传统支气管针抽吸(cTBNA)与ebus引导下的支气管针抽吸(EBUS-TBNA):两种方法在分子分析中诊断充分性比较的回顾性研究

F. Signorini, Martina Panozzi, A. Proietti, G. Alí, O. Fanucchi, Alessandro Picchi, A. Ribechini, A. Poma, R. Bruno, A. Chella, G. Fontanini
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引用次数: 2

摘要

近年来,针对各种类型实体肿瘤,特别是非小细胞肺癌(NSCLC)的分子靶向治疗得到了越来越多的发展。这就需要更多的组织来支持辅助研究,以及用于评估分子靶点的细胞组织学诊断。传统TBNA (cTBNA)和ebus引导的TBNA (EBUS-TBNA)对恶性纵隔和/或肺门淋巴结肿大和支气管周围肿块的诊出率很高;然而,很少有研究比较这两种方法。我们回顾性比较了TBNA患者(EBUS-TBNA和cTBNA),以确定诊断率和后续辅助分析的材料充分性。材料与方法:对318例临床怀疑为肺癌或有肺癌复发的患者进行回顾性分析。2017年1月至2021年6月期间,所有患者在意大利比萨大学医院接受了纵隔和/或肺门淋巴结肿大和支气管周围肿块的TBNA (EBUS-TBNA或cTBNA)。明确诊断后,在腺癌、鳞状细胞癌和非小细胞肺癌(NOS)病例中进行分子分析和PD-L1表达评估。结果:199例患者行EBUS-TBNA, 119例患者行cTBNA,分别有374和142个淋巴结。阳性诊断的总诊断率为59% (EBUS-TBNA诊断率为61%,cTBNA诊断率为55%)。腺癌(ADC)是两种方法中最常见的诊断。EBUS- tbna对分子分析的诊断充分性为72%,cTBNA的诊断充分性为55.5%,具有统计学意义(p = 0.08)。两种方法的平均肿瘤细胞百分比也有统计学差异(p = 0.05), EBUS-TBNA为51.19±22.14,cTBNA为45.25±22.84。关于PD-L1蛋白表达,两种方法的阳性百分比相似(EBUS-TBNA为86%,cTBNA为85%)。结论:传统TBNA (cTBNA)和ebus引导下的TBNA (EBUS-TBNA)是具有较高诊断率的微创诊断方法。然而,与cTBNA相比,EBUS-TBNA在分子分析方面具有更好的诊断充分性,并且与更高的肿瘤细胞平均百分比相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Conventional Transbronchial Needle Aspiration (cTBNA) and EBUS-Guided Transbronchial Needle Aspiration (EBUS-TBNA): A Retrospective Study on the Comparison of the Two Methods for Diagnostic Adequacy in Molecular Analysis
Introduction: In recent years, there has been a growing development of molecularly targeted therapies for various types of solid tumors—in particular, in non-small-cell lung cancer (NSCLC). This has required the need for greater quantities of tissue that is able to support ancillary studies, alongside cyto-histological diagnoses for the assessment of molecular targets. Conventional TBNA (cTBNA) and EBUS-guided TBNA (EBUS-TBNA) have shown a high diagnostic yield for malignant mediastinal and/or hilar lymph node enlargement and peribronchial masses; however, few studies have compared these two procedures. We retrospectively compared TBNA patients (EBUS-TBNA and cTBNA) in order to determine the diagnostic yield and material adequacy for subsequent ancillary analyses. Materials and Methods: We retrospectively evaluated 318 patients with clinical suspicion of lung cancer or with disease recurrence. All of the patients underwent TBNA (either EBUS-TBNA or cTBNA) on enlarged mediastinal and/or hilar lymph nodes and peribronchial masses between January 2017 and June 2021 at the University Hospital of Pisa, Italy. After a definitive diagnosis, molecular analyses and an evaluation of PD-L1 expression were performed in the cases of adenocarcinoma, squamous cell carcinoma, and NSCLC, not otherwise specified (NOS). Results: EBUS-TBNA was performed in 199 patients and cTBNA was performed in 119 patients with 374 and 142 lymph nodes, respectively. The overall diagnostic yield for positive diagnoses was 59% (diagnostic rate of 61% in EBUS-TBNA, and 55% in cTBNA). Adenocarcinoma (ADC) was the most frequent diagnosis in both methods. EBUS-TBNA diagnostic adequacy was 72% for molecular analysis, while it was 55.5% for cTBNA, showing a statistical trend (p = 0.08) towards the significance of EBUS. The average percentage of neoplastic cells was also statistically different between the two methods (p = 0.05), reaching 51.19 ± 22.14 in EBUS-TBNA and 45.25 ± 22.84 in cTBNA. With regard to the PD-L1 protein expression, the percentage of positivity was similar in both procedures (86% in EBUS-TBNA, 85% in cTBNA). Conclusions: Conventional TBNA (cTBNA) and EBUS-guided TBNA (EBUS-TBNA) are minimally invasive diagnostic methods that are associated with a high diagnostic yield. However, EBUS-TBNA has an improved diagnostic adequacy for molecular analysis compared to cTBNA, and is associated with a higher average percentage of neoplastic cells.
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