocarcinoma, initial stage IB. Recurrence at the stump site was suspected one year after right upper lobectomy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) confirmed recurrence. (B) A 65-year-old man with small cell lung cancer, initial stage of limited disease. Nodules in the radiation therapy field were observed 1.5 years after concurrent chemoradiation therapy. EBUS-TBNA diagnosed small cell lung cancer. (C) A 65-year-old man with adenocarcinoma, epidermal growth factor receptor (EGFR) mutation (L858R), initial stage IV. Cancer progression was suspected after treatment with gefitinib and erlotinib. EBUS-TBNA for re-biopsy detected EGFR T790M mutation.

Reference

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